JBJS case connector最新文献

Case: A 60-year-old right-hand-dominant woman experienced progressive enlargement of a mass over the index distal interphalangeal (DIP) joint over 5 years, leading to joint destruction and swan neck deformity. Radiography showed arthritis, erosion, and calcific deposition. Surgical intervention included mass excision, synovectomy, and DIP joint arthrodesis. After initial fixation failure, revision surgery achieved DIP joint fusion, with histology confirming synovial chondromatosis.

Conclusion: This case highlights the diagnostic and treatment challenges of treating rare presentations of synovial chondromatosis in small hand joints, emphasizing early recognition, synovial excision, and joint stabilization in the presence of poor bone quality to prevent recurrence and preserve function.

Case: A 51-year-old male polytrauma patient presented with bilateral calcaneus fractures after a fall. This report describes treatment of his right comminuted Sanders IV calcaneus fracture with percutaneous open reduction internal fixation (ORIF) and minimally invasive surgery (MIS) primary subtalar fusion to restore alignment and preserve soft tissue.

Conclusion: Unlike traditional open approaches, which are prone to wound complications due to larger incisions, our approach of maintaining fracture alignment during joint preparation using an MIS burr for acute posttrauma subtalar arthrodesis and percutaneous ORIF appears to have reduced these risks, resulting in successful radiological healing and functional recovery at 1-year follow-up.

Case: A 16-year-old woman presented with acute on chronic knee pain and instability following a twisting injury. The tibial insertion of the anterior cruciate ligament (ACL) was nonvisualized on magnetic resonance imaging. A cord-like ACL, originating from the lateral intercondylar notch and inserting smoothly into the anterior horn of the intact lateral meniscus, was found on arthroscopy. Her ACL was reconstructed with quadriceps tendon autograft.

Conclusion: We report a rare case of dysplastic ACL inserting into the lateral meniscus in a patient without obvious skeletal deformities. This pathology could be congenital or traumatic. Surgeons and radiologists should be aware of this rare variant.

Case: In this article, we present 2 cases of neglected patellar tendon rupture. One was treated using an Achilles tendon allograft, and the other with a patellar tendon-bone allograft. Both methods allowed for early range of motion and resulted in good functional outcomes with a 1-year follow-up period.

Conclusion: The choice of allograft for patellar tendon reconstruction is important. Although an Achilles allograft may be more readily available and have a high tensile strength, a bone-patellar tendon allograft may be a better choice when bone loss is present, and a high biological incorporation rate is desired.

Case: A 14-year-old adolescent girl sustained a Lisfranc fracture-dislocation with an interposed extensor hallucis brevis (EHB) tendon. Following multiple failed attempts at closed reduction in both the emergency department and the operating room, the patient was treated in a staged manner with temporizing closed reduction and percutaneous pinning in improved alignment, followed by definitive open reduction and internal fixation once soft tissues allowed.

Conclusions: Anatomic reduction and stable fixation of Lisfranc injuries is vital to regain stability and reduce the risk of midfoot arthritis and collapse. To our knowledge, this is the only case report describing the EHB tendon as a block to reduction of a Lisfranc fracture-dislocation.

Case: A 75-year-old woman underwent cruciate retaining total knee arthroplasty (TKA) for osteonecrosis of the knee, converted from unicompartmental arthroplasty due to an intraoperative medial tibial plateau fracture. Four years later, she experienced persistent knee pain. Computed tomography revealed tibial malalignments in 2 planes. In vivo kinematic analysis using single-plane fluoroscopy, which can visualize the femorotibial contact, indicated varus thrust with lateral subluxation of the tibial component and the femoral component recessing into the polyethylene insert. Revision TKA affirmed the polyethylene insert breakage.

Conclusion: Malalignment might have caused mechanical failure, and in vivo kinematic analysis was useful to visualize abnormal kinematics in TKA.

Cases: Two patients with spontaneous loss of thumb interphalangeal joint extension were referred after history, electrodiagnostic, and/or magnetic resonance imaging (MRI) findings were felt to demonstrate a posterior interosseous nerve (PIN) palsy. Subsequent physical examination and additional directed studies suggested an alternative explanation: rupture of the extensor pollicis longus (EPL) tendon, subsequently confirmed at surgery. An extensor indicis proprius to EPL transfer restored thumb function.

Conclusion: Electrodiagnostic and MRI changes consistent with diffuse PIN palsy may occur in the setting of EPL rupture. An accurate diagnosis of EPL dysfunction requires careful physical examination and confirmatory imaging. Further study of this previously unreported phenomenon is required.

Case: A 34-year-old man, amateur weight lifter presented with acute worsening of right shoulder pain after 5 months of prodromal, progressive, atraumatic pain. Imaging showed a short oblique proximal third humeral shaft fracture without evidence of other osseous abnormalities. He was treated operatively with open reduction and internal fixation, healed uneventfully, and returned to weight lifting within 3 months.

Conclusion: Humeral shaft stress fractures most commonly occur in athletes or military personnel who engage in repetitive overhead activity. It is important to include stress fracture on the differential diagnosis for chronic pain in the upper extremity, especially in a physically active patient.

Case: A 49-year-old woman with sternoclavicular insufficiency following medial clavicle resection underwent sternoclavicular joint reconstruction using a hamstring allograft and a cadaveric fibular cortical allograft. After 4 months of follow-up, the patient was pain-free, with radiographic evidence of graft incorporation by 8 months.

Conclusion: Medial clavicle resection is a rare procedure with broad indications. The necessity and optimal technique for subsequent sternoclavicular reconstruction remain debated. We demonstrate a figure-of-eight reconstructive technique that may provide acceptable clinical results when addressing large medial clavicle defects.

Level of evidence: IV.