Journal of Orthopaedic Case Reports最新文献

Introduction: Glomangiomas are rare vascular tumors derived from the vascular component of glomus bodies. Because glomus bodies play an important role in thermoregulation in the digits of the hand and foot, glomus tumors predominantly arise in these locations. Only six incidents of glomangiomas have arisen in the forearm since 1991. In nearly every case, the tumor was associated with extreme tenderness to palpation and pain with the use of the forearm. The diagnosis was delayed up to 21 years due to the low clinical suspicion of this type of tumor. However, eventual diagnosis and surgical management led to immediate resolution of pain in the forearm.

Case report: We report the diagnosis and treatment of a 52-year-old male who presented with a 5-year history of volar mid-forearm pain refractory to conservative treatment. Diagnostic evaluation with magnetic resonance imaging and histology identified the tumor as a glomangioma.

Conclusion: Surgical excision completely resolved the patient's symptoms by the 2-week follow-up.

Introduction: Ellis-van Creveld syndrome (EVC) is a rare autosomal recessive disorder characterized by growth retardation, dysplastic nails, cardiac defects, dental abnormalities, and polydactyly. Early diagnosis and multidisciplinary management are essential for improving patient outcomes.

Case report: We present a case of a 12-year-old male with EVC, born to consanguineous parents, who presented with bilateral bowing of the legs and difficulty walking. The patient exhibited classic features of EVC, including short stature, bilateral polydactyly, dysplastic nails, dental anomalies, and a history of cardiac defects. Radiological evaluation confirmed the diagnosis.

Conclusion: This case highlights the importance of early diagnosis and comprehensive management in EVC syndrome. Recognizing the characteristic clinical features is key to timely intervention and improved quality of life.

Introduction: Bilateral simultaneous rotational ankle fractures are an unusual phenomenon that remains unreported in the English literature, and to our knowledge, about 10 cases have been reported. The aim of the study was to evaluate and report clinical outcomes of bilateral simultaneous ankle fractures in our institution.

Case reoprt: We conducted a review of our 2-year experience with patients who had simultaneous bilateral fractures of the ankles and were treated at our institution. The included patients underwent surgical treatment using open reduction and internal fixation. Patients' functional outcomes were assessed using patient-reported outcome measures (PROMs), namely the Short Form-36 questionnaire and the Olerud and Molander Ankle Outcome Score (OMAS).

Results: Two cases (four ankles) of simultaneous bilateral rotational ankle fractures were identified in our institution's records. Both cases involved a pedestrian motor vehicle accident. They were both female and had an average age of 22.5 years. Due to an open injury, one ankle underwent a staging procedure, and the other three underwent open reduction and internal fixation with excellent clinical outcomes. Functional outcomes were measured with PROMs.

Conclusion: Simultaneous bilateral ankle fractures, while uncommon, can have a substantial impact on an individual's mobility and health-related quality of life. Early surgical intervention and effective rehabilitation enhance functional results in this devastating journey.

Introduction: Various surgical repair techniques, including autograft and allograft reconstructions, have been reported for the management of chronic pectoralis major ruptures, but outcome reporting remains highly heterogeneous. This narrative review aimed to provide a deeper understanding of these techniques, emphasizing the need for larger-scale prospective trials to support evidence-based recommendations for surgeons.

Materials and methods: We conducted a search of PubMed/Medline, Cochrane Library, Embase, and Google Scholar for English-language articles published between 1822 and 2023, using the following keywords: "chronic pectoralis major ruptures," "chronic pectoralis major tears," and "patient outcomes."

Results: Overall, more than 60 reported cases were retrieved, along with a few prospective studies and review articles. Based on the compiled literature, most pectoralis major tears tend to arise at the tendo-osseus junction. In the absence of contra-indications such as old age and multiple comorbidities, surgical intervention is considered the golden care standard. The most commonly performed repair techniques include suture anchor fixation, transosseous fixation (TOS), and cortical bone fixation. Among the three techniques, no significant differences in cyclic loading or load-to-failure properties of the constructs were recorded. In chronic cases, in which direct repair is not possible, various autograft and allograft reconstructions were described, with quite heterogeneous outcome reporting, rendering comparative analyses difficult.

