Journal of Orthopaedic Case Reports最新文献

Introduction: Sacral chondrosarcoma is a primary malignant bone tumor for which en bloc resection remains the standard treatment. Given its location and role within the pelvic ring continuity, it poses a surgical and reconstructive challenge. Even with successful oncologic resection, the lack of a comprehensive preoperative biomechanical analysis may contribute to late-onset complications requiring reinterventions and impair the patient's quality of life.

Case report: The case describes a 41-year-old woman with no previous diagnosis of osteoporosis or prior fractures who underwent en bloc resection of a sacral chondrosarcoma at the S1-S2 level, without initial complications. Six months post-operatively, the patient returned with pain and gait impairment. An insufficiency fracture at the S1 vertebral body and residual sacral wing was identified, without signs of tumor recurrence or associated fluid collection. It was managed with posterior lumbopelvic fixation, with a favorable outcome and recovery in a 5-year follow-up.

Conclusion: This case underlines the importance of the biomechanical integrity of the pelvic ring. It raises the need for assessment of the biomechanical risk within the oncologic surgical planning, despite the absence of classical bone fragility factors. Thus, structural destabilization of the pelvis must consider corrective or preventive strategies to prevent complications. A comprehensive analysis of these factors allows for improved functionality and patients quality of life.

Introduction: The aims and objectives of the study are to evaluate the functional improvement and radiological outcomes following partial resection of the calcaneal tuberosity in patients with Haglund's syndrome unresponsive to conservative management using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system as illustrated in Figure.

Materials and methods: From January 2023 to July 2025, 12 adult patients treated at Sree Balaji Medical College Hospital with symptomatic Haglund's syndrome underwent partial calcaneal tuberosity resection and bursectomy. Patients had failed ≥3 months of conservative care. Functional assessments (AOFAS hindfoot score) and lateral radiographs (Fowler-Philip angle, calcaneal pitch, and total calcaneal angle) were recorded preoperatively, and at 6 weeks, 3 months, and final follow-up (minimum 6 months).

Results: Mean AOFAS scores improved from 55.6 preoperatively to 77.5 at 6 months, indicating statistically and clinically significant improvement. No major complications were observed during the follow-up period.

Discussion: Partial osteotomy of the calcaneal tuberosity offers a safe and effective option for patients with Haglund's syndrome who fail to respond to conservative therapy. It significantly improves function and reduces pain, as evidenced by a consistent rise in AOFAS scores.

Conclusion: Partial osteotomy of the calcaneal tuberosity offers a safe and effective option for patients with Haglund's syndrome who fail to respond to conservative therapy. It significantly improves function and reduces pain, as evidenced by consistent rise in AOFAS scores.

Introduction: Osteochondroma, a benign bone tumor commonly found in younger individuals, is seldom observed in older adults. This case report presents an atypical occurrence of an osteochondroma in a 65-year-old female, located in the infrapatellar region of the right knee. Clinical examination revealed a firm, non-tender mass in the infrapatellar area, accompanied by mild joint effusion and restricted range of motion. This case highlights the importance of including osteochondroma in the differential diagnosis for knee pain in elderly patients and demonstrates the effectiveness of surgical intervention in managing symptomatic lesions in uncommon anatomical locations.

Case report: A 65-year-old female presented to the orthopedic outpatient department with a chief complaint of right knee pain and swelling that had progressively worsened over the last year. The pain was described as a dull ache, exacerbated by activity and partially relieved by rest. In addition, the patient experienced mechanical symptoms impacting her mobility and quality of life. Diagnostic imaging, including X-rays, magnetic resonance imaging, and computed tomography scans, confirmed an osteochondroma in the infrapatellar region, characterized by a bony outgrowth, with no signs suggesting malignant transformation. Due to the symptomatic nature and impact on the patient's quality of life, surgical excision was performed achieving complete removal of the lesion.

Conclusion: This case illustrates a rare presentation of infrapatellar osteochondroma in an elderly patient, highlighting that such lesions, though uncommon in older adults, should remain a differential consideration in cases of unexplained knee pain with mechanical symptoms. Timely diagnosis through appropriate imaging and surgical excision can lead to excellent symptomatic relief and functional recovery, even in atypical anatomical locations.

Introduction: Recurrent anterior shoulder instability with significant glenoid bone loss is associated with high failure after isolated soft-tissue repair. The open Latarjet procedure with congruent arc modification improves graft coverage and glenoid arc restoration, but mid-term clinical data are limited.

Materials and methods: This retrospective cohort included patients who underwent open Latarjet with congruent arc modification between January 2015 and December 2020. Eligibility criteria were ≥3 anterior dislocations, ≥15% glenoid bone loss, and ≥24 months of follow-up. Functional outcomes (Western Ontario Shoulder Instability Index [WOSI], Rowe), range of motion, complications, and graft union on computed tomography (CT) were assessed. Kaplan-Meier survival analysis estimated recurrence-free survival.

