JBJS case connector最新文献

Case: We present the case of a 27-year-old man who sustained a quadriceps tendon rupture within 3 months after surgical repair of an ipsilateral patellar tendon rupture repaired with the transosseous technique. At 1-year follow-up, the patient demonstrated outcome measures indicating an excellent functional recovery.

Conclusion: This case demonstrated a rare injury pattern treated with surgical repair and a structured rehabilitation program that led to a functional recovery. The case underscores the mechanical, technical, and compliance-related factors that contributed to this catastrophic sequential extensor-mechanism failure. Comprehensive patient education, careful tunnel planning, and structured follow-up are essential to optimize healing and prevent recurrence.

Level of evidence: Level IV, Case Report.

Case: A 14-year-old boy presented with a neglected patellar sleeve fracture, resulting in a 19 cm gap between the retracted quadriceps and patella. A stepwise surgical reconstruction combining the "Chambat Sardine Can" tensioning technique, tibial tubercle transfer, rectus femoris release, and allograft bridging was performed.

Conclusion: This is the first reported case of such a massive quadriceps retraction. The adaptable surgical strategy, tailored to defect severity, led to excellent functional outcomes and may be applied in both pediatric and adult chronic extensor mechanism ruptures.

Case: We present 3 patients (a 19-year-old man, a 37-year-old woman, and a 66-year-old woman) with chronic high hip dislocation and severe limb length discrepancy, managed with gradual soft tissue distraction using a motorized intramedullary nail and a temporary cup before total hip arthroplasty. All patients had at least 1 year of follow-up. Complications included transient foot drop (resolved), and 1 case of early infection and persistent foot drop.

Conclusion: This approach facilitates near-anatomical cup positioning without osteotomy but still carries risks. Further refinement, including shear wave elastography ultrasound monitoring of the ischial nerve, may reduce complications and improve the method.

Case: An 18-year-old man with severe hemophilia A (without inhibitors) developed severe left knee deformity after an untreated injury, resulting in wheelchair dependence. He underwent knee arthrodesis under factor VIII cover but developed a postoperative hematoma and inhibitor formation. Following evacuation and treatment with activated prothrombin complex concentrate and recombinant factor VII, solid fusion and pain relief were achieved within 6 months. Three years later, he walks independently with improved Lower Extremity Functional Scale and SF-36 scores.

Conclusion: Knee arthrodesis remains a viable salvage procedure that restores function and quality of life when joint preservation or total knee arthroplasty is unfeasible, especially in resource-limited settings.

Case: A 30-month-old boy with arthrogryposis multiplex congenita presented with severe, recurrent teratological clubfoot refractory to serial casting, Achilles tenotomy, and plantar fascia release. Because of repeated cast slippage and patient distress, comprehensive posterior, plantar, and medial releases were performed, with cast exchange 2 weeks thereafter. A robust, taut tibialis anterior prompted addition of tibialis anterior tendon transfer to the lateral cuneiform. Postoperatively, plantigrade alignment was achieved both clinically and radiographically and maintained at the 2-year follow-up.

Conclusion: Transfer of the tibialis anterior tendon after comprehensive correction may reduce recurrence by converting a deforming force into a corrective one during rapid growth in arthrogrypotic clubfoot.

Case: An 18-year-old male college student presented with persistent right knee pain 1 week after falling onto broken glass. Clindamycin therapy failed, and Emergency Department evaluation revealed knee pain with drainage near the inferior patella. Magnetic resonance imaging demonstrated a prepatellar abscess which was treated with operative irrigation and debridement, and he was discharged on trimethoprim-sulfamethaxol. Cultures grew Haemophilus influenzae, prompting transition to oral amoxicillin-clavulanic acid, which resulted in clinical improvement and sustained resolution at 2-year follow-up.

Conclusion: This case highlights the critical role of curiosity and details in exploring a patient's history as well as culture-guided therapy in persistent or atypical infection presentations.

Case: A 20-year-old man sustained a Gustilo-Anderson type IIIB open tibial shaft fracture with Achilles tendon exposure after a motorcycle accident. Early flap surgery was not feasible because of coronavirus disease 2019 restrictions. The initial debridement, external fixation, and negative pressure wound therapy failed to generate sufficient granulation. Perifascial areolar tissue, a thin layer of loose connective tissue located between the deep fascia and the deep layer of subcutaneous fat, was harvested from the thigh and grafted onto the defect, thereby enabling successful full-thickness skin grafting. At 3 years, bone union had been achieved without infection or ankle motion limitation.

Conclusion: Perifascial areolar tissue may be an alternative when early flap coverage is not possible.

Case: We report the case of a 28-year-old man who developed a profunda femoris artery pseudoaneurysm 7 months after cephalomedullary nailing of an intertrochanteric femur fracture. Coil embolization of the artery was performed with immediate cessation of further progression and growth of the pseudoaneurysm.

Conclusion: Profunda femoris artery pseudoaneurysm is an uncommon but life-threatening complication after femoral cephalomedullary nailing. We present the diagnostic challenges, management strategies, and recovery associated with this rare vascular complication following implantation of a cephalomedullary nail.

Case: A 69-year-old woman presented with a 5-year history of an enlarging popliteal cyst 7 years after total knee arthroplasty (TKA). Magnetic resonance imaging revealed a large, multilobulated popliteal cyst. Initial diagnostic workup was inconclusive but repeat evaluation met criteria for culture-negative prosthetic joint infection (PJI). She underwent revision TKA, intraoperative cultures identified Micrococcus luteus, and she remains on antibiotic suppression. At her 4-year follow-up, she demonstrated complete resolution of the popliteal cyst with minimal pain.

Conclusion: Popliteal cysts may represent a primary presenting symptom of PJI, especially when the causative organism is of low virulence, such as M. luteus.

Case: A 28-year-old active-duty man who had failed limb salvage after open Gustilo 3C knee dislocation underwent knee disarticulation-femoral shortening osteotomy, involving an 8-cm femoral resection osteotomy and stabilization with intramedullary nail. At 16-month follow-up, the patient achieved osseous union at the osteotomy site without need for reoperation, was ambulating using a prosthesis daily, and was running weekly.

Conclusion: Knee disarticulation with femoral shortening osteotomy preserves the advantages of a knee disarticulation amputation and solves the historical problem of knee length difference with this amputation level.