Conclusion: Currently, no single technique has been established as the gold standard for the treatment of chronic pectoralis major ruptures. The most commonly performed repair techniques include suture anchor fixation, TOS, and cortical bone fixation. In chronic cases where direct repair is not feasible, various autograft and allograft reconstructions are employed. There is a need for larger-scale prospective trials with standardized outcome reporting to develop evidence-based recommendations, providing surgeons with safe and effective guidelines for treatment.

Introduction: Posterior cruciate ligament (PCL) avulsion fractures of the tibia with ipsilateral tibial shaft represent a rare but challenging orthopedic injury, necessitating careful consideration of surgical interventions for optimal outcomes. This case report presents the successful management of tibial shaft fracture (proximal 1/3rd junction) along with ipsilateral PCL avulsion fracture of tibia using a novel approach using open reduction internal fixation (ORIF) of tibial shaft with Locking compression plate (LCP) with cannulated cancellous screw and spiked washer fixation of PCL avulsion. There are no case reports or research articles available for the management of PCL avulsion fracture of tibia associated with ipsilateral tibial shaft fracture.

Case report: The patient, 34-year old male, presented with significant pain, swelling, and limited range of motion following a road traffic accident. Radiographic evaluation revealed a comminuted fracture proximal tibia and fibula with PCL avulsion fracture of the tibia, prompting a comprehensive surgical intervention. We planned to manage both fractures in a two-stage surgery. The selected approach involved ORIF of the proximal tibia fracture by utilizing LCP, followed by open reduction and internal fixation of PCL avulsion using cannulated cancellous screws, supplemented by the innovative application of a spiked washer for enhanced stability.Patients underwent monthly follow-ups during the initial 3 months. During each follow-up, both clinical and radiological assessments were conducted. Clinical evaluations focused on stability and range of motion (ROM), employing a drawer test for stability assessment. Radiological evaluations were based on the union shown in X-rays. The follow-up duration was up to 6 months, culminating in the calculation of the final functional outcome using the Lysholm knee scoring system.

Conclusion: This case report contributes valuable insights into the successful management of PCL avulsion fractures associated with ipsilateral tibial shaft fracture, emphasizing the importance of customized surgical techniques and the utilization of advanced fixation devices. The presented approach with cannulated cancellous screws and a spiked washer showcases a promising option for achieving stable fixation and promoting efficient healing in such challenging cases. Further, research and long-term studies are warranted to validate the efficacy and durability of this innovative surgical method.

Introduction: Olecranon fractures account for 5-7% of elbow fractures, making them a common injury. The majority of these fractures are treated surgically because they are intra-articular and can disrupt the elbow extensor mechanism. Mayo Type II fractures are displaced with a stable ulnohumeral joint, indicating intact ligamentous structures, particularly the anterior portion of the medial collateral ligament.

Case report: In our case report, a male in his 20's came to the outpatient department with complaints of pain in the right elbow since 1 day following a fall from a bike. He also reported that he was unable to fully extend his right elbow. After a plain radiograph, a right displaced comminuted olecranon fracture was suggested. He underwent a pre-anesthesia checkup and standard laboratory testing before being taken for surgery. Open reduction internal fixation with fragment-specific plates was done. An above-elbow slab in the extended position was applied post-surgery and continued for 14 days. Elbow range of motion physiotherapy was started in accordance with tolerance, and the patient responded favorably to surgery.

Conclusion: To effectively categorize olecranon fractures according to displacement, comminution, and stability, the Mayo classification was developed. With appropriate computed tomography scan imaging and pre-operative planning, individual fragments of these comminuted fractures can be delineated, and fragment-specific implants can be used, resulting in good radiological and clinical outcome with minimal complications as compared to tension band wiring.

Background: Paraspinal muscle abscesses are rare, and generally occur due to injections or hematogenous dissemination. Here, we describe a rare case of a paraspinal muscle and the ipsilateral psoas major abscess in the lumbar region that communicated via the interspaces of the costal processes.

