Journal of Orthopaedic Case Reports最新文献

Introduction: Patients with stiff and brittle spines, such as those with ankylosing spondylitis (AS), are at an increased risk of intraoperative and post-operative complications. Specifically, patients with AS who undergo total hip arthroplasty (THA) with a direct anterior approach are at risk for vertebral fractures due to patient positioning and manipulation necessary to utilize this approach. To the best of our knowledge, this is the second publication discussing vertebral fracture following THA with direct anterior approach and the first depicting a hyperextension fracture.

Case report: A 78-year-old male with previous medical history of rheumatoid arthritis, AS, chronic back pain, and non-union left acetabular fracture and post-traumatic arthritis following a fall and subsequent open reduction and internal fixation presented for THA. The patient did not complain of back pain preoperatively. On post-operative day (POD) 1 he began complaining of back pain when ambulating. On POD 3, he complained of acute on chronic exacerbation of back pain, and computed tomography at that time was significant for unstable L2 hyperextension fracture necessitating T12-L4 fusion.

Conclusion: Patients with a history of AS are at increased risk for vertebral fractures when having THA with a direct anterior approach. This approach subjects patients to extension forces that may cause damage to their vertebrae. Due to this risk, physicians should take care when planning their method for THA in this population and consider using alternative approaches or be more mindful of the patient's condition when positioning them intraoperatively.

Introduction: Infection following a primary total hip arthroplasty (THA) is a devastating complication. An infected revision THA carries even more significant consequences. This case report describes the successful management of an infected revision THA using debridement, antibiotics, implant retention (DAIR), and a musculocutaneous anterolateral thigh flap coverage in a resource-constrained setting.

Case report: A 37-year-old male patient with hepatitis C presented with a sinus tract at the surgical site following implant removal for an infected THA. He underwent a two-stage revision, utilizing a constrained acetabular cup, due to a lack of identifiable abductor mass observed intraoperatively. Postoperatively, the surgical site dehisced with purulent discharge with exposure of the greater trochanter and trunnion. In consultation with a plastic surgeon, DAIR with musculocutaneous anterolateral thigh flap coverage was done. At 12-month follow-up, the flap remained healthy and well settled, without evidence of infection.

Conclusion: This case highlights the potential of DAIR with flap coverage as a valuable option for managing infected revision THA, particularly in resource-limited settings, considering the associated complications, morbidity, and cost of further revisions.

Introduction: Rotator cuff tears are a common cause of shoulder disability, often requiring surgical repair. The high cost of suture anchors presents a significant economic burden, driving the need for cost-effective alternatives like transosseous repairs. This paper details a novel arthroscopic anchorless technique utilizing an anterior cruciate ligament (ACL) jig with the "J Technique" to provide a biomechanically sound and economically advantageous solution.

Case report: We present a technique for arthroscopic anchorless rotator cuff repair (RCR). Standard arthroscopic portals are established. An ACL jig is introduced to guide the creation of a precise transosseous tunnel in the greater tuberosity using a 4.5 mm cannulated reamer. Suture strands (FiberWire and FiberTape) are passed through the tunnel and the rotator cuff tendon. The sutures are tied with SMC sliding knots, strategically placing the post to ensure knots settle at the lower tunnel exit, forming an inverted "J" configuration that secures the tendon to its footprint.

Conclusion: The arthroscopic anchorless "J Technique" using an ACL jig is a reproducible and cost-effective surgical alternative for RCR. It provides robust fixation, minimizes hardware-related risks, and prevents subacromial impingement through strategic knot management, offering a valuable option for surgeons seeking to control costs without compromising stability.

Introduction: Dog bite injuries are common, but dog bite avulsion amputations are rare, and in the paediatric population, they are even rarer. We report a successful thumb replantation in a 2-year-old girl following avulsion amputation from a dog attack, representing one of the youngest cases to date, and review relevant literature to emphasize the importance of multidisciplinary management.

Case report: A 2-year-old girl presented with complete thumb avulsion at the proximal phalanx after a dog bite, having also sustained a prior bite one week earlier. . Multidisciplinary consensus involving plastic, orthopaedic, and infectious disease consults supported replantation. The procedure included thorough debridement, skeletal fixation, vascular and nerve repair, with empiric broad-spectrum antibiotics.. At 18 months follow-up, the child achieved full functional recovery: zero VAS pain, restored grip strength, near-normal range of motion, and excellent standardized scores (Tamai, QuickDASH). Age-appropriate psychosocial adjustment was confirmed by YCPC and PedsQL.

