JBJS case connector最新文献

Case: Wide resection of a synovial sarcoma of the anteromedial distal leg involving the dimetaphyseal tibia and posterior tibial tendon produced an 8.5-cm osseous defect. To keep the free flap from invaginating into the defect and prevent kinking of the anastomosis, six 1.5-mm Ilizarov wires (held in place by the external fixator) were placed under the flap to suspend it over the defect. No problems resulted with the vascularity or healing of the flap or with consolidation of the defect.

Conclusion: Suspending the flap over the defect with Ilizarov wires can prevent tissue invagination while avoiding need for additional procedures.

Case: A 49-year-old gentleman sustained a closed, right tibia peri-implant fracture with a bent intramedullary nail. This resulted in a 17° valgus and 5° recurvatum deformity with fracture at the distal third of the tibial shaft. The patient underwent closed manipulation with an F-Tool and was reviewed by our unit over the following year.

Conclusion: This is the first case report of closed manipulation of a tibial fracture over a bent implant. This approach was successful in correcting deformity to within acceptable limits, achieved radiological union, and was associated with excellent patient-reported outcomes at all points of follow-up.

Case: Triple pelvic osteotomy (TPO) is used to treat developmental dysplasia of the hip in a pediatric population. This case report highlights a new indication for this procedure. Acetabular coverage was restored in a 9-year-old patient who experienced instability following hip hemiarthroplasty and proximal femur composite allograft implantation for the treatment of Ewing sarcoma.

Conclusion: TPO can be used to treat instability following prosthetic hip replacement in pediatric patients with open triradiate cartilage. It restores the acetabular bone stock and should facilitate future acetabular component implantation or revisions.

Case: Heterotopic ossification (HO) is a relatively rare but severe clinical finding around the hip joint, characterized by the formation of extraskeletal bone in soft tissue. We present the case of a 66-year-old man with a severe, painful gait disorder caused by extensive neurogenic bilateral HO. In this case, due to the medial HO localization, we performed a staged bilateral, combined HO resection and total hip arthroplasty using the single medial Ludloff approach.

Conclusion: Our case highlights that, for combined hip osteoarthritis and medial HO, a Ludloff approach can be an effective option for achieving favorable surgical outcomes.

Case: A 41-year old man fell from height sustaining displaced radial shaft and ulnar styloid fractures underwent open reduction internal fixation of the radius with early recognition of a radiocapitellar dislocation and longitudinal forearm instability in the early postoperative period. Revision surgery was performed 13 days postoperatively involving annular ligament reconstruction, elbow spanning external fixation, and distal radioulnar joint stabilization. Favorable functional and radiographic outcomes are shown at 1-year follow-up.

Conclusion: Longitudinal forearm instability is associated with multiple patterns of forearm fractures. Early recognition of the injury with appropriate anatomic reconstruction likely results in improved outcome.

Case: We present a case of isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient with a 5-year follow-up. The diagnosis was established by core needle aspiration and biopsy. He was treated with antituberculous chemotherapy and immobilization. The lesion healed with collapse of the calcaneal tuberosity that clinically resulted in shortening and heel valgus. A literature review is also presented.

Conclusion: Isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient is rare. It may pose diagnostic dilemma, and orthopaedist should work through the differential diagnosis.

Case: We outline the management of a 10-month-old girl with an Ewing sarcoma involving the entire radius. The patient was treated with neoadjuvant chemotherapy resulting in almost a complete response. A limb-sparing procedure was performed consisting of a radical resection of the entire radius and centralization of the carpus to the ulna.

Conclusion: This case is the first to describe an Ewing sarcoma of the entire radius in a 10-month-old girl treated with a radical resection of the radius and centralization of the carpus on the ulna. Over 2 years postoperatively, the construct remains stable with a very good functional and aesthetic outcome.

Case: We present 3 cases demonstrating radiographic posterior subluxation in lateral functional radiographs taken in the flexed-seated position. Two of the patients were asymptomatic, and 2 showed the posterior translation of the femoral head, which is almost a dislocation, with spontaneous reduction. The subluxation can occur not only in patients after lumbar fusion surgery but also in patients with relatively normal lumbar spine due to excessive hip flexion.

Conclusion: Functional lateral radiographic assessment in the flexed-seated position may be useful in detecting asymptomatic subluxation and identifying patients at high risk of dislocation after THA.

Case: The effective reconstruction and functional restoration of the shoulder joint after surgical treatment of shoulder girdle tumors, especially those involving resection of the glenoid, poses significant challenges. Reconstruction methods include allograft reconstruction and shoulder prosthesis. In this report, we present 2 cases of scapulectomy for tumors involving the glenoid, followed by shoulder reconstruction using custom-designed reverse shoulder prostheses that are partially fixed to the clavicle. Functional outcomes were satisfactory at 25 and 19 months, respectively.

Conclusion: This novel prosthesis design, which is partially fixed to the clavicle, provides stability and promising functional outcomes in scapular reconstruction with short-term follow-up.

Case: We present a 79-year-old woman with a complex elbow fracture including a comminuted proximal ulna fracture, coronoid process fracture, and comminuted radial head fracture treated with primary total elbow arthroplasty (TEA). The patient completed an early therapy protocol and had complete healing. At 15 months postoperatively, she had full pronosupination and elbow arc of motion from 10 to 135° with no reported pain.

Conclusion: Primary treatment of unstable, complex fractures of the proximal ulna and radius with TEA has not been previously reported in the literature. This case reports suggests that indications for primary TEA for traumatic elbow injuries in the elderly could be expanded.