JBJS case connector最新文献

Case: A 60-year-old man presented with a chronic right pectoralis major muscle belly tear of the lower sternal head that was missed and previously treated with tendon repair of the sternal and clavicular heads. The tear was repaired and reconstructed with an Achilles allograft. At the 1.5-year follow-up, the patient had excellent outcome scores on the Short Form Survey-36 and American Shoulder and Elbow Surgeons Scores, cosmesis, and strength.

Conclusions: To our knowledge, this is the first report of a chronic pectoralis muscle belly tear reconstructed with an Achilles allograft, an uncommon injury traditionally treated nonoperatively.

Case: A patient presented with midline back pain radiating into the left lower extremity. Magnetic Resonance images revealed an abnormal midline dorsal structure described as a facet cyst. Rupture was attempted by spinal needle under fluoroscopic guidance. His pain returned in less than 2 weeks. Further study of the images showed the structure was more medial and cephalad than typical facet cysts, leading to a revised diagnosis of Baastrup disease. The cyst was surgically removed by minimally invasive techniques; an uninstrumented spinal arthrodesis was performed.

Conclusion: Baastrup disease is commonly misdiagnosed. Despite the delay in treatment, surgical intervention was effective.

Case: A 67-year-old woman sustained a periprosthetic tibial tubercle avulsion fracture with extensor mechanism disruption. She underwent open reduction internal fixation (ORIF) with orthogonal mini-fragment plates applied in a tension band fashion with patellar tendon suture augmentation. Radiographs, range of motion, and patient-reported outcomes were completed over 1 year.

Conclusion: Isolated periprosthetic tibial tubercle fractures with disruption of the extensor mechanism can be treated with ORIF using orthogonal tension band plating. At 1-year follow-up, the surgical technique described in this report yielded radiographic union, clinical restoration of preinjury motion, and excellent patient-reported outcomes.

Case: Stump overgrowth is the most common complication in skeletally immature amputees. Various techniques including capping the amputated stump have been used to prevent it but have been associated with variable rates of recurrence of bony overgrowth. We report a technique of intercalary tibial shortening prophylactically to avoid stump overgrowth in some specific situations in children with traumatic crush injuries of the leg/foot.

Conclusion: The technique described in this case report not only provides more soft tissue coverage but also at 1-year follow-up, successfully prevented one of the most frequent complications seen in pediatric post-traumatic amputation, the stump overgrowth.

Case: A 14-year-old adolescent boy sustained a Gustilo-Anderson Type 3A tibia fracture treated with medullary nailing. He developed an atrophic nonunion with a 10.5-cm defect after debridement. An automated hexapod system was adapted to perform trifocal tandem cable transport. Transport proceeded at 0.75 mm/day per focus, segmented into 16 increments. Docking and conversion to a nail occurred 103 days after frame application for an external fixation index of 9.8 days/cm.

Conclusion: Automated balanced cable transport is a viable option for segmental bone defects. This is the first reported automated balanced cable transport.

Case: A 64-year-old woman with a history of World Health Organization Grade II (Ki-67 20%) atypical meningioma presented with T12 vertebral body burst fracture as a complication of metastatic meningioma (SSTR2+). Following disease progression, decompression surgery and stabilization through T10-L2 posterior thoracolumbar instrumented fusion was performed.

Conclusion: This is one of few documented cases of spinal metastatic meningioma causing pathological fracture and the first to detail surgical management and longitudinal follow-up. Applying the neurologic, oncologic, mechanical, and systemic decision framework to this rare presentation, the patient was indicated for the selected surgical approach, yielding short-term improvement of patient outcome and neurologic deficit.

Case: Erdheim-Chester's disease (ECD) is a rare multisystem disorder considered as a neoplasm of non-Langerhans cell histiocytes. We report a case of uncemented total hip arthroplasty in a 74-year-old patient with ECD for femoral neck fracture with pathological involvement of distal metaphysis and diaphysis. We reviewed the literature on bony involvement.

Conclusion: Adequate osseointegration was achieved in our case; however, longer follow-up is essential. Vigilant reporting of bony involvement, such as pathological fractures, fracture healing, deformities, osteosynthesis, and outcome of joint replacement surgeries, is needed in ECD-like bone diseases.

Case: A 34-year-old patient was involved in a motorcycle accident, resulting in an anterior hip dislocation associated with an open book pelvic fracture and compression to the femoral artery. He required an emergent closed reduction of the hip dislocation and open reduction and internal fixation of the pelvic fracture.

Conclusion: This case underscores the importance of maintaining a high level of suspicion for anterior hip dislocation, particularly in patients involved in motorcycle accidents, where a flexed, abducted, and externally rotated hip is common. Timely diagnosis allows for prompt treatment, leading to better functional prognosis and improved survival opportunities.