JBJS case connector最新文献

Case: We describe the clinical presentation, management, and outcomes of 3 patients, aged 1.5 to 4 years, with C1 synchondrosis ("Jefferson") fractures treated nonoperatively. Minimally widened anterior arch fractures were identified on computed tomography that were not visible on conventional radiographs. Serial imaging showed fracture healing in all patients at minimum 1-year follow-up.

Conclusion: These cases highlight the susceptibility of preschool-aged children to "baby Jefferson" fractures through the anterior synchondroses, the importance of early computed tomography imaging when conventional radiographs are inconclusive, and the favorable outcomes of nonoperative treatment with cervical immobilization of stable, nondisplaced pediatric C1 fractures.

Case: A 10-year-old girl developed persistent torticollis after surgery for a clavicular fracture. This condition was initially misattributed to muscle spasms and hardware irritation, leading to a delayed diagnosis. Eventually, the patient developed cervical myelopathy, and subsequent evaluation revealed atlantoaxial rotatory subluxation (AARS) equivalent to Fielding and Hawkins type III, ultimately requiring emergency surgical fusion.

Conclusion: Persistent torticollis after pediatric clavicle fractures warrants careful evaluation for possible AARS. Awareness of this rare coexistence and timely imaging are essential to avoid invasive surgery and serious complications.

Case report: This report describes a 22-year-old man who sustained a severe left ankle injury caused by a lawnmower at the age of 4 years, resulting in loss of the lateral malleolus. He was treated with a pedicled composite flap using the ipsilateral second metatarsal and was followed until skeletal maturity. A favorable functional outcome was maintained for 15 years.

Conclusion: At final follow-up after growth completion, no limb length discrepancy was observed. The ankle was stable, painless, and preserved good range of motion, with no significant donor site morbidity. This surgical technique represents a technically simpler alternative with lower morbidity compared with vascularized proximal fibular epiphyseal transfer for lateral malleolus reconstruction in growing children.

Case: A 17-year-old man presented with an unstable C5 flexion-compression injury and bilateral comminuted distal radius fractures after a motorcycle collision. Despite standard opioid therapy, he experienced difficulty with pain control during and after treatment. Genetic testing revealed a polymorphism in the cytochrome P450 2D6 (CYP2D6) gene, resulting in ultrarapid metabolism.

Conclusion: Genetic mutations in CYP2D6 can result in impaired opioid metabolism and impaired pain control. Impaired pain control in musculoskeletal trauma patients should raise concern for a potential CYP2D6 mutation. A proper understanding of this condition and adjustments in pain management can guide optimal care for these patients.

Case: Familial expansile osteolysis (FEO) is a rare inherited autosomal dominant condition causing the development of painful lytic bone lesions. We present the case of a 54-year-old man with FEO who was treated with denosumab. The patient's progress was monitored with radiographs, magnetic resonance imaging, bone turnover markers, pain, and functional scores.

Conclusion: The use of denosumab for FEO displays improvement in radiological appearances of the affected bone, increased quality of life and may prevent the development of further lesions. It is a safe treatment modality for patients with FEO that allows for limb salvage surgery rather than amputation.

Case: A 77-year-old man with myelodysplastic syndrome presented with a dedifferentiated solitary fibrous tumor (SFT) of the proximal femur in the setting of a prior total hip arthroplasty. Diagnosis involved biopsy, NAB2::STAT6 gene fusion identification, and imaging. Management included wide resection, revision arthroplasty, and postoperative infection control. Despite local control, metastatic lung disease developed, and the patient opted for hospice care.

Conclusion: This case underscores the aggressive potential of dedifferentiated SFTs and highlights the diagnostic role of NAB2::STAT6 fusion. It emphasizes the importance of multidisciplinary care in managing rare, high-risk tumors of the bone.

Case: We report on a 20-year-old male patient with shoulder pain and severely altered scapulothoracic kinematics due to pectoralis minor muscle hyperactivity and compensatory trapezius hypertrophy. After failed conservative treatment, an isolated arthroscopic release of the pectoralis minor tendon was performed, resulting in substantial pain relief and improved range of motion in the 6-week follow-up and sustained benefits 6 years later.

Conclusion: Persistent pectoralis minor hyperactivity may be the cause of altered scapulothoracic movement, resulting in pronounced hypertrophy of the trapezius muscle. It can be safely treated with an isolated arthroscopic detachment of the pectoralis minor tendon.

Case: A 67-year-old woman who presented with left-sided upper back pain, upper trunk paresthesia, and CT-identified left neural foraminal stenosis at T7 to T8 was planned for posterior spinal fusion and decompression using a robotic system. T7 to T8 was labelled with manual sacral counting. T7 to T8 level was registered robotically, but the arm was sent to the T5 to T6 level. T7 to T12 was re-registered, and the robot successfully targeted the correct site.

Conclusion: Technology is still fraught with error and is still in its nascency. It is important to use traditional methods with intraoperative verification to prevent errors in wrong-level thoracic spinal surgery.

Case: A 5-year-old boy sustained a right elbow fracture dislocation with an associated displaced comminuted coronoid fracture. Acute closed reduction as well as an initial attempt at open repair and fixation failed. This case was salvaged 8 weeks after injury with coronoid reconstruction using an iliac crest allograft.

Conclusion: This is the first reported case of coronoid reconstruction using iliac crest allograft in a pediatric patient. 2.5 years after reconstruction, the elbow joint is stable, pain free, and demonstrates elbow motion well within the range for full function.

Case: We report the case of a patient with a below-the-knee amputation who sustained a complex femur fracture ipsilateral to his residual limb after a fall from height. His fracture was managed with a lateral locking plate of the distal femur for fixation. He was followed for 16 months; at 7 months, he demonstrated return to pretrauma functional status.

Conclusion: Fixation of the distal femur with a lateral locking plate did not interfere with the patient's ability to wear a prosthesis and should be considered for managing "periprosthetic" femur fractures in those with a below-the-knee amputation to maintain prosthetic usage.