JBJS case connector最新文献

Case: A 90-year-old woman with osteoporosis sustained a right intertrochanteric fracture and underwent closed reduction and internal fixation with a Proximal Femoral Nail Antirotation (PFNA). During preaugmentation assessment, radiopaque contrast injected through the PFNA blade-intended to exclude intra-articular communication-unexpectedly leaked into surrounding vasculature, indicating potential intravascular access. Cement injection was aborted, and the patient recovered uneventfully under a multidisciplinary fragility fracture care pathway.

Conclusion: This is the reported case of intravascular contrast leakage during preaugmentation assessment in hip fixation, highlighting the importance of routine contrast injection to identify vascular communication and prevent possible cement embolism.

Case: A 64-year-old woman with fibrodysplasia ossificans progressiva (FOP) sustained a Gustilo-Anderson type III open tibia and fibula fracture. She underwent debridement, irrigation, open reduction and internal fixation, and primary closure, followed by postoperative corticosteroids. A nondisplaced peri-implant fracture slowed recovery 3.5 months postoperatively, but she improved steadily and subjectively regained 90% of baseline function at 1 year, without significant heterotopic bone formation.

Conclusion: In FOP patients with open fractures, standard surgical management and careful postoperative inflammation control can yield favorable outcomes. An interdisciplinary approach is critical for the safe care of patients with this rare pathology.

Case: Mixed Martial Arts (MMA) is one of the fastest growing sports in the world. Although rare, cervical spine injuries can occur in MMA athletes. We report a unique case of a professional MMA world champion that successfully underwent 2 motion preservation surgeries to treat cervical radiculopathy. The athlete was able to return to elite competition after both operations.

Conclusion: This case highlights that cervical spine motion preservation procedures can be used for safe and successful return to combat sports in the properly indicated patient.

Case: A 20-year-old man with prior ulnar shortening osteotomy and triangular fibrocartilage complex repair presented with wrist pain, clunking, and midcarpal instability. Arthroscopic dorsal and volar capsulorrhaphy of the lunotriquetral and scapholunate ligaments was used to tighten the radiocarpal and midcarpal joints.

Conclusion: In young, active patients, arthroscopic treatment of midcarpal instability offers a promising alternative to restore wrist biomechanics and reinforce volar and dorsal extrinsic stabilizers.

Case: Three-dimensional atlantoaxial rotatory fixation (AARF) is usually evaluated by computed tomography (CT). This report describes 3 cases of AARF that were diagnosed and treated based on CT-like bone contrast magnetic resonance imaging (CTLBC MRI) findings. Three-dimensional volume rendering CTLBC MRI scans helped with diagnosis and treatment planning.

Conclusion: CTLBC MRI can determine the severity of dislocation and C1/C2 facet deformity in AARF and inform the treatment strategy. CTLBC MRI may reduce ionizing radiation exposure in children and merits broader evaluation.

Study design and level of evidence: Case series, Level V.

Case: Total hip arthroplasty (THA) in hips ankylosed and deformed from childhood infection is technically demanding because of distorted anatomy, poor bone quality, and abductor deficiency. A 48-year-old woman with fused hip, subtrochanteric nonunion, and proximal femoral hypoplasia underwent conversion THA through a posterior approach. A dual mobility acetabular cup and long-stem uncemented femoral component were used to reduce the instability risk and achieve fixation. Her postoperative course was uneventful, though rehabilitation was prolonged due to abductor atrophy.

Conclusion: This case highlights the importance of surgical planning, implant selection, and tailored rehabilitation in complex hip reconstructions.

Case: We report a case of a 65-year-old man attempting suicide through anterior neck stabbing with an ice pick. Computed tomography showed spinal canal penetration at C4-5 near the midline, sparing the trachea, esophagus, and major vessels. The foreign body was removed under general anesthesia; cerebrospinal fluid leakage was noted, and the wound was tightly closed with a fibrin-based sealant. No motor or sensory deficits were present preoperatively or postoperatively.

Conclusion: This case shows that penetrating cervical spinal canal injuries may occur without neurological impairment. Careful extraction under general anesthesia, ideally with neuromonitoring, is recommended to minimize complications.

Case: A 30-year-old man presented 11 months after a Gustilo type IIIA open knee fracture-dislocation, previously treated with femur fixation and posterior cruciate ligament reconstruction, with persistent painful instability and contracture. Examination showed a positive dial test at 30° and 90° and varus thrust gait. Imaging revealed anterolateral tibial plateau deficiency with external rotatory subluxation. Staged treatment involved gradual correction using a hexapod external fixator followed by patient-specific 3D guided intra-articular osteotomy and posterolateral corner reconstruction. He regained knee stability and returned to full activity.

Conclusion: Hexapod-assisted correction with patient-specific 3D osteotomy enabled successful joint preservation in chronic posttraumatic knee instability.

Case: We present the case of a 38-year-old male powerlifter, with a history of anabolic steroid use, who sustained a high-grade acute-on-chronic core muscle injury including both adductor longus and rectus abdominis avulsions while squatting 540 lbs. He underwent core muscle repair with reattachment of the rectus abdominis to the pubis without adductor tendon repair. Postoperatively, the patient reported full return of function and returned to the same level of sport.

Conclusion: Weightlifting and anabolic steroid use are unusual causes of core muscle injuries. Core muscle repair with reattachment of the rectus abdominis to the pubis provides good results in this setting.

Case: A 46-year-old man suffered thoracic spine fracture dislocation in a motorcycle accident, presenting with complete lower extremity paralysis. Imaging revealed a T8 vertebral dislocation and complete spinal cord transection. Urgent surgery approximately 36 hours postinjury included posterior fixation, bone grafting, duraplasty, and spinal cord stump-plasty. Postoperatively, his neurological status remained unchanged. Minimal cerebrospinal fluid leakage resolved; no other major complications developed. He is stable and mobile through a wheelchair.

Conclusion: Prompt surgical stabilization and dural repair can be essential to prevent life-threatening complications in complete thoracic spinal cord transection. This case illustrates 1 possible management strategy for this exceptionally severe and rare injury pattern.