Journal of Orthopaedic Case Reports最新文献

Introduction: Alkaptonuria is a metabolic disorder due to accumulation of homogentisic acid, leading to destruction of major joints. Very few cases of ochronosis with shoulder involvement have been reported in literature.

Case report: We report a 31-year-old male who presented with shoulder pain for 4 months. Clinical examination and magnetic resonance imaging showed tear of the long head of biceps tendon and labral tear. On arthroscopy, we discovered that there was blackish discoloration of the glenoid rim. On investigating further, homogentisic aciduria was found (865; normal value <0.99), suggesting a diagnosis of alkaptonuria. Our patient had relief of symptoms following debridement and biceps tenodesis at 12 weeks.

Conclusion: Arthroscopy helps in the diagnosis and treatment of ochronosis with shoulder involvement.

Introduction: Total hip arthroplasty (THA) surgeries are rapidly increasing due to an aging population, leading to an increase in degenerative hip osteoarthritis. However, 1% of these patients go through prosthetic joint infection (PJI), which gives rise to implant failure with prolonged periods of patient incapacitation and higher mortality risk.

Case report: In this article, we report an unusual case of a 62-year-old male who developed a PJI 7 months after a THA. The patient complained of groin, buttock pain, and swelling. He underwent MRI examination, which revealed the presence of a voluminous three-lobed formation with liquid content located around the prosthesis. After several attempts where microbiological samples reported negative results, a microbiological sample came out positive for Staphylococcus Caprae at the time of femoral component sonication. S. caprae is a Gram-positive bacillus belonging to the Staphylococcus spp. It is most commonly found as a commensal in goats and sheep, but it is a rare pathogen in human infections. The patient underwent two-stage revision surgery, resulting in the total resolution of the infection.

Conclusion: Staphylococcus Caprae still remains an unusual cause of infection. We report the 11th hip PJI due to S. caprae successfully treated with a two-stage exchange protocol.

Introduction: Inferior or subacromial dislocation of the distal clavicle is a rare entity. Previous reports of this injury pattern have largely been limited to Rockwood VI acromioclavicular joint (AC) dislocations, with the distal clavicle located in the subcoracoid position. Few case reports have been described with the inferior clavicle being located in the subacromial space, and these have all been previously associated with clavicle fractures. To our knowledge, no previous case report exists in the literature with this AC joint injury and associated scapular spine fracture.

Case report: Here, we report on a case of a 30-year-old right-hand dominant African American male who suffered a high-energy left-sided inferior distal clavicle dislocation with an associated scapular spine fracture that was successfully treated with open reduction of the AC joint dislocation, followed by open reduction and internal fixation (ORIF) of the scapular spine fracture. After ORIF of the scapular spine and reduction of the AC joint, the AC joint was deemed to be a capsular injury with intact ligaments, so a simple capsular repair was performed. We also summarize the existing literature on this topic.

Conclusion: Inferior dislocation of the clavicle into the subacromial space with an associated scapular spine fracture is an extremely rare injury which has not been previously reported. This injury can successfully be managed by first reducing the AC joint, and then proceeding with anatomic reduction and fixation of the scapular spine with good functional result. The ligaments surrounding the AC joint in the subacromial pattern are often intact, and the dislocation is a result of capsular injury. This leads us to believe that subtyping the Rockwood VI classification to VIa (subacromial) and VIb (subcoracoid) would be useful for orthopedic surgeons due to differences in associated injury and subsequent operative management.

Introduction: A form of tenosynovial giant cell tumors (GCTs) that diffusely affects the soft tissue lining of joints and tendons is called pigmented villonodular synovitis or PVNS. About equal percentages of men and women are often affected, and it typically affects young individuals. The most typical sites of PVNS are the knee and ankle, making PVNS of the wrist a rare presentation. Patients with PVNS might develop symptoms of carpal tunnel syndrome (CTS) and only a handful of cases are reported in the literature. The gold standard of treatment has traditionally been surgical excision for localized lesions and additional total synovectomy of the affected joint in cases of diffuse PVNS. The objective of this article is to present a patient with PVNS of the right wrist leading to CTS, resolved with surgical treatment which led to satisfactory results.

