JBJS case connector最新文献

Case: Apex posterior or recurvatum deformity of the proximal tibia is an uncommon skeletal alignment. Guided growth, or hemiepiphysiodesis, is a well-established technique for correcting periarticular deformities of the knee in children. A novel technique of posterior proximal tibial hemiepiphysiodesis (PPTHE), performed though a posterior approach, is described in combination with physeal bar resection for correction of post-traumatic proximal tibial recurvatum. Two cases are reviewed including surgical technique with 21-month and 30-month outcomes.

Conclusion: Proximal tibial recurvatum in children can be corrected with posterior proximal tibial hemiepiphysiodesis. The procedure may be combined with physeal bar resection in cases of post-traumatic deformity.

Case: We present the case of a 15-year-old adolescent boy with recurrent metastatic osteosarcoma to the ilium and describe the surgical technique of iliac wing wide resection with allograft reconstruction using a custom 3D-printed cutting guide that accounts for complex anatomy by enabling nonlinear osteotomies.

Conclusion: Use of a custom 3D-printed cutting guide to resect a circumferential metastatic focus allows for targeted lesion removal with less morbidity than unguided resection. Importantly, this novel technique improves the ease of resecting a cylindrical bone segment.

Case: Neurofibromatosis type 2 (NF2) is an autosomal dominant condition characterized by the development of neoplasms, which infrequently arise in the subscapular fossa. Surgical removal of large subscapular tumors carries the risk of shoulder dysfunction due to muscle or nerve injury. We describe the case of a patient with NF2 who presented with a hybrid subscapular neurofibroma and schwannoma tumor that was completely resected through a muscle-sparing medial scapular osteotomy approach.

Conclusion: We describe a unique muscle-sparing scapula splitting surgical approach to the subscapular region that provides excellent exposure for tumor removal and clinical outcomes with minimal postoperative scapular dyskinesis.

Level of evidence: IV (case report).

Case: A 59-year-old man developed a chronic atraumatic rupture of the flexor hallucis longus (FHL) tendon due to an os trigonum. The FHL to flexor digitorum longus (FDL) rerouting tendon transfer resulted in recovery of active motion in the hallux.

Conclusion: Atraumatic chronic rupture of FHL is rare. Altering the course of FHL and tendon transfer is an easy and reliable technique for FHL chronic rupture. This technique avoids resection of the FDL and lowers the risk of FDL weakness.

Case: Traumatic extrusion of the posterior facet of the calcaneus is a rare phenomenon that has seldom been reported on. In this report, we describe a 46-year-old woman who sustained an open right calcaneal fracture with extrusion of the posterior facet after motor vehicle collision. The fragment was reinserted, then underwent definitive fixation. Postoperatively, patient went on to radiographic union and with return to work with little to no residual pain.

Conclusion: Reinsertion of the fragment with temporary fixation with subsequent definitive fixation is a viable option for extrusion a tarsal bone, specifically of the posterior facet of the calcaneus.

Case: A 79-year-old woman presented with persistent left leg pain following right-sided L4-5 minimally invasive transforaminal lumbar interbody fusion. Imaging studies revealed residual left L4-5 stenosis, a filum terminale lipoma, and no bone bridging. Additional left L4-5 decompression with reinstrumentation achieved temporary relief, but complete pain resolution was achieved only after sectioning of the filum terminale lipoma causing the tethered cord syndrome.

Conclusion: Although rare, the coexistence of lumbar spinal stenosis and filum terminale lipoma can occur, and even in cases presenting with radicular leg pain, the potential contribution of the lipoma to the symptomatology should not be dismissed.

Case: An 11-year-old girl presented 8 months after conservative treatment of lower third fracture tibia with inability to extend the great toe. There was no neurovascular deficit. Radiograph showed a liner lucent band in the callus. Magnetic resonance imaging confirmed an entrapped, thinned out, intact extensor hallucis longus (EHL) tendon passing through a tunnel in the lower tibia. Surgical decompression was undertaken and tendon freed from bone.

Conclusion: This is the first reported case of EHL entrapment following closed distal fracture of the tibia in the pediatric age group. We demonstrate full recovery of extensor at 1 year of review.

Case: We report a 9-month-old girl who was involved in a motor vehicle collision and sustained atlanto-occipital dislocation (AOD), atlantoaxial instability, and a C2 synchondrosis fracture. Initial management with a halothoracic vest for damage control failed to maintain reduction, necessitating definitive posterior occipitocervical fusion.

Conclusion: Traumatic AOD is a rare injury, most common in children following high-energy trauma. Early diagnosis and timely intervention are imperative for improved clinical outcomes. Even in young patients with small anatomy, with careful preoperative planning, occipitocervical fusion is effective and safe with successful postoperative outcomes.

Case: Three cases of pediatric patients with knee injuries from cactus thorns are included. These cases are variable in presentation ranging from acute inflammatory responses to permanent limb deformity secondary to growth arrest. Definitive treatment also varied widely from nonoperative conservative management to multiple arthroscopic and open surgeries.

Conclusion: Pediatric cactus thorn injuries have varied presentations, requiring a high level of clinical suspicion for diagnosis and treatment to prevent permanent damage.