Results: A total of 80 patients (62 males, 18 females; mean age 28.5 ± 6.4 years) were analyzed with a mean follow-up of 4.5 ± 1.2 years. WOSI improved from 46.7 ± 12.3 to 79.4 ± 15.8 (P < 0.001), and Rowe from 32.5 ± 9.6 to 85.6 ± 10.7 (P < 0.001), both exceeding minimal clinically important difference thresholds. Forward flexion (+15°) and abduction (+20°) improved significantly, whereas external rotation showed a mild, non-significant reduction (-10°, P = 0.079). Complications occurred in 12.5%, mainly graft non-union (5%). CT confirmed graft union in 95%. Kaplan-Meier analysis showed 97.5% recurrence-free survival at 5 years.

Conclusion: Open Latarjet with congruent arc modification provides clinically meaningful functional improvement, reliable graft union, and durable mid-term stability in recurrent anterior instability with glenoid bone loss.

Introduction: Medial Hoffa fractures are exceptionally rare, especially when associated with intra-articular knee injuries (anterior cruciate ligament, medial collateral ligament, and meniscus tears). The discussed case highlights a single-stage fully arthroscopic fixation of a medial Hoffa fracture with associated ligament and meniscal injuries - representing a novel and effective, though challenging, treatment option. This is the first report of this kind in the literature.

Case report: A 42-year-old male patient presented 5 days after an injury to the left knee after a slip and fall in the bathroom. The knee was swollen, unstable, and painful, and the patient was a known case of left poliotic lower limb.

Conclusion: This case represents the first documented instance of a fully arthroscopic fixation of a medial Hoffa fracture with simultaneous ligament and meniscal repair in a poliotic patient.

Introduction: Periprosthetic acetabular fractures following total hip arthroplasty (THA) represent a rare but challenging condition, particularly in patients with previous surgeries through the direct anterior approach (DAA). The case described is, to our knowledge, the first report of a central dislocation of the acetabular component treated using a Burch-Schneider anti-protrusion cage through an extensile DAA. This surgical choice was aimed at minimizing instability and optimizing exposure in a complex revision setting, thus offering an innovative contribution to the orthopedic literature.

Case report: A 64-year-old Caucasian female affected by ischemic vascular transverse myelopathy leading to asymmetric paraparesis, with greater involvement of the right lower limb, presented after a fall on her previously operated left hip. She underwent THA 2 years earlier. Radiological evaluation revealed a transverse acetabular fracture with medial cup migration and an associated Vancouver AG fracture. Given the patient's reliance on the left limb for mobility and the risks of instability from multiple surgical approaches, the revision was performed through an extensile DAA. An antiprotrusio cage specifically designed for anterior implantation was used, and the femoral component was preserved. Early mobilization was initiated postoperatively, with the patient regaining pre-injury mobility within 6 months.

Conclusion: This case demonstrates the feasibility and benefits of using the extensile DAA in managing complex acetabular defects with a Burch-Schneider antiprotrusio cage. It highlights a surgical strategy that may reduce the risk of instability and improve functional outcomes in selected patients. The originality of this case lies in the use of an anterior approach to address a complication with a reconstruction technique typically reserved for posterior approaches. This report contributes to expanding the surgical options in revision hip arthroplasty and provides new insights into optimizing care in patients with complex anatomical and functional constraints.

Introduction: Sternal fracture is a common complication of chest trauma but has a low incidence. Various treatments have been developed to reconstruct sternal fractures. Among these approaches, analgesia, corset fixation, and open reduction with wiring or plate internal fixation have been suggested. The use of newly developed minimally invasive plate osteosynthesis is a feasible method. In this study, we report a case involving a 31-year-old young man with a sternal fracture accompanied by a small amount of lung contusion. All procedures including retro-sternal dissection and fracture reduction with placement of the dual plate as railroad technique were performed using video-assisted thoracoscopic surgery. The minimally invasive thoracoscopic technique provided effective repair and rigid fixation with immediate relief from intractable chest pain that had persisted before surgery. The postoperative recovery was good. No pneumothorax or complications such as chest pain, paresthesia, or wound infection were observed at the 6-month follow-up visit. This case describes a novel method for internal fixation of sternal fractures under thoracoscopic assistance.

