JBJS case connector最新文献

Case report: A 76-year-old female patient underwent revision T12-L4 decompression and fusion surgery. During the procedure, a large dural defect occurred associated with an abrupt drop in end-tidal CO2, severe hypotension, bradycardia, and cardiac arrest. Prone chest compressions were initiated, and the patient survived without postoperative comorbidities. The sudden hemodynamic instability was attributed to a venous air embolism (VAE) confirmed by findings on intraoperative capnography.

Conclusion: Managing cardiac arrest caused by VAE in lumbar spine surgery is challenging. This case showcases that prone chest compressions may lead to better survival chances compared with waiting to initiate supine chest compressions.

Case: A 58-year-old woman underwent delayed fixation of an unstable distal radius fracture. At staged hardware removal, an isolated rupture of extensor carpi radialis brevis (ECRB) was discovered and tenodesed to extensor carpi radialis longus acutely. The surgical intervention allowed her to return to gardening at 2 weeks after the hardware removal with preserved function and pain control at 13-month follow-up, respectively.

Conclusion: We present a rare complication of isolated abrasive ECRB rupture with an intra-articular distal radius fracture treated with a late decision for surgery. Our surgical intervention resolved the patient's pain and preserved function in this case.

Case: A 10-year-old girl with a history of distal femur osteosarcoma underwent resection and limb reconstruction with a cemented custom expandable endoprosthesis. Immediately following stemmed implant insertion, the patient experienced severe cardiopulmonary collapse. Following emergent fluid and oxygen resuscitation by anesthesia, her transient cardiopulmonary instability resolved.

Conclusion: This is the first report describing acute bone cement implantation syndrome in a pediatric patient. This case highlights the importance of vigilance and interdisciplinary communication with anesthesia when inserting cemented implants in pediatric patients.

Case: A 44-year-old morbidly obese man suffered an ultra-low velocity knee dislocation with anterior and posterior cruciate and medial collateral ligament tears after falling from a stationary bike. He underwent open reduction, external fixator application, and multiligamentous reconstruction. Postoperatively, he developed septic arthritis requiring debridement, graft removal, and antibiotic therapy, with eventual conversion to total knee arthroplasty (TKA). We present nearly 20-year follow-up on this complex case.

Conclusion: Morbid obesity amplifies the risks of knee dislocation management, including ligament reconstruction failure and septic arthritis. Long-term follow-up allows for analysis of treatment strategies of severe complications.

Case: A 7-year-old girl with an aggressive proximal femur aneurysmal bone cyst (ABC) who sustained a pathological fracture of the femoral neck required an open reduction and internal fixation with curettage and bone grafting. This was followed by early aggressive recurrence of the ABC, which was treated successfully with percutaneous doxycycline sclerotherapy.

Conclusion: Doxycycline sclerotherapy seems to be an effective and relatively low-risk treatment for recurrent ABCs.

Case: This is a case of a 6-year-old patient diagnosed with Gorham-Stout disease (GSD), a rare lymphangiogenic skeletal disorder, localized to the left femur. Initial nonoperative treatment with pharmaceuticals and bracing was unsuccessful. We describe a definitive operative treatment with radical femoral resection and a modified rotationplasty technique through a tibiopelvic rotational hip arthroplasty. At 2-year follow-up, the patient was able to walk with a prosthetic device.

Conclusion: The use of this modified rotationplasty technique is an effective treatment option for patients with femoral GSD to improve function and quality of life.

Case: A 25-year-old man presented with neck and upper-limb pain. He underwent surgery for the resection of a left hypoplastic first rib, which was causing thoracic outlet syndrome. The subclavian vein was retracted through an infraclavicular incision, and an endoscope was inserted dorsally to the vein. With the assistance of endoscopy, the first rib was partially resected, and scalene muscles were released from the rib. The preoperative symptoms improved after surgery without any complications.

Conclusion: The endoscopic-assisted infraclavicular approach enabled sufficient resection of the hypoplastic first rib, leading to satisfactory outcomes. This method can be considered as an option for resecting a hypoplastic first rib.

Case: We present a marginal mandibular branch of the facial nerve palsy that occurred in a 55-year-old woman from external compression of a rigid cervical collar. This nerve palsy occurred after less than 24 hours of collar utilization and was treated conservatively with delayed recovery.

Conclusion: A marginal mandibular branch of the facial nerve palsy is a rare complication of cervical collar usage with only 1 other documented case in the literature. The resemblance of this palsy to a postoperative cerebrovascular accident makes it an important complication to consider when using a collar.

Case: A 73-year old man who underwent previous L2-S1 decompression presenting with new right radicular leg pain. Imaging suggests a large central disk herniation at L1-2 with possible intrathecal extension requiring surgical decompression. When positioned prone on a Jackson frame, neuromonitoring motor signals became diminished, and thus, the case was aborted. On returning to the operating room 2 days later, careful positioning in a more neutral/flexed position facilitated normal neuromonitoring signals, allowing for an uneventful intradural approach and discectomy.

Conclusion: With conus-level intrathecal disk herniation, consider using prepositional neuromonitoring and avoid hyperextension with positioning to ensure neurological safety.

Case: A 34-year-old man presented at our hospital with knee collapse. Magnetic resonance imaging (MRI) revealed posterior compression of the dural sac by a lumbar epidural lesion; however, a diagnosis could not be reached. Gadolinium (Gd)-enhanced 3-dimensional MRI (3D-MRI) clearly delineated the morphology, enabling us to make a preoperative diagnosis of posterior epidural migration of the lumbar disc fragment (PEMLDF). Furthermore, detailed location information enabled surgical removal of the lesion in a minimally invasive manner.

Conclusions: PEMLDF is rare and often difficult to diagnose. Gd-enhanced 3D-MRI provides useful information for the diagnosis and surgical planning for PEMLDF.