JBJS case connector最新文献

Case: A 46-year-old male patient presented with shoulder pain, limited range of motion, and loss of sensation for a year after undergoing hemiarthroplasty for a proximal humerus fracture. Workup demonstrated a greater tuberosity nonunion and deltoid paralysis secondary to upper trunk brachial plexopathy. The pectoralis major (PM) for deltoid transfer successfully restored shoulder function and resolved pain without requiring any subsequent intervention.

Conclusion: A PM transfer for deltoid and rotator cuff insufficiency restored shoulder stability and improves biomechanics for shoulder abduction and flexion in this case. Dynamic radiography demonstrates enhanced fluidity of shoulder kinematics with improved scapulohumeral motion.

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 35-year-old man with morbid obesity sustained an ultra-low velocity (ULV) rotational knee dislocation secondary to a fall from standing. The patient was successfully treated using a subcutaneous knee-spanning internal fixator, the "INFIX" technique, which has previously been described for pelvic ring injuries.

Conclusion: This novel technique maintained the stable reduction of an ULV knee dislocation in a patient with morbid obesity until adequate healing was achieved.

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.

Case: We report a case of a lesser tuberosity avulsion fracture in a 14-year-old adolescent boy who presented to Orthopaedic Urgent Care where he was promptly diagnosed after magnetic resonance imaging. The patient was successfully treated with an open transosseous equivalent suture repair 3 weeks after initial injury.

Conclusion: The purpose of this case report was to advance the understanding of these injuries, enable appropriate diagnosis and treatment, and optimize patient's shoulder outcomes and return to sport.

Case: We describe treatment of severe multilevel congenital thoracic fusion in a 3-year-old girl with Apert Syndrome by posterior element excision, posterior column osteotomies, and gradual distraction with magnetically controlled growing rods (MCGR) with 3-year follow-up. We also describe short-term follow-up with similar management in an 8-year-old patient with a congenitally fused thoracic spine from Jarcho-Levin syndrome.

Conclusion: Posterior element resection and targeted posterior column osteotomies combined with gradual distraction with MCGR offers a promising treatment course for children with severe thoracic insufficiency syndrome derived from congenital fusions.