JBJS case connector最新文献

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.

Case: A 23-year-old male with no medical history presented with a painless, slowly enlarging heel mass present for 5 years. Physical examination revealed a firm lesion with mild varicosities. Magnetic resonance imaging demonstrated a 4.3 × 1.7 × 4.2-cm lobular mass with peripheral enhancement. Advanced molecular workup confirmed a glioma-associated oncogene 1 (GLI1)-altered mesenchymal neoplasm-a rare, emerging tumor with evolving classification and diagnostic challenges. The mass was widely excised with negative margins, followed by free-flap reconstruction.

Conclusion: GLI1-altered neoplasms are rare, unpredictable tumors requiring meticulous resection and multidisciplinary surveillance. This novel presentation from the subcutaneous soft tissue surrounding the calcaneus supports adequate excision and surveillance involving patient-specific considerations.

Case: Three patients aged 29, 30, and 38 with diabetes mellitus presented with medial tibial plateau fractures after the insidious onset of knee pain. All were treated with open reduction and internal fixation that failed early and required revision surgery. None were initially diagnosed with a neuropathic knee. In retrospect, the clinical scenario and fracture patterns were similar and should raise suspicion for charcot arthropathy.

Conclusion: Atraumatic pain with a progressive deformity and fragmentation of the medial plateau are concerning for Charcot knee. Correct diagnosis is crucial to develop an appropriate treatment plan.

Case: We report the cases of 2 male patients (aged 66 and 48) with hip avascular necrosis (AVN) and no history of hip infection, who presented pus-like synovial fluid during primary total hip arthroplasty (THA). Intraoperative C-reactive protein was normal, and cultures remained negative. Both underwent uncomplicated THA with favorable outcomes at 1-year follow-up.

Conclusion: Pus-like joint fluid can occur in AVN without infection. Negative cultures in both cases suggest this finding is related to AVN pathology rather than septic arthritis.