JBJS case connector最新文献

Case: Empty toe phenomenon describes a rare presentation of closed degloving injury of the toe. This is a case report on a 68-year-old patient who had a closed degloving injury of the left fifth toe, with the bony component of the fifth toe displaced into the soft tissue envelope of the fourth toe. She underwent open reduction through a C-shaped incision at the dorsal fourth webspace, followed by K-wire fixation and prophylactic fasciotomy. The toe survived with satisfactory functional outcome 1 year after surgery.

Conclusion: Prompt reduction with fasciotomy may improve toe survival. Initial radiographic findings might have prognostic implications.

Case: This case describes a 26-year-old male Division-1 college senior American football player who sustained a traumatic choroidal rupture from a direct blow to the eye during a regular season football game. Despite prompt ophthalmologic evaluation and treatment, the player developed permanent post-traumatic mydriasis (pupil dilation) and infratemporal quadrantanopia.

Conclusion: Sports-related ocular injuries are common, and their impact may be devastating, potentially resulting in complete vision loss and permanent disability. The purpose of this case report was to highlight sports ocular injuries, their sideline evaluation, and the importance of protective eyewear in contact sports, particularly American football.

Case: Two patients sustained severe lower-extremity physeal trauma. The first patient suffered distal femoral/proximal tibial physeal disruption; the second patient sustained an open distal femoral physeal fracture. Both were treated with prophylactic cement interposition within the distal femur to reduce the risk of growth disturbance/physeal bar formation. Both demonstrated physeal growth without angular deformity or limb length discrepancy at follow-up (case 1: 2 years, case 2: 18 months).

Conclusion: Prophylactic cement interposition may prevent physeal bar formation following severe, distal femur physeal trauma and reduce the need for future corrective surgeries. Further studies are warranted to investigate long-term outcomes and complications of this technique.

Case: A 49-year-old woman with West Nile encephalitis presented with right arm paralysis and left arm weakness. After limited success with nonsurgical treatments, she underwent surgery involving 3 nerve transfers based on brachial plexus reconstruction techniques. This led to gradual improvement in arm movement and restoration of ADL's.

Conclusion: Since treatment of the underlying disease may not be enough to restore nerve function, an algorithm incorporating brachial plexus principles may enhance treatment outcomes. Though this case study demonstrates success, we believe this technique deserves further exploration as a potential solution for neurovascular damage following West Nile infection.

Case: A 32-year-old man sustained a rare and complex injury pattern representing an anterior glenohumeral fracture dislocation with critical intra-articular glenoid bone loss, and a double disruption of the superior shoulder suspensory complex (acromion + coracoid fractures), following a fall. To restore joint stability, surgical reconstruction of the glenoid fossa was performed, while fixation of the acromion and coracoid fractures was necessary to re-establish superior shoulder suspensory complex integrity.

Conclusion: Achieving structural stability facilitated fracture healing and rehabilitation, resulting in excellent functional outcomes at 1 year. This report presents a clinical entity that has not been previously described in literature.

Case: A 13-year-old adolescent girl presented with right hip pain and restricted motion, 3 days following closed reduction of post-traumatic hip dislocation. Initial radiograph looked innocuous. A computed tomography scan was performed due to persistent pain, revealed a bony ligamentum teres (LT) avulsion fragment incarcerated within the hip joint. The fragment was excised through a safe surgical dislocation, and an intraoperatively discovered posterior labral tear was repaired. The patient is asymptomatic at 2-year follow-up.

Conclusion: This is a rare case of pediatric LT bony avulsion. Cross-sectional imaging is essential following closed reduction of the hip to detect any intra-articular pathologies that may be overlooked on plain radiographs.

Case: A 13-year-old adolescent boy with open growth plates in the metacarpal bones developed an osteochondral defect in the metacarpal head of his ring finger. The defect was treated by autologous osteochondral plug transplantation from the femoral condyle. The osteochondral plug was shortened enough to avoid damaging the growth plate and press-fitted to the recipient site. After surgery, the transplanted osteochondral plug united with the surrounding bone tissue, and the articular cartilage and growth plate were well preserved.

Conclusion: Autologous osteochondral plug transplantation is a treatment option for children with open growth plates to achieve favorable finger function.

Case: This report describes a 20-year-old woman with aggravating pain and swelling in the left foot a year after lower extremity angiography and embolization for a vascular lesion. Despite successful embolization, the patient continued to experience worsening pain, swelling, and hypersensitivity, which was diagnosed as complex regional pain syndrome. Imaging revealed a retained microcatheter with embolization material causing a significant cystic lesion in the cuboid with cortical erosion. Surgical intervention was performed including removal of the foreign material, debridement, and viable cellular bone allograft, which yielded symptom resolution.

Conclusion: This case highlights the importance of maintaining clinical suspicion for possible complications of lower extremity endovascular procedures. Persistent foot pain after embolization for vascular lesions may mimic complex regional pain syndrome, but retained foreign material should remain in the differential to avoid missed osseous complications.

Case: A 78-year-old woman presented to the clinic with right medial foot and ankle pain with an associated new-onset, planovalgus foot after a fall descending stairs. Preinjury imaging demonstrated an intact posterior tibial tendon (PTT) and normal alignment of the foot. Postinjury imaging revealed PTT rupture and classic features of progressive collapsing foot deformity (PCFD).

Conclusion: This report provides rare chronologic insight that enhances the understanding of tendon-driven PCFD and how PTT rupture can precipitate a rapid progression in deformity. Early recognition of a PTT injury may be essential to mitigating the rapid onset and progression of PCFD.

Case: An 86-year-old man underwent closed reduction and internal fixation of a comminuted intertrochanteric hip fracture with a cephalomedullary nail on a Hana table. Postoperatively, a displaced fracture subluxation of L1 was detected, resulting in complete loss of motor and sensory function below L1. Urgent posterior decompression and fusion from T10-L4 was performed. Diffuse idiopathic skeletal hyperostosis (DISH) was only diagnosed after the incident.

Conclusion: A diagnosis of DISH, with increased risk of occult fracture and/or iatrogenic spine injury during hip fixation, may be unknown before surgery. Multiple fractures may prompt consideration of a trauma workup even in assumed low-energy injuries.