JBJS case connector最新文献

Case: A 21-year-old male sustained a high-velocity open knee injury with extensive osteochondral loss of the lateral femoral condyle, patella, and proximal tibia with an intact extensor apparatus. Following staged debridement and external stabilization, reconstruction was performed using a size-matched osteochondral allograft (OCA). The graft was contoured to restore condylar geometry and incorporated using internal fixation. At the 2-year follow-up, radiographs confirmed graft incorporation and the patient demonstrated excellent functional recovery.

Conclusion: OCA transplantation is a valuable joint-preserving option for massive post-traumatic defects in young patients. In open injuries, careful planning, staged reconstruction, and size-matched graft-selection are critical for successful outcomes.

Case: An 82-year-old woman presented with right medial thigh pain. Her medical history included multiple lumbar decompression and fusion surgeries. She was diagnosed with L3 radiculopathy secondary adjacent segment disease (ASD) after lumbar fusion. Full-endoscopic spine surgery (FESS) was performed for targeted decompression. Preoperative planning was conducted using AI-assisted 3-dimensional (3D) magnetic resonance imaging (MRI)/computed tomography (CT) fusion images. The procedure was completed under local anesthesia, resulting in postoperative pain relief. At the 3-year follow-up, the patient remained asymptomatic with no symptom recurrence.

Conclusion: FESS, combined with detailed surgical planning using artificial intelligence -assisted 3D MRI/CT fusion imaging, may be an effective treatment strategy for ASD.

Case: A 45-year-old female patient presented with acute perianal numbness, severe back pain, and bilateral radiculopathy. Magnetic resonance imaging revealed a large cystic lesion involving the L5-S1 vertebrae with compression of the thecal sac. Given the erosion of the L5 pedicle and sacral involvement, navigation-guided tumor resection with L4-S2 alar-iliac fixation and L4-5 transforaminal lumbar interbody fusion was performed. Intraoperative O-arm navigation ensured accurate resection and safe instrumentation despite distorted anatomy. Postoperatively, the patient had significant pain relief and neurological improvement at 1 year.

Conclusion: Navigation-assisted resection with spinopelvic fixation is a safe and effective approach in complex schwannomas with bony erosion, ensuring maximal decompression, accurate instrumentation, and durable stability.

Case: A 75-year-old woman on long-term hemodialysis sustained anterior shoulder dislocation without a fracture. Four months later, she presented with persistent shoulder pain and limited motion. Imaging revealed humeral head osteonecrosis (Cruess stage V) and a massive rotator cuff tear. Reverse shoulder arthroplasty was performed with favorable outcome.

Conclusion: Osteonecrosis of the humeral head following anterior shoulder dislocation without a fracture is rare. To our knowledge, this is the first reported case in a dialysis-dependent patient. This case highlights the need for increased clinical awareness regarding this complication in such patients.

Case: We report a 55-year-old woman with bull gore trauma to the lower neck who developed dysphagia and airway compromise due to a retropharyngeal chyle collection. Imaging revealed a prevertebral fluid collection. Surgical drainage, which confirmed chyle, followed by thoracic duct ligation through video-assisted thoracoscopic surgery, was required due to a persistent high-output leak.

Conclusion: Thoracic duct injury at the cervicothoracic junction is an uncommon but serious complication of trauma. High suspicion, timely diagnosis, and surgical intervention ensure favorable outcomes especially in cases with isolated retropharyngeal collection without chylothorax.

Case: We report the case of bilateral acetabula fractures including an associated both column (ABC) acetabulum fracture with dissociation of the sciatic buttress in a 33-year-old woman. The patient was treated with open reduction internal fixation.

Conclusion: The case highlights approach utilization and thoughtful sequencing of this rare fracture pattern and constellation of injuries. The displaced sciatic buttress fragment adds complexity to the typical treatment of ABC fractures regarding reduction sequence and exposure. Successful clinical and radiographic outcomes are shown at the 2-year follow-up.

Case: A 15-year-old girl presented with isolated anterolateral tibial bowing without fracture, an unusual manifestation. The deformity was initially corrected with a double-level osteotomy sparing the apex and intramedullary nail fixation. A second corrective procedure was performed for residual deformity, resulting in satisfactory alignment and union.

Conclusion: Congenital tibial pseudarthrosis most often progresses to fracture in early childhood, but this rare presentation without fracture highlights the variability of the condition. Successful correction was achieved through staged, apex-preserving, double-level osteotomies and intramedullary fixation, providing a potential strategy for atypical cases.

Case: A 3-year-old female patient presented with pseudoarthrosis of the tibia secondary to amniotic band syndrome (ABS). Before presenting to our institution, the patient underwent a band release without improvement of the deformity. She was subsequently treated using a cross-union technique of the tibia and fibula synostosis. Radiographs taken 2 years postoperatively demonstrated complete union of the tibia and fibula and no refracture.

Conclusion: This case demonstrates successful surgical intervention to treat ABS-related pseudoarthrosis. In cases where the deformity persists despite band release, the cross-union technique may be useful to consider.

Case: A 16-year-old girl presented to the emergency department after a 6-foot fall while skiing. The patient presented with left-sided pelvic pain and acute blood loss anemia. She was diagnosed with pelvic ring fracture (LC-2) and underwent open reduction internal fixation using a trans-sacral trans-iliac (TSTI) screw. She initially recovered but reported chronic right-sided back pain 4 years later. After hardware removal, she remained symptom-free for 1 year.

Conclusion: Very few cases report contralateral pain associated with TSTI screws penetrating the opposite SI joint. This report highlights a possible long-term complication surgeons should account for when considering TSTI fixation.

Case: A 44-year-old woman with an infected pilon fracture nonunion developed Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) after prolonged intravenous vancomycin and implantation of a vancomycin/tobramycin-loaded antibiotic cement spacer (ACS). Fevers, rash, and eosinophilia persisted despite stopping systemic vancomycin and starting corticosteroids. ACS explantation led to symptom resolution; however, severe thrombocytopenia developed, requiring therapeutic plasma exchange. A daptomycin-loaded spacer was reimplanted before definitive hindfoot fusion.

Conclusion: This case of DRESS in the setting of an ACS highlights management challenges, supports early recognition and spacer removal, proposes a treatment algorithm, and suggests daptomycin as an alternative for local antibiotic delivery.