Journal of Orthopaedic Case Reports最新文献

Introduction: The robotic-assisted total knee arthroplasty (RA-TKA) facilitates real-time intra-operative balance assessment and accurate component positioning customized to the patient's ligamentous behavior, enhancing procedural accuracy and precision. Preliminary findings suggest RA-TKA, using fully autonomous computed tomography based systems, such as Cuvis, result in better short-term outcomes and improved patient-reported outcome measures. Coronal plane alignment of the knee classification aids to decide pre-arthritic phenotype of the knee and soft tissue balance judgment.

Materials and methods: This investigation was conducted as a retrospective matched-cohort observational study. We retrospectively analyzed a matched group of patients to compare RA TKA with functional alignment (n = 26) and mechanically aligned conventional-TKA (CM-TKA) (n = 24) in individuals with a valgus deformity Ranawat grade 1 and 2. The evaluation included radiographic assessments and PROMs over a 6-month period. The Western Ontario and McMaster University Osteoarthritis Index score and Oxford Knee Score (OKS) were used to determine the outcomes.

Results: The RA TKA cohort showed faster recovery than CM TKA patients. The RA TKA cohort required less soft tissue releases (P = 0.010). At the 3-month follow-up, there was a substantial reduction in pain in the RA TKA cohort (19.73 ± 2.38 vs. 25.71 ± 3.96, P = 0.000). However, over 6 months, pain reduction was found to be similar in both groups (13.27 ± 1.99 vs. 13.21 ± 2.04, P = 0.281). The improvement in OKS in RA TKA cohort was significant at 3 months (33.96 ± 3.88 vs. 31.04 ± 2.79, P = 0.006) and at 6 months (39.77 ± 2.97 vs. 36.46 ± 3.18, P = 0.136), and improved ROM in both groups (111.25 ± 13.29 vs. 116.96 ± 9.31, P = 0.083), with improvement in flexion (12.73 ± 5.85 vs. 7.08 ± 10.41, P = 0.210) in RA TKA compared to the CM-TKA cohort.

Conclusion: The CUVIS robotic system leads to optimum gap balancing throughout the range of motion, less soft tissue release, less post-operative pain, and improved function in short-term follow-up with optimum patella tracking in valgus knees.

Introduction: Neglected Monteggia fracture-dislocations in children remain challenging due to adaptive deformities of the ulna, chronic radial head dislocation, and soft tissue contractures. While early recognition ensures excellent outcomes, delayed cases often require complex reconstructive surgery. This study presents the clinical and radiological outcomes of a case series involving corrective oblique ulnar osteotomy in neglected Monteggia fractures (NMF), open reduction of the radial head, temporary transcapitellar fixation, and annular ligament reconstruction (ALR).

Materials and methods: Eight children (5 males and 3 females; mean age 9.9 years) with NMF presenting >4 weeks after trauma were retrospectively reviewed over a 3-year period. The mean delay from injury to surgery was 11.6 months. All underwent oblique flexion osteotomy of the ulna with plate fixation, open reduction of the radial head, temporary Kirschner wire stabilization, and ALR using an extensor carpi radialis fascial sling. Clinical outcomes were assessed by range of motion and the Mayo Elbow Performance Index (MEPI), while radiological outcomes were graded as good, fair, or poor. Mean follow-up was 30.1 months.

Results: At final follow-up, mean flexion improved from 110.6° to 133.1° and mean extension from 9.4° to 3.1°. Forearm supination and pronation averaged 81.9° and 66.3°, respectively. The mean MEPI score increased from 77.6 preoperatively to 91.3 postoperatively, indicating significant functional improvement. Stable reduction of the radial head was maintained in six patients, while one showed subluxation and one developed arthritic changes. Complications included heterotopic ossification in one case and delayed union requiring revision in another.

Conclusion: Corrective ulnar osteotomy combined with open reduction, temporary fixation, and ALR provides reliable functional recovery and stable reduction in neglected pediatric Monteggia fractures. Despite delayed presentation, favorable outcomes can be achieved with this comprehensive surgical approach.

Introduction: Intrapelvic migration of cephalomedullary screws is an exceptionally rare but potentially life-threatening complication of internal fixation of intertrochanteric femur fractures. When displaced implants lie near major vascular structures, the clinical concerns rise significantly. This case highlights the importance of early recognition, detailed imaging, and multidisciplinary surgical coordination in managing this high-risk scenario.

