JBJS case connector最新文献

Case: Traditional surgical intervention for brachial plexus birth injury (BPBI) has involved proximal nerve grafting. At the age of 6 months, an infant with Klumpke birth palsy had not recovered finger flexion and extension. He underwent extensor carpi radialis brevis to anterior interosseous nerve and supinator-to-posterior interosseous nerve transfers. Three months postoperatively, he was noted to have recovery of finger flexion and extension which continued to improve to 18 months postoperative follow-up.

Conclusion: This case shows effectiveness of early surgical intervention using distal nerve transfers, as opposed to traditional proximal nerve grafting, for reanimating the hand in BPBI.

Case: This case report describes the successful treatment of a year-round teenage softball pitcher who sustained a proximal biceps tendon rupture who underwent successful subpectoral tenodesis. To our knowledge, this is the only reported case of such an injury occurring in an underhand throwing teenage athlete.

Conclusion: This case highlights an unusual instance of a sport-related injury in an adolescent softball pitcher, suggesting that the softball pitch in elite athletes may put similar stress on the shoulder to overhead throwing athletes over time and further demonstrating that patients may continue to have success at elite levels of competition after tenodesis.

Case: We present the case of a 33-year-old World Cup giant slalom skier treated by endoscopically assisted proximal vastus lateralis (VL) release for persistent lateral thigh pain, due to a VL proximal myo-aponeurosis rupture. At the completion of rehabilitation, he was able to return to Olympic-level competition following surgery and was still symptom free at the 3-year follow-up.

Conclusion: The unusual location of this injury and the symptoms and physical examination are of interest. The endoscopic release of the VL proximal insertion allowed a rapid and lasting result with a return to competitive skiing at an elite level.

Case: Fourteen-year-old boy, history of autism presented with bilateral knee instability. Imaging revealed bilateral anterior cruciate ligament (ACL) insufficiency, 20° of posterior tibial slope (PTS) on the right and 18° on the left. A guided growth technique using anterior placed tension band plates was used to correct the PTS. At 22 months, the PTS corrected to 5.5° on the right and 6° on the left. The patient's knee stability improved, and he resumed activities at 30 months.

Conclusion: Pediatric ACL insufficiency in the setting of elevated PTS can be successfully corrected with a guided growth technique.

Case: Vohwinkel syndrome is a rare, inherited condition marked by defective keratinization. The disorder may feature digital constriction bands (pseudoainhum) which can lead to autoamputation. Surgical excision is the only treatment of pseudoainhum; however, it is fraught with recurrence. We present a 10-year-old boy with pseudoainhum of the right long and small fingers at the distal interphalangeal joints. He underwent 180-degree band excision and z-plasty.

Conclusion: Since establishing care 8 years ago, he has undergone treatment of 5 constriction bands with only 1 recurrence. We believe this success can at least be partially attributed to the technique described by Upton.

Case: A 77-year-old man experienced acute failure of fixation of his humeral shaft fracture after fixation with IlluminOss photodynamic system stabilization (Photodynamic Bone Stabilization System [PBSS]). Owing to the well-fixed IlluminOss PBSS implant to the humeral intramedullary canal, complete removal was deemed not indicated. Partial implant removal and revision open reduction internal fixation with a proximal humerus plate was performed. However, this was complicated by recalcitrant deep hardware infection that failed multiple surgical debridements, requiring eventual humeral osteotomy to remove the remainder of the infected IlluminOss PBSS implant.

Conclusion: This is one of the first articles highlighting the technical challenges and morbidity associated with removal of an IlluminOss PBSS.

Case: We discuss a 16-year-old adolescent boy presenting with a minimally displaced greenstick fracture of the distal third ulnar diaphysis sustained during a fall playing football. Initial treatment consisted of in situ casting followed by removable forearm splinting. The patient returned 3 months postinjury with complete forearm motion loss. Imaging demonstrated a post-traumatic radioulnar synostosis. Surgical management of the synostosis restored forearm motion without recurrence.

Conclusion: Clinicians should be aware of this atypical presentation of a radioulnar synostosis when evaluating stiffness in the post-treatment setting even for fractures that are minimally displaced and do not require reduction or surgery.

Case: A 4-year-old girl with no relevant medical history presented with left knee swelling. Knee laxity, magnetic resonance imaging findings of anterior cruciate ligament (ACL) deficiency and discoid meniscus, and the chronicity of symptoms prompted arthroscopic ACL reconstruction and meniscal saucerization. Pain and swelling continued, and repeat arthroscopy revealed regeneration of the discoid meniscus at 18-month follow-up.

Conclusion: In this unusual case, a discoid lateral meniscus regenerated after saucerization. Regeneration could be attributed to the robust vascularity of the meniscus in pediatric patients. Surgeons should counsel about the risk of recurrence after treatment of discoid meniscus.

Case: A 28-year-old man presented for a painful lower extremity mass. Imaging revealed a nonspecific, poorly defined lucent lesion in the left distal tibial cortex with scalloping. The diagnosis of intracortical schwannoma was made after open biopsy revealed positive S-100 immunohistochemical staining and characteristic spindled cells. Definitive management was achieved through curettage and bone grafting. Six months postoperatively, the patient's pain had improved with complete radiographic healing.

Conclusion: An intracortical schwannoma is a rare, benign lesion which may have atypical radiological findings and nonspecific presentations. Definitive diagnosis is made with permanent histology and S-100 immunohistochemical staining.

Case: The golf club deformity is the most notable malreduction that occurs after distal femur fracture fixation. This can lead to disruption of the patient's knee biomechanics, arthritis, and functional deterioration. There is a lack of consensus for optimal treatment of these malunions among the orthopaedic community. We present a technique that uses an osteotomy and ring external fixation with computer-assisted deformity correction and retrograde intramedullary nailing to secure correction.

Conclusion: Our case shows a potential means to achieve a reliable and objective method of measuring, correcting, and securing the fixation of a golf club deformity.