JBJS case connector最新文献

Case: A 34-year-old man with a distal tibia bone defect was treated with an intramedullary bone transport nail (Precice Bone Transport System, NuVasive). During planned removal after successful treatment, 7 separate subcomponents of the nail became disconnected and had to be separately removed using specialized instrumentation. This occurred despite adherence to the manufacturer's recommended technique for nail removal and in the absence of clinical or radiographic evidence of implant failure.

Conclusion: When planning for implant removal, surgeons should be aware of potential intraoperative disconnection of subcomponents of this magnetic bone transport nail and ensure that equipment for retrieval (e.g., very long endoscopy forceps) is available.

Case: This case demonstrates a 2-year-old boy with a rare benign supraclavicular mass diagnosed as neuromuscular choristoma through open biopsy. Postoperatively, he underwent semiannual surveillance with ultrasound without development of neurological complaints, limb deformity, or recurrence at 2-year follow-up.

Conclusion: Neuromuscular choristoma involving the brachial plexus is a rare tumor that should be in the differential diagnosis of pediatric peripheral nerve-based tumors. The intimate association with neural elements limits complete resection. Therefore, open biopsy with partial resection is recommended. While postoperative fibromatosis may occur, open biopsy remains the gold standard for definitive diagnosis. Ultrasound can be used to monitor recurrence.

Case: This case report describes a patient who presented with clinical and radiographic features of a soft tissue sarcoma of the shoulder. Despite having a painless and relatively large mass, a biopsy and resection revealed nodular fasciitis (NF).

Conclusion: This is an unusual case of a painless 10 cm mass that histopathologically was diagnosed as NF in the upper extremity with proximity to the axillary nerve and posterior humeral circumflex vessels. The USP6 rearrangement was helpful in confirming the diagnosis. Careful clinical, radiographic, and pathologic correlation is necessary in diagnosing these relatively rare tumors. In cases where there are discordant findings, molecular markers can be very helpful.

Case: A 46-year-old man presented with continued pain after distal biceps repair. On revision surgery, he was found to have entrapment of the lateral antebrachial cutaneous nerve (LABCN). After nerve transection, relocation to its native course, and subsequent repair, the patient experienced complete resolution of his preoperative symptomatology.

Conclusion: To the author's knowledge, the current study is the first to describe symptomatic entrapment of the LABCN after distal biceps repair with a satisfying outcome after nerve transection, relocation, and repair.

Case: A 39-year-old man fell during a mountain hike and injured his left, nondominant ring finger, presenting with swelling, tenderness, and crepitus of the proximal interphalangeal joint. A computed tomography scan demonstrated a displaced intra-articular impaction fracture of the middle phalanx base. Surgery was performed with a combination of intramedullary reduction by K-wire and dynamic external fixation, using a Suzuki frame, to allow early active motion and prevent collapse of the reduced fragments. At 1-year follow-up, the clinical and radiological results were excellent.

Conclusion: The impaction fracture of our patient was successfully treated with Suzuki pins and rubber after intramedullary reduction by K-wire.

Case: Bean bag projectiles (BBPs) are less lethal munition composed of a cloth bag filled with lead pellets and marking powder housed in a plastic casing fired from a 12-gauge shot gun. Two patients sustained penetrating BBP injuries that resulted in open fractures and retained BBP. Patient clothing and all BBP components were found deep in the wounds with marking powder surrounding fracture edges. Both patients healed without infection.

Conclusion: Surgical exploration of penetrating BBP injuries is recommended to remove marking powder, fabric, plastic, and potentially other forms of contamination. Fracture stabilization should adhere to existing guidelines pertaining to open contaminated wound conditions.

Case: A 15-year-old adolescent girl underwent revision surgery for a posteromedial osteochondral lesion of the talus (OLT). To provide anatomic reduction of her lesion, fluoroscopy and ankle arthroscopy facilitated a transmalleolar tunnel for screw fixation. Now, 8 years after surgery, the patient reports high patient satisfaction and pain-free functional use of her ankle.

Conclusion: A transmalleolar tunnel technique provides an alternative method to treat posteromedial OLT. This minimally invasive procedure allows patients to be spared potential complications from a medial malleolar osteotomy or a posteromedial incision. Most importantly, this case report demonstrates a positive long-term patient outcome.

Case: We report a 17-year-old boy with Klippel-Trénaunay syndrome (KTS) who underwent total hip arthroplasty with subtrochanteric shortening osteotomy through an extensile direct anterior approach (DAA) in the setting of Crowe IV hip dysplasia. The patient was transitioned from toe-touch weight-bearing to a progressive weight-bearing protocol at 6 weeks postoperatively and was ambulating painlessly at 3 months.

Conclusion: Patients with KTS undergoing orthopaedic surgical intervention necessitate a multidisciplinary approach to care. This case demonstrates that THA in Crowe IV hip dysplasia with an associated subtrochanteric shortening osteotomy can be safely and successfully performed through an extensile DAA in this population.

Case: An 18-year-old immunocompetent man presented with symptomatic lumbar canal stenosis, discharging sinuses, and cold abscess for 3 years treated with multiple incision drainage procedures with cottonoid packing antibiotic therapy. Radiographic imaging showed a soft tissue mass in the canal causing bony destruction. Postoperative histopathological examination showed an Aspergillus fungal ball. Patient showed improvement at 6-month follow-up with medical management.

Conclusion: As far as we know, this is the first case report showing an aspergilloma involving the vertebral column. Inadequate antibiotic treatment and blind introduction of a foreign body into sinus tracts can lead to fungal infections mimicking tuberculosis, causing disastrous outcomes. Fungal cultures are recommended routinely.

Case: A 53-year-old man presented with a 13-mm leg length discrepancy following left hip resurfacing arthroplasty (HRA), resulting in pain and imbalance. Advanced osteoarthritis of the contralateral hip was also noted. The patient strongly preferred HRA over total hip arthroplasty. Adequate remaining bone stock and the ability to resurface the contralateral hip allowed for resolution with 2 HRAs.

Conclusion: This is the first known revision of a HRA with a subsequent HRA. Assuming sufficient bone stock and precise implant positioning, resurfacing presents a feasible methodology to overcome complex anatomical deformities and improve mobility.