Conclusion: This case demonstrates that replantation can be feasible and successful in select paediatric dog bite-related amputations despite contamination, when supported by aggressive debridement and infectious disease-optimized care. The outcome highlights the regenerative capacity in children and reinforces the role of multidisciplinary management in expanding replantation indications for contaminated traumatic injuries.

Introduction: Lateral epicondylitis (LE) or tennis elbow is a degenerative condition that causes pain and tenderness at the lateral aspect of the elbow, usually secondary to repetitive strain of wrist extensors. Although there is a well-defined association between musculoskeletal disorders and environmental, genetic, and lifestyle risk factors, the etiological role of Vitamin D in musculoskeletal diseases is still an area of active research. The objective of this study was to evaluate the correlation between serum Vitamin D levels and the incidence of LE among a population in Eastern India.

Materials and methods: A total of 150 subjects, 75 with diagnosed LE and 75 age- and sex-matched controls, were studied cross-sectionally. Serum Vitamin D concentrations were determined and calculated for the possible association with LE prevalence and severity.

Results: A total of 75 cases and 75 controls were analyzed. Both groups were comparable in age and gender. Mean serum Vitamin D levels were significantly lower in cases than controls (15.3 ± 7.2 vs. 28.5 ± 10.1 ng/mL, P < 0.001), with Vitamin D deficiency more common among cases (70% vs. 22%). Serum Vitamin D level was strongly negatively correlated with LE (Pearson's r = -0.62, P < 0.001). Vitamin D deficiency increased the odds for LE by over threefold (odds ratio 3.2; 95% confidence interval: 1.8-5.6). This association remained significant across subgroups, with the highest prevalence observed in those performing repetitive upper-limb activities.

Conclusion: The study showed a strong negative correlation between the low serum Vitamin D status and the occurrence of LE, implicating a possible role for Vitamin D in the pathogenesis of this disease. This emphasizes the clinical significance of Vitamin D status monitoring in at-risk subjects for LE development and its role in both preventive and therapeutic treatment.

Introduction: Congenital talipes equinovarus (CTEV) is a common pediatric deformity, with conservative management being the primary method of management. Even with appropriate management of CTEV, relapses can still occur, and some cases may present with residual deformities or prove resistant to treatment. The cause of these conditions is multifactorial, and there exists a difference of opinion regarding the management of such cases. The study aimed to provide clinically relevant outcome data in this specific and less frequently encountered population. The relatively small sample reflects the rarity of idiopathic relapsed, residual, and resistant CTEV and provides valuable preliminary data to guide future larger studies.

Materials and methods: This prospective, descriptive, observational study included 33 clubfeet in 25 patients presenting with relapsed, residual, or resistant CTEV between July 2022 and June 2024. Patients were treated with either Ponseti's method, including serial manipulation, casting, and tendo-achilles tenotomy, or Joshi's external stabilization system (JESS), a minimally invasive external fixation technique. Pre- and post-correction outcomes were assessed using the Pirani and Dimeglio scoring systems. Data on treatment compliance, complications, and outcomes were analyzed.

Results: The mean age of patients was 44.6 months, ranging from 9 months to 8 years. Among 33 feet, 19 were classified as relapsed (59%), 9 as residual (28%), and 5 as resistant CTEV (13%). Ponseti's method was used for 45.45% of feet, and JESS for 54.55%. Post-correction Pirani scores improved significantly (mean pre-correction 4.11, post-correction 0.55; P < 0.001). Similarly, Dimeglio's scores improved (mean pre-correction 13.22, post-correction 2.88; P < 0.001). Complications were minimal and manageable, including cast slippage and pin-tract infections. JESS demonstrated superior outcomes for older children with more severe deformities.

Conclusion: Both Ponseti's method and JESS are effective for managing relapsed, residual, and resistant CTEV, with JESS particularly beneficial for older children. Recurrence is commonly associated with inadequate bracing and follow-up. Comprehensive management, including early treatment, patient education, and consistent follow-up, is crucial for achieving and maintaining correction.

