JBJS case connector最新文献

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.

Case: 43-year-old man with an adjacent segment C7-D1 left paracentral and foraminal disk and left-hand grip weakness underwent unilateral biportal endoscopic discectomy with O-arm navigation. The patient underwent C5-6 and C6-7 anterior cervical discectomy and fusion (ACDF) 10 years ago and was asymptomatic for nearly 10 years.

Conclusion: In revision of the cervical spine with a short neck, cervicothoracic junctional disks can be precisely located using O-arm navigation and effectively removed with a minimally invasive unilateral biportal endoscopy approach.

Case: A 44-year-old man sustained a thrombosed popliteal artery after a closed left knee dislocation after a high-energy motor vehicle collision. He underwent emergency open popliteal artery embolectomy, with insertion of endovascular stent. After arthroscopic multiligamentous knee injury reconstruction (MLKI-R) on day 18 after injury, he developed stent thrombosis, which resolved with urgent percutaneous thrombectomy.

Conclusion: This is the first report of popliteal artery stent thrombosis after MLKI-R. Knee surgery in a revascularized limb has remained controversial, but studies are scarce in the literature. Frequent circulation monitoring and vascular specialist availability postoperatively are still key to detecting this complication and early revascularization.

Case: A 1-year old boy was presented with cauda equina syndrome and progressive loss of motor function in lower limbs. MRI and CT scans revealed a sacrococcygeal teratoma with metastases para-aortically and in L3 producing compression into the epidural space. Despite metastases and a progressive cauda equina, neoadjuvant treatment was given to achieve cytoreduction for neurological recovery and facilitate curative treatment.

Conclusion: Malignant sacrococcygeal teratoma with intraspinal infiltration or metastasis requires surgical and adjuvant treatment. If primary neurologic function-sparing surgery makes curative treatment impossible, adequate and quick decompression of neural structures with similar results can be achieved by preoperative chemotherapy, avoiding the local spill of malignant cells.

Case: A 4-year-old boy developed malunion after open reduction and internal fixation (ORIF) of a rare lateral condylar humeral fracture running from the lateral humerus, through the trochlear cartilage, to the medial trochlea. Five months after ORIF, the active elbow flexion was limited to 50°. Magnetic resonance imaging (MRI) showed a step-off of the anterior trochlear cartilage, causing the limited flexion. After conservative observation for 5 years, the flexion improved to 135° and MRI showed that the step-off had disappeared.

Conclusion: This case indicates that it is possible for pediatric patients to recover their range of motion following malunion of an elbow fracture.

Case: An 86-year-old woman suffered from dropped head syndrome (DHS). As she was not willing to undergo fusion surgery, we proposed a novel nuchal ligament reconstruction surgery, which is not a direct correction of the malalignment but rather a recovery of the function of extensor muscles under local anesthesia. Twelve months after surgery, the patient remains satisfied and is able to maintain a horizontal gaze.

Conclusion: This is the first report regarding a less invasive nuchal ligament reconstruction surgery successfully performed for DHS.

Case: This case report describes 3 patients who developed acromioclavicular joint cysts secondary to rotator cuff arthropathy. The patients underwent arthroscopic cyst decompression and distal clavicle resection, resulting in successful excision of the cyst and minimal cyst recurrence.

Conclusion: Based on these cases, arthroscopic cyst decompression with concomitant distal clavicle resection should be considered as an effective alternative to serial aspirations or open cyst excision and distal clavicle resection.

Case: This is a rare case describing the management of a traumatic chylous effusion discovered during operative fixation of a Sanders type III calcaneus fracture in a 58-year-old man, sustained after a fall from height. Chylous effusions are uncommon and can mimic septic arthritis. Given the concern for possible infection intraoperatively, provisional K-wire-assisted reduction was performed and definitively maintained through antibiotic mixed polymethylmethacrylate cement. Despite foregoing traditional fixation techniques, an excellent outcome was achieved.

Conclusion: This case outlines the use of antibiotic cement as a reduction aid for an intra-articular calcaneus fracture in the setting of a traumatic chylous effusion.

Case: A 62-year-old ultramarathon athlete presented to the clinic with right posterolateral knee pain for 3 to 4 weeks and muscle tightness. Magnetic resonance imaging demonstrated a right lateral femoral condyle fracture. The fracture was treated conservatively, with return full Ironman competition 14 months later.

Conclusion: Femoral condyle fractures should be suspected in endurance athletes with nonspecific knee pain to prevent further injury. These fractures are rare, and more studies are needed to determine risk factors, risk classification, and optimal treatment protocol. With rising popularity of ultraendurance events, sports medicine physicians must educate patients on injury recognition and mitigation strategies.