Case report: An 83-year-old man with poorly controlled diabetes mellitus and no history of puncture complained of right low back pain for the past 2 months. He was diagnosed with pyelonephritis and referred to our department for close examination of the low back pain. Magnetic resonance imaging revealed a paraspinal muscle and an ipsilateral psoas major abscess in the lumbar region, which communicated through the interspaces of the costal processes. A definitive diagnosis was made using percutaneous aspiration and the patient was successfully treated conservatively.

Conclusion: This case is very rare and impressive because the paraspinal muscle abscess directly communicated with the ipsilateral psoas major muscle abscess. Spinal infections should always be considered in the differential diagnosis of low back pain, particularly in the absence of long-term improvement. Local physical examinations are essential when examining patients with low back pain. Conservative treatment is effective, even if the abscess is extensive.

Introduction: In recent years, numerous hospitals have established in-house three-dimensional (3D) printing centers, enabling health-care facilities to leverage the transformative capabilities of additive manufacturing technology on their premises. With this emerging opportunity arises a necessity to undertake a thorough assessment of the manufactured tools employed in clinical practice. The objectives of this article are to describe the pathway of in-house printing and evaluate the accuracy of 3D-printed specific instruments.

Case report: A case is reported along with the workflow for creating a patient model and cutting guide. The patient is a 76-year-old Caucasian woman with bone metastasis from a known renal cancer located in the pelvis. The model was used preoperatively, while the guide was used during surgery. Following this, the guide underwent computed tomography (CT) scanning, and a 3D digital model was reconstructed. Two dimensions, labeled A and B, were established. We compared pre-operative measurements, respectively, with measurements from the printed physical guide and from the rescanned post-operative digital model. Finally, A and B were measured on the bone defect on the patient's post-operative CT. Variation in axis A value between the mean of the first two groups was 0.5 mm and in axis B was 0.7 mm. On the printed physical guide, the mean of axis A was 73.5 mm, and the mean of axis B was 71.8 mm. Variation in A value between the mean of this group and the pre-operative was 1.7 mm and in B value was 0.5 mm.

Conclusion: The workflow used at our hospital was described with an example of how to evaluate the accuracy of in-house 3D printing. Results showed high accuracy of the printing method, a reliable correlation between desired and actual outcomes, and a short lead time.

Introduction: Calcific tendonitis is characterized by calcium hydroxyapatite crystal deposition in tendons, leading to inflammation and pain. While predominantly observed in the rotator cuff tendons of the shoulder, its occurrence in the rectus femoris tendon of the hip is exceedingly rare and poses a diagnostic challenge.

Case report: A 38-year-old female housewife presented with a 1-month history of left hip pain, which was dull, aching, and exacerbated by movements such as standing and walking. High-resolution computed tomography imaging showed calcification at the insertion of the left rectus femoris muscle. A magnetic resonance imaging confirmed the diagnosis, revealing no significant abnormalities in the hip joints or surrounding structures. The patient was diagnosed with calcific tendonitis at the insertion of the left rectus femoris muscle and was managed conservatively with rest, Non-steroidal anti-inflammatory drugs, and physical therapy. Follow-up visits were scheduled to monitor her progress and response to treatment.

Conclusion: This case underscores the importance of thorough clinical and imaging evaluations in diagnosing calcific tendonitis in atypical locations. Conservative treatment proved effective, highlighting the need for tailored management strategies. Future research should focus on elucidating the pathogenesis and optimizing treatment for calcific tendonitis in uncommon sites.

Introduction: Distal femur fractures present significant surgical challenges due to their complex anatomy and limited soft tissue coverage. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising alternative to traditional open techniques, aiming to reduce soft-tissue damage while maintaining stable fixation, particularly when used with locking plates.

Materials and methods: This retrospective study analyzed 40 consecutive patients with distal femur fractures treated with MIPO and locking plates.

Results: The results showed a high union rate of 92.5%, with fractures healing within 16-24 weeks (mean: 19.2 weeks). Complications occurred in 12.5% of cases, including three cases of malalignment, one case of screw breakage, and one infection. Functional outcomes were positive, with 85% of patients achieving excellent or good results based on the Knee Society Score, indicating satisfactory postoperative mobility and joint function.

Conclusion: MIPO using locking plates is a reliable and effective treatment for distal femur fractures, offering high union rates, manageable complication rates, and favorable functional outcomes while minimizing soft-tissue disruption.