Case report: An 85-year-old male underwent short cephalomedullary nail fixation for a left intertrochanteric femur fracture. After a subsequent fall in a respite facility, investigations revealed superomedial migration of the lag screw into the pelvic cavity. Computed tomography angiography showed the screw tip lying within 2 cm of the iliac bifurcation, without evidence of hemorrhage or visceral injury. A multidisciplinary team, including orthopedic, vascular, and general surgeons, recommended operative retrieval. An initial exploratory laparotomy was aborted due to intraoperative bleeding risk. Definitive removal was achieved safely via a second laparotomy 2 weeks later, with an uneventful post-operative course.

Discussion: This case highlights a rare but dangerous complication. Unlike more routine cases of implant failure managed through direct hip revision alone, the intrapelvic trajectory and vascular proximity in this case required intra-abdominal retrieval. High-resolution imaging was critical in defining anatomy and risk, and the collaborative surgical approach ensured a successful outcome.

Conclusion: Superomedial migration of cephalomedullary screws can pose an imminent danger due to their proximity to critical pelvic structures. When standard revision techniques are not feasible, multidisciplinary surgical planning, guided by advanced imaging, becomes essential to avoid catastrophic outcomes.

Introduction: Enchondroma is the most common benign cartilaginous tumor of the small tubular bones of the hand. Although typically indolent, it may present with pain, swelling, or pathological fracture, and requires careful differentiation from low-grade chondrosarcoma. Management strategies range from observation in asymptomatic cases to surgical curettage with or without grafting in symptomatic lesions.

Case report: We present three cases of hand enchondroma involving the phalanges in patients aged 20-37 years. Clinical features included fusiform swelling, pain, and, in one case, pathological fracture. Radiographs showed well-circumscribed lytic lesions with chondroid matrix. All cases were treated with intralesional curettage, cavity filling with cancellous autograft harvested from the olecranon, and prophylactic K-wire fixation. Histopathology confirmed enchondroma in each case. Postoperatively, patients underwent short-term immobilization followed by physiotherapy. At 12 weeks, all achieved full functional recovery with radiological consolidation and no recurrence or complications.

Conclusion: Enchondroma of the hand, though benign, requires timely recognition and appropriate surgical management. Curettage with autologous bone grafting and prophylactic fixation offers reliable outcomes with minimal morbidity, while early mobilization reduces the risk of post-operative stiffness, even in cases with pathological fracture.

Introduction: Vascular complications after ankle arthroscopy (AA) are rare but potentially serious. Pseudoaneurysm (PA) formation, especially involving the anterior tibial artery, requires prompt diagnosis and management to avoid severe outcomes.

Case report: We report a case of a 68-year-old obese, hypertensive male patient with a history of severe acute respiratory syndrome coronavirus 2 infection, who developed a rigid equinus deformity of the left ankle. He underwent Achilles tendon tenotomy and arthroscopic ankle arthrodesis. On post-operative day 23, he presented with a pulsatile mass in the anterolateral ankle region. Duplex Doppler ultrasound confirmed an anterior tibial artery PA. Surgical ligation of the artery proximal and distal to the lesion was successfully performed.

Conclusion: Although rare, PA formation following AA should be considered when patients present with pulsatile swellings postoperatively. Early diagnosis and surgical intervention are crucial to prevent serious complications.

Introduction: Total elbow arthroplasty (TEA) is a valuable salvage procedure, traditionally reserved for elderly or rheumatoid patients. However, expanding indications have allowed selective application in younger patients with debilitating post-traumatic elbow pathology.

Case report: A 74-year-old female presented with persistent instability and ulnar neuropathy following non-union of a distal humerus fracture and chronically dislocated elbow, complicated by progressive arthropathy. On evaluation, she exhibited valgus-varus laxity, restricted range of motion (ROM), and crepitus. A semi-constrained TEA was performed using a posterior triceps-splitting approach. The humeral condyles, though destabilised from prior instrumentation, were preserved and secured using No. 5 Ethibond sutures. These sutures were tied to the humeral prosthesis. Postoperatively, by 3 months the patient achieved a functional, pain-free elbow with improved ROM and resolution of neurological symptoms.

Conclusion: This case highlights the potential of condylar-preserving TEA as a reliable management option with advanced post-traumatic elbow dysfunction. Even in the presence of instability, non-union and prior instrumentation, preserving the native condyles and securing them to the prosthesis can yield a stable, pain-free, functional result.