Case report: A 29-year-old right-hand dominant female patient arrived at our out-patient department with complaints of swelling, pain, tingling, and numbness of the right palm. The patient had similar complaints 1 year ago when carpal tunnel release surgery was done for her elsewhere. After 1 year of surgery, the symptoms persisted along with diffuse swelling. Clinical examination of the patient confirmed the presence of CTS. A tenosynovial mass around the flexor tendons located along the carpal tunnel at the level of the distal radioulnar joint was visible on magnetic resonance imaging. The median nerve's conduction velocity was found to be lowered on electrodiagnostic testing. Total lesion excision was done along with carpal tunnel release, and the mass was excised and sent for histopathology. Histopathological evaluation of the extracted material confirmed the diagnosis of PVNS. At the 5-year follow-up, there were no complaints or indications of recurrence.

Conclusion: Localized PVNS of the wrist presenting as CTS is a rare condition. To diagnose this illness, several investigations and a high index of suspicion are needed. Total excision of the lesion, along with surgical release of the carpal tunnel, should be ensured to avoid recurrence.

Introduction: Gas gangrene, is an aggressive and life-threatening necrotizing infection of soft tissues. We report a case of upper-limb trauma resulting in clostridial gas gangrene.

Case report: A 36-year-old healthy male presented to our department with a left humeral shaft fracture and an open elbow fracture. During surgery wound discharge, and diffuse crepitations due to gaseous accumulation were noted around the medial elbow and forearm. Debridement and fasciotomy were performed, and IV penicillin and clindamycin were administrated. The infection spread into adjacent soft tissues, requiring repeated surgical interventions and long-term IV antibiotics till resolution.

Conclusion: Early and repeated debridements are imperative in traumatic gas gangrene, to preserve limb and function.

Introduction: This report describes the use of a combination of a retrograde femoral nail and distal femur locking plate for the treatment of an open intra-articular distal femur fracture in a 99-year-old female. The purpose of this report is to highlight that nail-plate fixation constructs can be performed percutaneously and expeditiously even in extremely old patients; therefore, patient age should not be a limiting factor in choosing this construct to allow for immediate weight-bearing.

Case report: The patient was a 99-year-old female who presented to the emergency room after a fall. Plain radiographs demonstrated a comminuted supracondylar distal femur fracture with a sagittal intercondylar split (OTA classification 33A3.3). She was indicated for operative repair and was fixed with a combination of a retrograde Stryker T2 alpha nail and Stryker distal femur locking plate. This method was chosen to allow the patient to be weight-bearing as tolerated after surgery so she could immediately start work with physical therapy to work towards getting back to her pre-injury ambulatory status. At 3 months post-operatively, she had minimal pain, no difficulties with activities of daily living, and was ambulating with the assistance of a cane. At 9 months post-operatively, she was ambulating with a cane (pre-injury status). She did not report any pain, and her radiographs illustrated fracture site consolidation. Furthermore, her short musculoskeletal functional assessment score was the same as it was pre-injury (81).

Conclusion: This case supports the idea of using a nail-plate combination for repair of intra-articular distal femur fractures, even in the very elderly as the patient's functional outcome data reached pre-injury levels. In addition, it allows even elderly patients to begin early weight-bearing and decreases complications related to lack of extremity use.

Introduction: Painter first described painful periarticular soft-tissue calcium deposits in 1907. Further research has led to a variety of nomenclature, including calcareous tendinitis, pseudopodagra, and rheumatism. This report details the journey of a patient with acute calcific periarthritis (ACP) and explores issues concerning diagnosis, management, and provides possible preventative strategies.

Case report: A 39-year-old female presented to the emergency department after developing severe thumb metacarpophalangeal joint pain and swelling in her right dominant hand. A slight pain over the radial aspect of the first metacarpal was noticed 5 months before her acute hospital attendance.

Conclusion: ACP of the thumb is commonly misdiagnosed due to its comparably low prevalence and clinical features which mimic more common conditions. Our case highlights the need for radiological imaging in patients with acute atraumatic thumb pain and evidence of a connection between chronic behavioral patterns and the development of ACP.

