JBJS case connector最新文献

Case: A 75-year-old woman status post total shoulder arthroplasty and posterior rib resection 29 years previously experienced a low-energy intrathoracic scapular dislocation (ISD). Closed reduction under anesthesia was unsuccessful, and she required open surgical repair performed by a novel modification of Kibler's technique for medial scapular muscle repair.

Conclusion: This case is unique because increased range of motion after successful arthroplasty allowed her shoulder to flex forward enough to result in ISD. Successful surgical repair was performed by a technique previously not described.

Case: A 72-year-old woman with undifferentiated pleomorphic sarcoma of the thigh received neoadjuvant chemotherapy and radiotherapy. She underwent wide resection and was scheduled for prophylactic fixation of the femur. However, prophylactic fixation was deferred secondary to COVID-19 pandemic. Unfortunately, when stepping out of an elevator, she sustained femur fracture. The fracture was treated with a cemented intercalary endoprosthesis. Three-year follow-up reveals stable fixation without any failure.

Conclusion: Postradiation fractures are challenging. Delayed union, nonunion, and infection are associated with internal fixation. To the best of our knowledge, this is the first report of intercalary endoprosthesis used for primary management of radiation-associated femur fracture.

Case: Physeal stability in slipped capital femoral epiphysis (SCFE) depends on integrity of the hypertrophic zone. This in turn is affected by imbalance between circulating growth hormones and gonadal hormones. This case describes the occurrence of SCFE in a Māori (indigenous New Zealander) transgender girl, undergoing gender-affirming therapy with a gonadal-releasing hormone analog (GnRHa).

Conclusion: Surgeons and clinicians alike should be aware that GnRHa in gender-affirming therapy may confer an additional risk factor, lowering the threshold required for SCFE to occur. Counseling patients about potentially increased risk, and need for timely presentation could be warranted, particularly in high-risk individuals.

Case: A 47-year-old man presented with neck pain, restricted neck movements, along with involvement of facial and hypoglossal nerve. On the basis of clinico-radiological correlation, the patient was diagnosed with craniovertebral junction tuberculosis and was started on antitubercular therapy (ATT). Failing the conservative trial, the patient was operated and occipitocervical fusion was done with bone grafting. After 12 months of ATT intake, he showed complete recovery of the facial and hypoglossal nerve, with complete resolution of instability pain.

Conclusion: Craniovertebral junction tuberculosis is uncommon, and its manifestation with cranial nerves involvement is even more rare. Meticulous clinico-radiological assessment should be done to diagnose and plan the treatment. Early recognition and prompt initiation of ATT, along with timely surgical intervention, when necessary, are crucial for optimal management and outcomes.

Case: Traditional surgical intervention for brachial plexus birth injury (BPBI) has involved proximal nerve grafting. At the age of 6 months, an infant with Klumpke birth palsy had not recovered finger flexion and extension. He underwent extensor carpi radialis brevis to anterior interosseous nerve and supinator-to-posterior interosseous nerve transfers. Three months postoperatively, he was noted to have recovery of finger flexion and extension which continued to improve to 18 months postoperative follow-up.

Conclusion: This case shows effectiveness of early surgical intervention using distal nerve transfers, as opposed to traditional proximal nerve grafting, for reanimating the hand in BPBI.

Case: This case report describes the successful treatment of a year-round teenage softball pitcher who sustained a proximal biceps tendon rupture who underwent successful subpectoral tenodesis. To our knowledge, this is the only reported case of such an injury occurring in an underhand throwing teenage athlete.

Conclusion: This case highlights an unusual instance of a sport-related injury in an adolescent softball pitcher, suggesting that the softball pitch in elite athletes may put similar stress on the shoulder to overhead throwing athletes over time and further demonstrating that patients may continue to have success at elite levels of competition after tenodesis.

Case: We present the case of a 33-year-old World Cup giant slalom skier treated by endoscopically assisted proximal vastus lateralis (VL) release for persistent lateral thigh pain, due to a VL proximal myo-aponeurosis rupture. At the completion of rehabilitation, he was able to return to Olympic-level competition following surgery and was still symptom free at the 3-year follow-up.

Conclusion: The unusual location of this injury and the symptoms and physical examination are of interest. The endoscopic release of the VL proximal insertion allowed a rapid and lasting result with a return to competitive skiing at an elite level.

Conclusion: The surgical principles of treating a high riding hip dislocation in patients with positive PYCR1 gene mutation should be comprehensive including open reduction, pelvic osteotomy, and femoral shortening osteotomy with derotation. Meticulous capsulorrhaphy optimizes the development and stability of the hip joint.

Case: Fourteen-year-old boy, history of autism presented with bilateral knee instability. Imaging revealed bilateral anterior cruciate ligament (ACL) insufficiency, 20° of posterior tibial slope (PTS) on the right and 18° on the left. A guided growth technique using anterior placed tension band plates was used to correct the PTS. At 22 months, the PTS corrected to 5.5° on the right and 6° on the left. The patient's knee stability improved, and he resumed activities at 30 months.

Conclusion: Pediatric ACL insufficiency in the setting of elevated PTS can be successfully corrected with a guided growth technique.

Case: Vohwinkel syndrome is a rare, inherited condition marked by defective keratinization. The disorder may feature digital constriction bands (pseudoainhum) which can lead to autoamputation. Surgical excision is the only treatment of pseudoainhum; however, it is fraught with recurrence. We present a 10-year-old boy with pseudoainhum of the right long and small fingers at the distal interphalangeal joints. He underwent 180-degree band excision and z-plasty.

Conclusion: Since establishing care 8 years ago, he has undergone treatment of 5 constriction bands with only 1 recurrence. We believe this success can at least be partially attributed to the technique described by Upton.