Introduction: Conservative management has always been used for pediatric fractures. However, surgical management has shown outstanding results. Closed reduction and titanium elastic nailing (TEN) is one of the procedures that is used for the management of pediatric injuries. We undertook this study to see the outcome of pediatric fractures treated with TEN.

Materials and methods: A prospective study conducted at Krishna Institute of Medical Sciences, Karad. Thirty children with femoral fractures managed with TENs were included in this study. Patients were followed up till 12 months postoperatively for limb length discrepancy, pelvic asymmetries, rotational deformity, axial angulation, and hip and knee range of motion. Scoring criteria for TEN by Flynn et al. [t2.1]was used, and results were classified as excellent, satisfactory, or poor.

Results: There were 19 boys and 11 girls in this study. The mean duration of surgery was 50 min. Radiological union was achieved in an average time of 7 weeks. Full weight bearing was achieved in a period of 7 weeks. As per the Flynn et al. criteria, the results were excellent in 24 patients, successful in 5, and poor in 1 patient. One patient had varus angulation, 3 patients had entry site irritation, and 2 had limb length discrepancy.

Conclusion: The TENS is an efficient and acceptable form of treatment in selected cases of femoral diaphyseal fractures in children.

Introduction: Primary synovial chondromatosis (PSC) is a rare benign disorder characterized by cartilaginous nodule formation within synovial tissue. Hip joint involvement is uncommon, and optimal surgical management remains debated.

Case report: We report a 27-year-old woman with a 2-year history of progressive right hip pain and functional limitation. Radiographic evaluation revealed multiple calcified loose bodies with mild joint space narrowing. The patient underwent safe surgical dislocation with complete loose body removal and partial synovectomy. Histopathological examination confirmed PSC. At 24 months, there is no evidence of early complications related to surgical dislocation, such as avascular necrosis, trochanteric osteotomy nonunion, and infection. We acknowledge that longer-term follow-up is necessary to exclude delayed recurrence or late complications such as heterotopic ossification which remains a limitation of our report.

Conclusion: Safe surgical dislocation provides excellent visualization and complete loose body removal in hip PSC while minimizing the risk of avascular necrosis. This technique represents a viable alternative to arthroscopic management, particularly for cases with large or numerous loose bodies.

Introduction: Distal radius fractures and elbow dislocations are commonly encountered as isolated injuries. However, bilateral simultaneous occurrence is exceedingly rare, typically linked with high-energy trauma. Such injury combinations require prompt diagnosis and an individualized management strategy.

Case report: We report a case of a 42-year-old male laborer who sustained bilateral distal radius fractures (AO/OTA 23-C2) with simultaneous posterior dislocation of both elbow joints following a fall from approximately 10 feet. The elbow dislocations were managed with immediate closed reduction. Definitive fixation of both distal radius fractures was performed using volar locking plates. At the 12-month follow-up, the patient achieved good functional recovery and returned to manual work with minor limitations.

Conclusion: Bilateral elbow dislocations with simultaneous distal radius fractures are extremely rare. Prompt recognition, appropriate surgical intervention, and structured rehabilitation are essential to restore function and prevent long-term disability.

Introduction: Medial Hoffa fractures are rare intra-articular injuries of the femoral condyle, and their association with posterior cruciate ligament (PCL) avulsion fractures presents a highly uncommon and complex clinical scenario. This case report describes the successful surgical management of such a combination using a posterior open approach.

Case report: A 48-year-old male sustained a medial Hoffa fracture with a PCL avulsion following a road traffic accident. Surgical intervention involved open reduction and internal fixation (ORIF) through a posterior approach, allowing direct access to both fracture sites. The PCL avulsion fragment was anatomically reduced and fixed with a cancellous screw, while the Hoffa fracture was stabilized using opposing Herbert screws. Postoperatively, the patient underwent structured rehabilitation with an early range of motion exercise. At 6 months, the patient achieved full knee function (0-130°), no instability, and high functional scores. Radiographs showed complete union, and follow-up at 18 months confirmed maintained function without complications.

Conclusion: This case highlights the effectiveness of a posterior approach for single-stage ORIF in managing rare medial Hoffa fractures with PCL avulsion. Early surgical intervention, anatomical fixation, and dedicated rehabilitation are key to achieving optimal outcomes in such complex knee injuries.