Introduction: Post-traumatic arthritis of elbow is a crippling condition that frequently develops after a serious joint injury. The condition is characterized by pain, rigidity, and diminished functionality, considerably affecting the quality of life of those impacted. Despite advancements in surgical and conservative management, the optimal treatment strategy remains elusive.

Case report: A 31-year-old male presented to us with post-traumatic elbow arthritis with loss of function affecting his activities of daily living, 2 years post a road traffic accident. Radiographs showed a malunited right proximal humerus fracture with arthritic right elbow joints with implants present in situ. As he was a young person with high functional demands, we decided to take him up for elbow interposition arthroplasty. Fascia lata graft was taken and interposed between the prepared ends of the distal humerus and proximal ulna. Intraoperative range of 20-120 degree was possible. One year post-surgery after undergoing rehabilitation therapy, the patient had good clinical function with elbow range of motion between 15 and 110° of flexion.

Conclusion: Interposition elbow arthroplasty provides satisfactory functional results in young patients with post-traumatic elbow arthritis.

Introduction: Surgeries in the occipitocervical and upper cervical region are always quite challenging and need adequate surgical experience and expertise. Especially in cases, where both anterior and posterior surgical access is required, complication rates could be significantly high. The transoral approach for the ventral pathologies of the upper cervical region has been previously described using the conventional open technique where post-operative morbidity is a concern. Moreover, problems such as dysphagia, risk of injury to the oral components, and surgical site infection are always an issue. In patients requiring a combined posterior approach, surgical morbidity, and post-operative recovery is always an area of concern. We describe a case report of upper cervical myelopathy managed under full navigation using a combined tubular transoral (minimally invasive) and posterior approach.

Case report: A 74-year-old male patient presented with myelopathy and weakness in bilateral upper and lower limbs (MRC Grade 4/5) due to a cystic lesion at C1 causing ventral cord compression. A staged anterior (minimally invasive transoral tubular approach) - posterior procedure was performed under full navigation for decompression and stabilization of C1-C2. Postoperatively, the patient showed neurological improvement (MRC Grade 5/5) in all four limbs.

Conclusion: A 360° navigation-guided approach to the upper cervical spine is a safer and more effective procedure with less risk of neurological and vascular complications. Furthermore, combining minimally invasive access anteriorly to the odontoid ensures reduced surgical morbidity of the overall procedure.

Introduction: Gouty arthritis is a common inflammatory condition caused by the deposition of uric acid crystals in the joints, leading to intense pain, swelling, and functional impairment. Thermal therapies, including hot and cold fomentation, are often used as adjunctive treatments for managing inflammation and pain in various musculoskeletal conditions. However, the efficacy of these therapies in acute gout remains underexplored. This study aims to compare the effects of hot fomentation versus cold fomentation in patients experiencing acute gout flares, assessing pain reduction, swelling, joint mobility, and overall patient satisfaction.

Materials and methods: A randomized controlled trial was conducted with 2,400 patients diagnosed with acute gouty arthritis, divided into two equal groups: Group A received hot fomentation (38°C-42°C) and Group B received cold fomentation (5°C-10°C). Both interventions were applied twice daily for 20 min over 5 days, alongside standard gout care. Pain intensity was measured using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5. Statistical analyses compared outcomes between the two groups.

Results: Cold fomentation significantly reduced pain intensity (VAS score reduction of 68% by day 5) compared to hot fomentation (26% reduction, P < 0.001). Joint swelling decreased by 25% in the cold group versus 5% in the hot group, with cold therapy also leading to greater improvements in joint mobility (average increase of 15° vs. 5°, P < 0.01). Notably, 35% of patients in the hot fomentation group experienced flare-ups, compared to only 2% in the cold fomentation group (P < 0.001). Patient satisfaction was also higher in the cold group, with 85% of participants reporting satisfaction versus 30% in the hot group.

Conclusion: This study demonstrates that cold fomentation is significantly more effective than hot fomentation in managing acute gouty arthritis. Cold therapy provided superior pain relief, reduced swelling, improved joint mobility, and minimized the risk of symptom exacerbation. In contrast, hot fomentation often worsened symptoms, making it unsuitable for acute gout management. These findings suggest that cold fomentation should be the preferred thermal therapy for gout flare-ups, while heat applications should be avoided.