Case report: A 31-year-old male sustained injuries from a road traffic accident on May 16, 2024, and initially received treatment at a nearby government hospital. Two days later, he presented to our facility with chest pain and injuries to his right leg, wrists, and forearm. Physical examination revealed sutured wounds on the right wrist and elbow, along with external fixation on the right leg. Due to the persistence of chest pain, a computed tomography scan was performed, which revealed a displaced sternal body fracture. The cardiothoracic vascular surgery team recommended surgical fixation because of the displacement and ongoing chest pain. On May 20, surgery was conducted by an orthopedic surgeon using a minimally invasive technique with video-assisted thoracoscopic assistance to ensure proper visualization and protection of vital structures during fixation with two long 3.5 mm pre-bent titanium locking plates using the railroad technique. Care was taken to ensure that the screws did not excessively penetrate the posterior cortex, which was confirmed through thoracoscopy. The post-operative recovery was uneventful, with significant improvement in chest pain noted at the 6-week follow-up.

Conclusion: This case suggests that minimally invasive fixation with video-assisted thoracoscopy offers faster recovery, shorter hospitalization, and reduced tissue damage, ensuring proper reduction in sternal fractures. The low-profile 3.5 mm titanium locking plate using the railroad technique is an effective option for managing transverse sternal fractures.

Introduction: Ultrasound (US) examinations of the ulnar nerve and measurement of cross-sectional area (CSA) are now used to diagnose cases of ulnar neuropathy. However, the CSA values vary across the population. The present study was planned to prepare a preliminary dataset of ulnar CSA among the symptomatic ulnar neuropathy patients diagnosed by electrodiagnostic studies at our institute and compare the values with those of healthy volunteers.

Materials and methods: A hospital-based case-control study was conducted, which included 20 diseased upper limbs diagnosed with ulnar neuropathy and 40 non-neuropathic upper limbs as controls. They all underwent an US examination of the ulnar nerve in both upper limbs. The demographic data, nerve CSA at five predetermined locations, swelling and flattening ratios were compared and analyzed.

Results: The mean values of ulnar CSA at the medial epicondyle, 5 cm proximal and distal to it, at mid-forearm, and at the wrist were 11.5 ± 2.38 mm2, 7.43 ± 1.47 mm2, 6.17 ± 1.42 mm2, 5.78 ± 2.53 mm2, and 4.67 ± 2.3 mm2, respectively, in ulnar neuropathy patients. All the values were statistically significantly higher in cases than in controls. The swelling and flattening ratios were statistically significantly higher in ulnar neuropathy cases than in controls.

Conclusion: This study presents a data set of ulnar nerve CSA and some other parameters for the ulnar neuropathy patients and the normative values of ulnar nerve CSA in healthy subjects for the population of West Bengal (Eastern India). This data might be helpful for the diagnosis and management of ulnar neuropathy in this region.

Introduction: Avascular necrosis of bone, due to various etiologies, is not an uncommon skeletal pathology seen in clinical practice. Treatment of these conditions includes treating the resultant pain, stiffness, and limitations of movement surgically with bone grafts both vascularized and non-vascularized and arthroplasty in most advanced stages.

Materials and methods: In a duration of 2 years, five patients were treated for such pathologies using vascularized bones (pedicled or free). All of them were subjected to radioisotope (Technetium 99m) scan postoperatively to evaluate the viability of the transferred bones. The post-operative pain was assessed using visual analog scale (VAS) to assess the outcome of treatment by comparing the score before and after surgery.

Results: All patients improved symptomatically as per the outcome assessment with VAS score with viability of the transferred bones as evidenced by radioisotope scan.

Conclusion: Vascularized bone transfer is indispensable in the treatment of avascular necrosis of bone and the complications thereof, and should always be offered primarily to younger patients especially.

Introduction: Bucket-handle tears of the lateral meniscus (LM) are uncommon in young athletes and are particularly challenging when associated with a discoid meniscus. Restoration of meniscal hoop tension is critical for functional recovery and to prevent reinjury. This case describes the application of the circumferential fiber augmentation (CFA) technique, initially reported by Kita et al. (2024), for the repair of a bucket-handle tear in a discoid LM.

Case report: A 20-year-old male sustained an acute twisting injury while playing soccer, resulting in a locked knee. Magnetic resonance imaging (MRI) revealed a displaced bucket-handle tear of a discoid LM. He underwent an all-inside meniscus repair using fiber-wire sutures combined with CFA using fibertape and transtibial pullout fixation with a knotless suture anchor.

Outcome: At 6-month follow-up, the patient achieved a full range of motion with the Lysholm 95, IKDC 92, and KOOS-Pain 90. MRI confirmed complete meniscal healing without extrusion or signal alteration.

Conclusion: Application of CFA in bucket-handle meniscus repair may enhance fixation strength and prevent recurrent tearing in active young patients, especially in discoid variants. This represents an evolution in biological and mechanical augmentation for complex meniscal injuries.