JBJS case connector最新文献

Case: A 30-year-old man presented with left proximal tibia fracture (open Grade 3A) and a transverse lateral malleolus fracture (Weber B) following direct impact injury. Computed tomography revealed a rare posteromedial tubercle fibula fracture at the posterior inferior tibiofibular ligament (PITFL) insertion, with syndesmosis disruption. Initial damage control included an external fixator. Definitive surgery, performed 10 days later, used Herbert screws and a tubular plate, along with syndesmotic screws.

Conclusion: This case highlights a unique fracture pattern: PITFL avulsion from the fibular end which we wish to name as Patel-Sharma fragment. Identifying this fragment is essential as it needs to be fixed to ensure posterior syndesmosis ring stability.

Case: A 14-year-old male athlete presented with a 9-month history of low back pain, worse with hyperextension. Nonoperative management for bilateral L4 spondylolysis had been unsuccessful. The patient underwent a novel magnetic resonance imaging (MRI) that generated a synthetic computed tomography (sCT). MRI/sCT revealed nonunion of the spondylolysis with persistent edema. The patient underwent minimally invasive bilateral L4 robot-navigated intralaminar screw fixation. CT at 3 months demonstrated complete healing.

Conclusion: This case is the first to document the use of MRI-generated sCT in the management of pediatric spondylolysis, offering improved assessment of both bony and soft tissue pathology in a single study without the ionizing radiation of traditional CT.

Case: We present the case of a 24-year-old woman who sustained a left midshaft clavicle fracture with acute subclavian artery compression, subclavian vein laceration, and complete brachial plexus palsy after a motor vehicle collision. The patient underwent urgent open reduction internal fixation of the clavicle and repair of the subclavian vein. Two years later, she underwent opponensplasty and flexor digitorum profundus tendon transfers. She regained satisfactory hand function, allowing her to return to full-duty work.

Conclusion: Clavicle fractures with associated acute neurovascular and brachial plexus injuries are rare pathologies that result from high-energy trauma and should undergo urgent fixation.

Case: We describe a 13-year-old adolescent girl experiencing persistent pain and reduced grip strength following nonoperative treatment of a medial epicondyle fracture-dislocation with closed reduction over 5 years before her referral to our clinic. Neurological examination and magnetic resonance imaging of the elbow revealed damage to the median nerve due to an entrapment within the elbow. Surgical release of the nerve resulted in complete pain relief and improved neurological function with normalized nerve conduction.

Conclusion: Persistent neurologic deficits should be investigated following pediatric elbow trauma. Promising results can be achieved with surgical treatment even after long-term entrapment of the median nerve.

Case: We report a case of coccygeal dislocation complicated by defecatory dysfunction and discuss its treatment and mechanisms. A 58-year-old man was presented with coccygeal pain and defecatory dysfunction after sustaining an injury from a 1-m fall. Following diagnosis, a combined approach involving surgical treatment and physiotherapy was adopted, resulting in early symptom improvement and favorable long-term outcomes.

Conclusion: Traumatic anterior dislocation of the coccyx is a rare but significant injury with no clear treatment guidelines. This report suggests the mechanisms underlying the association between defecatory dysfunction and coccygeal dislocation and underscores the therapeutic role of surgical intervention and physiotherapy.

Case: A 60-year-old right-hand-dominant woman experienced progressive enlargement of a mass over the index distal interphalangeal (DIP) joint over 5 years, leading to joint destruction and swan neck deformity. Radiography showed arthritis, erosion, and calcific deposition. Surgical intervention included mass excision, synovectomy, and DIP joint arthrodesis. After initial fixation failure, revision surgery achieved DIP joint fusion, with histology confirming synovial chondromatosis.

Conclusion: This case highlights the diagnostic and treatment challenges of treating rare presentations of synovial chondromatosis in small hand joints, emphasizing early recognition, synovial excision, and joint stabilization in the presence of poor bone quality to prevent recurrence and preserve function.

Case: A 51-year-old male polytrauma patient presented with bilateral calcaneus fractures after a fall. This report describes treatment of his right comminuted Sanders IV calcaneus fracture with percutaneous open reduction internal fixation (ORIF) and minimally invasive surgery (MIS) primary subtalar fusion to restore alignment and preserve soft tissue.

Conclusion: Unlike traditional open approaches, which are prone to wound complications due to larger incisions, our approach of maintaining fracture alignment during joint preparation using an MIS burr for acute posttrauma subtalar arthrodesis and percutaneous ORIF appears to have reduced these risks, resulting in successful radiological healing and functional recovery at 1-year follow-up.

Case: A 16-year-old woman presented with acute on chronic knee pain and instability following a twisting injury. The tibial insertion of the anterior cruciate ligament (ACL) was nonvisualized on magnetic resonance imaging. A cord-like ACL, originating from the lateral intercondylar notch and inserting smoothly into the anterior horn of the intact lateral meniscus, was found on arthroscopy. Her ACL was reconstructed with quadriceps tendon autograft.

Conclusion: We report a rare case of dysplastic ACL inserting into the lateral meniscus in a patient without obvious skeletal deformities. This pathology could be congenital or traumatic. Surgeons and radiologists should be aware of this rare variant.

Case: In this article, we present 2 cases of neglected patellar tendon rupture. One was treated using an Achilles tendon allograft, and the other with a patellar tendon-bone allograft. Both methods allowed for early range of motion and resulted in good functional outcomes with a 1-year follow-up period.

Conclusion: The choice of allograft for patellar tendon reconstruction is important. Although an Achilles allograft may be more readily available and have a high tensile strength, a bone-patellar tendon allograft may be a better choice when bone loss is present, and a high biological incorporation rate is desired.