Introduction: Giant cell tumor (GCT) arising in the small bones of the feet is a rare entity, often presenting diagnostic and therapeutic challenges due to local aggression and the need to preserve foot architecture. This report details the case of a 27-year-old female diagnosed with a GCT of the left fifth metatarsal.

Case report: This particular patient was managed with en masse resection of the fifth metatarsal followed by reconstruction using a non-vascularized autologous hemifibular strut graft fixed with K-wire. The patient demonstrated good clinical and radiographic fusion at 6 months and excellent functional recovery at 2-year follow-up.

Conclusion: GCT of the metatarsal has been managed with vascularized bone graft, which is technically difficult. We could achieve good results with a non-vascular hemifibular graft, confirming this as a viable method for managing rare GCTs in critical load-bearing locations.

Introduction: Unicameral (simple) bone cysts (UBCs) are fluid-filled intramedullary cavities commonly seen in the metaphysis of long bones in young patients under the age of 20 years. Pathological hip fractures associated with UBCs in the proximal femur are rare, especially in non-osteoporotic elderly patients. The management of such tumors, such as benign lesions of bone causing pathological fractures at the biomechanically critical load-bearing zone of the neck of the femur, remains a clinical challenge due to limited literature on optimal treatment strategies.

Case report: A 60-year-old non-osteoporotic male presented with right hip pain and inability to walk for 10 days, without any history of recent trauma. X-ray pictures revealed a pathological hip fracture of the right hip in the neck of the femur with an associated lytic lesion with benign radiological appearance. Computed tomography scan confirmed a bony cystic lesion, whereas a DEXA scan ruled out osteoporosis. Oncological workup excluded any metastatic pathology, and the patient was managed surgically with cemented total hip replacement (THR). Intraoperatively, a cystic lesion in the femoral neck was excised and sent for histopathological analysis, which confirmed it to be a unicameral (simple) bone cyst. The patient was mobilized on the first post-operative day and achieved excellent functional recovery, with a Harris Hip Score of 90 at 12 months follow-up.

Conclusion: Pathological fractures of the femoral neck due to UBCs are exceptionally rare in elderly patients. This case highlights the successful management of a unicameral bone cyst with cemented THR, demonstrating that THR can be a viable treatment option for pathological hip fractures due to benign bone lesions in older adults.

Introduction: Lipomas are common benign soft-tissue tumors typically found in subcutaneous regions. Intra-articular lipomas, however, are exceedingly rare and may present with functional impairment.

Case report: A 27-year-old male presented with chronic right knee pain, limited flexion, and inability to run. Clinical examinations ruled out ligamentous or meniscal injuries. Magnetic resonance imaging revealed a 30 × 10 × 27 mm encapsulated intra-articular lipoma in the inferomedial recess of the anterior knee joint. The mass was excised surgically through a medial parapatellar approach, and histopathology confirmed a lipoma. Postoperatively, the patient regained a full range of motion and resolution of pain.

Conclusion: This case underscores the importance of considering intra-articular lipomas in differential diagnoses for chronic joint pain and restricted mobility. MRI remains pivotal for accurate diagnosis, and surgical excision ensures favorable outcomes.

Introduction: Pediatric osteoarticular infections often present diagnostic challenges, especially in regions endemic to tuberculosis (TB). Misinterpretation of imaging findings may lead to inappropriate treatment, including the unwarranted use of anti-tubercular therapy (ATT).

Case report: We present the case of a 10-year-old child with chronic left ankle swelling and pain for over a year, initially diagnosed with tuberculous arthritis based on magnetic resonance imaging findings. Despite 2 months of ATT, symptoms persisted. Upon referral, further evaluation, including biopsy and culture, revealed a retained foreign body (thorn) within the ankle joint capsule and Pseudomonas aeruginosa infection. ATT was discontinued, and antibiotic therapy, as per culture sensitivity, was initiated, leading to complete clinical recovery.

Conclusion: This case underscores the importance of microbiological or histopathological confirmation before initiating ATT in osteoarticular infections. Reliance solely on imaging may lead to misdiagnosis, delayed appropriate treatment, and potential public health implications. Clinicians should maintain a high index of suspicion for alternative diagnoses, especially in atypical presentations or non-responders to ATT.