JBJS case connector最新文献

Case: A 23-year-old man presented with a 2-month-old injury involving a volar base metacarpal fracture dislocation of carpometacarpal joint (CMC), metacarpophalangeal joint (MP) dislocation, floating metacarpal, and proximal phalanx base fracture. Treatment involved open reduction of volar base metacarpal's fracture and CMC dislocation, MP joint reduction, collateral ligament repair, and proximal phalanx fixation with plates and screws. A modified Eaton-Littler procedure with flexor carpi radialis tendon enhanced CMC joint stability. At 6 weeks, fractures had healed well, achieving good thumb motion. One-year follow-up showed no arthritis or dislocation.

Conclusion: Thumb injuries are relatively common and can involve complex fractures and dislocations. Open reduction of the delayed fractures, dislocations, and ligament repair and reconstruction can lead to successful outcome.

Case: We performed total knee arthroplasty (TKA) on a 62-year-old male patient who presented with symptomatic knee osteoarthritis resulting from habitual dislocation of the patella. The patient had a painless unassisted gait with stable patella and 5 to 95° knee range of motion, 23 months after surgery.

Conclusion: TKA can be an effective treatment option for geriatric patients with habitual patellar instability and concomitant knee osteoarthritis, but may require surgical modifications based on individual pathoanatomy.

Case: A 22-year-old man with habitual dislocation of the patella (HDP), characterized by lateral dislocation in flexion with spontaneous relocation with extension, presented with right knee pain and inability to actively extend. Imaging revealed lateral patellar dislocation, flat articular surface of the patella, and trochlear dysplasia. His symptoms persisted despite physical therapy. A 4-directional patellar stabilization surgery, incorporating lateral release, medial tibial tuberosity osteotomy, quadriceps muscle lengthening, and medial patellofemoral ligament reconstruction, was performed, with significant improvement in pain and function postoperatively.

Conclusion: The procedure could be feasible in cases of severe HDP when conservative measures failed to relieve the patient's symptoms.

Case: Burosumab is a novel drug developed to treat hereditary fibroblast growth factor 23 (FGF23)-related disorders. We report the case of an 11-year-old girl with McCune-Albright syndrome (MAS) who sustained hypophosphatemia due to excess FGF23 and multiple bone lesions of fibrous dysplasia (FD). Burosumab therapy markedly improved not only the biochemical parameters but also the radiographic appearance of the FD lesions and clinical symptoms.

Conclusion: This is the first report to demonstrate that burosumab is effective in improving FD lesions in a patient with MAS.

Case: A rarely reported complication with sacroiliac joint fusion (SJF) is an iatrogenic injury to the superior gluteal artery (SGA). This case series includes 3 cases which had a suspected injury to the SGA. Case 1 describes how hemostasis achieved with exploration of the wound followed by embolization by interventional radiology (IR). In Case 2, electrocautery, hemostatic agents, and pressure were used with success. Case 3 highlights the use of IR as the initial method for controlling bleeding.

Conclusion: This report describes a rare complication during SJF and provides an algorithm to help guide surgeons in decision making.

Case: A 30-year-old man with a history of advanced HIV disease (AHD) presented with bilateral equinocavus, leg, and foot muscle paresis, Brooker grade 4 heterotopic ossification of hips and knee stiffness, and was unable to sit upright, stand independently, or walk. Electromyography showed demyelinating sensorimotor and axonal polyneuropathy of lower extremities. Multiple surgeries of bilateral hips, ankles, and feet enabled joint mobility, plantigrade feet, and independent ambulation.

Conclusion: Patients with AHD may develop multijoint pathologies, secondary to HIV, antiretroviral therapy, or prolonged immobility, resulting in loss of ambulation and independence. Restoring ambulation may necessitate multiple surgeries, with potential for success.

Case: Odontoid fractures with atlantoaxial dislocations are rare injuries. We report a case of a 41-year-old man with a Type 2 odontoid fracture with locket facet and posterolateral dislocation. He underwent single-stage C1-C4 posterior fixation and fusion, and at 2-year follow-up, he is symptom-free without any residual pain. Follow-up radiograph and CT scan show healed odontoid fracture with posterior fusion.

Conclusion: This case highlights successful management of a complex odontoid fracture by a single-stage posterior surgery. Closed reduction is usually unsuccessful, and open reduction using posterior approach is preferable.

Case: We present a case of a 66-year-old man with lumbar vertebral body erosions after glue embolization of a Type II endoleak secondary to endovascular repair of an infrarenal aortic aneurysm. Multiple biopsies of the affected vertebrae were culture-negative confirming no evidence of infection. He underwent posterior spinal fusion from L2 to L5 with complete resolution of mechanical low back pain and improved functional outcomes.

Conclusion: Vertebral body osseous erosion is a rare complication of aortic endoleak intervention that can be successfully treated with spinal fusion.

Case: We present a case of robot-assisted placement of 3 trans-sacral transiliac screws through a single corridor for an unstable U-type sacral fracture in a 95-year-old woman. She had persistent pain and inability to mobilize with physical therapy. At 3-month follow-up, the patient had evidence of interval healing and stable hardware and was able to return to her prior functional baseline.

Conclusion: We demonstrate successful utilization of robotics to place 3 trans-sacral transiliac screws in a single corridor for fixation of an unstable pelvic ring injury. This technique was used to overcome challenges with visualization and implant placement.

Case: Fourteen-year-old boy presented with bilateral proximal humerus lesser tuberosity avulsions after swinging between 2 desks. Injuries were not visualized on radiographs but identified on magnetic resonance imaging. He underwent bilateral open reduction and internal fixation of the bony avulsions. Following repair, he returned to full activities, including sports, without limitations.

Conclusion: Lesser tuberosity avulsions are rare injuries in the pediatric population that can be missed. Our case is a low energy noncontact mechanism resulting in bilateral injury, highlighting the importance of having a high index of suspicion for this diagnosis in adolescent patients with shoulder pain with normal radiographs.