JBJS case connector最新文献

Case: A 53-year-old man with bilateral sacroiliac (SI) fracture-dislocations underwent open reduction internal fixation with subsequent loss of fixation. Revision involved the placement of pelvic brim screws and robotic-assisted lumbopelvic fixation, resulting in minimal blood loss and soft-tissue injury. At 3-month follow-up, the patient had healed and was advanced to full weight-bearing status.

Conclusion: Percutaneous SI screws and robotic-assisted spinopelvic fixation effectively managed bilateral SI fracture-dislocations, despite narrow osseous corridors, providing adequate stabilization while minimizing complications. The combination of these 2 techniques helped overcome anatomical limitations and reduced technical challenges, leading to a successful short-term outcome.

Case: A pediatric patient with focal fibrocartilaginous dysplasia (FFCD) developed angular deformity and growth arrest despite standard guided growth management. The patient underwent implant-mediated guided growth for proximal tibia varus deformity which recurred; subsequently, a physeal bar of the medial proximal tibia was diagnosed, which progressed to physeal arrest.

Conclusion: Treatment options for FFCD-associated angular deformity include observation and guided growth. This case highlights the risk of complete physeal arrest in FFCD.

Cases: We report 2 cases of common peroneal nerve (CPN) palsy after inside-out lateral meniscus (LM) repair with very different presentations, occurring despite the standard surgical precautions (open counter incision and proper retraction between the biceps femoris tendon, lateral gastrocnemius, and capsule). On exploration, needle was found to have penetrated the nerve in one case and the nerve sheath in the other case. Patient 1 had near-complete neurological recovery, while patient 2 had partial neurological recovery after suture removal and neurolysis.

Conclusion: CPN palsy can occur despite following all precautions during LM repair and should be managed as an iatrogenic injury unless proven otherwise.

Case: The direct anterior total hip arthroplasty is known for a steep learning curve and femoral-sided intraoperative complications. This is a case report of a failure of femoral broach with a subsequent incarcerated femoral broach and novel extraction technique during a direct anterior total hip arthroplasty. This rare complication has only one other report in the literature.

Conclusion: Femoral broach failure is a rare complication of direct anterior hip arthroplasty. Surgeons should be familiar with alternative extraction techniques to safely remove an incarcerated broach.

Case: The authors present a case of a 6-year-old boy who was treated nonoperatively for an unstable C2-3 hyperflexion injury with posterior cervical ligamentous disruption 8 years ago. The patient was managed with cervical collar immobilization for 2.5 years with long-term follow-up demonstrating complete healing of posterior element disruption, normal sagittal vertebral alignment on dynamic imaging, and full return to activities of daily living and sports.

Conclusion: Pediatric spine injuries up to the C2-3 level with posterior ligamentous disruption alone without neurological deficit may be successfully treated nonoperatively with careful long-term immobilization and close follow-up.

Case: A 71-year-old man with a history of C5-7 anterior cervical discectomy and fusion (ACDF) sustained a C7 spinous process fracture after falling from a ladder. He was initially managed nonoperatively but developed anterolisthesis and kyphosis at C7-T1 with left hand weakness over the course of 11 days. Surgical treatment included spinous process wiring and C5-T3 posterior fusion. At 14-month follow-up, he demonstrated resolution of pain and returned motor function.

Conclusion: The patient's ACDF likely created a longer lever arm, allowing the force of his fall to be concentrated at C7-T1. Patients with a suspected Clay-Shoveler's fracture require close follow-up.

Case: We report the case of a 44-year-old man who sustained an Achilles tendon rupture with an associated trimalleolar fracture and traumatic peroneal dislocation of the left ankle after a snowboarding injury. These injuries have been surgically repaired; the patient has returned to all his activities 18 months after surgery.

Conclusion: The possibility of such injuries occurring in combination should be considered. A thorough history, physical examination, and plain radiographs should be performed in higher energy trauma to the ankle. Additional diagnostic tests such as ultrasonography or magnetic resonance imaging may be used to supplement treatment.

Levels of evidence: Level 5.

Case: A 15-year-old male patient diagnosed with arthrogryposis presented with a left knee extension contracture. He underwent an innovative percutaneous quadricepsplasty performed arthroscopically. Subsequent to the procedure, the patient was enrolled in an aggressive physiotherapy program. Over a follow-up period of 12 months, significant improvement was observed, with the patient achieving a 95° range of motion in his left knee.

Conclusion: Noninvasive percutaneous quadricepsplasty, combined with methods such as arthroscopy, may enhance therapeutic outcomes and alleviate chronic knee extension contractures in patients with arthrogryposis. This combination of treatment methods has the potential to revolutionize the management of such conditions.

Case: Lynch syndrome (hereditary nonpolyposis colorectal cancer) is associated with extracolonic manifestations, but skeletal tumors are rare. Our patient, a 12-year-old boy with Lynch syndrome, developed osteosarcoma of the left femur. Treatment included cytotoxic chemotherapy, wide resection, and pembrolizumab. Two years later, he developed an aggressive lesion in the contralateral femur that was thought to be metastatic osteosarcoma but which histology revealed to be Langerhans cell histiocytosis.

Conclusion: This case underscores the importance of advanced testing in patients with osteosarcoma and poor response to chemotherapy, and of tissue sampling when patients with a primary malignancy develop new bone lesions.

Level of evidence: IV.

Case: A 3-year-old boy with unilateral tibia vara was diagnosed with focal fibrocartilaginous dysplasia (FFCD) of the left proximal tibia. Because of progressive deformity with intercondylar distance of 9 cm and tibia metaphyseal-diaphyseal angle of 28°, the child was treated with curettage of the lesion and lateral proximal tibia hemiepiphysiodesis with 8 plates. The deformity was corrected within 12 months, the implant was removed, and the child is being followed up till skeletal maturity.

Conclusion: Curettage of the lesion and guided growth with an 8-plate is a viable treatment method for FFCD of the proximal tibia with progressive tibia vara deformity.