JBJS case connector最新文献

Case: A 41-year-old woman with prior T12-L4 instrumentation for adolescent lumbar scoliosis presented with left posteromedial thigh pain initially diagnosed as an adductor strain. Two years later, she re-presented with knee stiffness, lower leg mottling, and paresthesia suspected to be reflex sympathetic dystrophy. Radiographs later revealed a 13.6-cm radiopaque object in the popliteal fossa and rod absence from the lumbar spine. The spinal rod was removed from the popliteal vein by orthopaedic surgery.

Conclusion: Radiographs are an easily obtained, low-cost, and high-yield resource that are integral to workup of musculoskeletal pain, especially in patients with orthopaedic implants.

Case: A 17-year-old lacrosse player presented 2 days after ankle injury with increasing lateral calf pain and lateral ankle numbness. Testing demonstrated a lateral compartment pressure of 134 mm Hg. The patient underwent emergent anterior and lateral compartment release. The peroneus longus and brevis were dusky, but regained perfusion. The patient's serum creatine kinase (CK) spiked initially because of reperfusion injury but ultimately normalized.

Conclusion: Isolated nontraumatic lateral compartment syndrome is extremely rare. Compartment release in a timely fashion restores perfusion to the compartment; however, CK is released and needs to be diluted to prevent renal injury.

Case: A 27-year-old man presented with an 8-year history of chronic right gluteal and posterior thigh pain, worsened by sitting and unresponsive to conservative treatment. Imaging revealed widespread melorheostosis and osteopoikilosis of the right lower extremity, with 2 gluteal soft tissue masses compressing the sciatic nerve. The masses were excised using a dual surgical approach, achieving successful sciatic nerve decompression. Postoperatively, the patient regained normal sitting and sleeping tolerance, with complete pain relief maintained over a 15-month follow-up.

Conclusion: Melorheostosis, a rare sclerosing bone disorder sometimes associated with osteopoikilosis, may require surgery when large lesions cause nerve compression.

Case: A 73-year-old gentleman presented with clinical features of progressive cervical myelopathy for a month. He underwent C3-C6 double-door laminoplasty with a hydroxyapatite (HA) spacer 16 years ago. Magnetic resonance imaging scan revealed a delayed infection at the laminoplasty site, along with dislodgement of the HA spacers. He underwent thorough surgical debridement with removal of the spacers, followed by an appropriate antibiotic regimen based on culture sensitivity pattern.

Conclusion: Delayed infection following HA spacer dislodgement is a rare event, causing progressive myelopathy in laminoplasty. However, it can be effectively treated by timely diagnosis followed by thorough debridement, complete removal of spacers, and appropriate antibiotic management.

Case: We describe a case of late dislocation of the hip in a male infant at the age of 5 months after a normal screening ultrasound study using multiplanar static and dynamic images at the age of 6 weeks. The patient was treated with adductor tenotomy, closed reduction, and spica casting, and followed to the age of 7 years with normal hip stability.

Conclusion: This case demonstrates that despite evidence of both static and dynamic stability on ultrasonography earlier in life, late developmental hip dislocation can occur.

Case: A 19-year-old baseball player and a 16-year-old golfer presented with persistent thumb pain and instability after prolonged nonoperative management and magnetic resonance imaging (MRIs) showing grade 1 to 2 thumb ulnar collateral ligament (UCL) injuries (typically treated nonoperatively). Both underwent fluoroscopic stress examinations showing significant UCL instability, opted to undergo operative repair, and were able to return to play.

Conclusion: A fluoroscopic stress examination should be performed in patients with low-grade injuries reported on MRI but with continued symptoms, especially in young athletes. If the stress examination shows significant asymmetric widening and the patient is unable to grip properly, surgery may be indicated.

Case: A 63-year-old woman presented with an infected left total knee arthroplasty (TKA) having pain, sinus, and cobblestone-like swelling due to elephantiasis nostras verrucosa (ENV). A two-stage revision was performed, with strict asepsis and wound management. At midterm 15-month follow-up, no infection or loosening was noted, and daily knee functions improved.

Conclusion: No established guidelines exist for revision TKA in ENV. In ENV with structural lymphatic obstruction, infection control and meticulous soft-tissue protocols are essential, and long-term surveillance remains necessary.

Case: An 18-year-old man with no significant medical history presented with persistent anterior knee pain. Imaging revealed multifocal marrow-replacing lesions in the distal femur and patella. Open biopsy confirmed the diagnosis of pseudomyogenic hemangioendothelioma. Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography showed intense multifocal hypermetabolism (SUVmax 13.8). Surgery was deferred due to morbidity, so the patient was treated with intravenous zoledronic acid, resulting in clinical improvement and sustained radiographic and metabolic response over 18 months (SUVmax reduced to 2.26).

Conclusion: This case highlights a durable radiographic and clinical response to zoledronic acid monotherapy in multifocal pseudomyogenic hemangioendothelioma, supporting its role as a function-preserving systemic therapy.

Case: Genu recurvatum is an uncommon but functionally significant deformity in the pediatric population, especially in children with neuromuscular conditions. The application of guided growth in genu recurvatum remains rarely reported. This study reports the successful correction of symptomatic genu recurvatum secondary to cerebral palsy in a pediatric patient using coronally oriented 8-plates for posterior distal femoral hemiepiphysiodesis (PDFH).

Conclusion: PDFH using coronally oriented 8-plates is a novel and effective technique for correcting genu recurvatum in children with open physes with low morbidity and satisfactory clinical and radiological outcomes.

Case: Three patients with chronic locked posterior shoulder dislocation diagnosed 4 to 10 weeks after injury, each with a reverse Hill-Sachs lesion involving >25% of the humeral head, underwent closed reduction under general anesthesia using the "2 thumbs" technique, followed by immobilization in external rotation.

Conclusion: At a mean 4-year follow-up, all had excellent function without recurrent instability, avascular necrosis, or osteoarthritis. In carefully selected patients, closed reduction remains a safe and effective option beyond the 3-week time frame, when surgery is traditionally recommended.