Journal of Orthopaedic Case Reports最新文献

Introduction: Chronic juvenile massive osteochondritis dissecans (OCD) presents significant therapeutic challenges due to the lack of established treatments. We herein report a case of chronic juvenile massive OCD treated with poly-L-lactic acid pin fixation.

Case report: A 13-year-old boy presented to another hospital with right knee pain after playing football. Initially, no significant abnormalities were noted, and he was placed under observation. However, the pain later worsened, and he was referred to our hospital with a diagnosis of OCD. An X-ray revealed a defect posterior to the lateral femoral condyle and a loose body in the suprapatellar bursa. Magnetic resonance imaging indicated the presence of a lateral discoid meniscus. Three months after the onset of symptoms, osteochondral fragment fixation and saucerization of the lateral meniscus were performed. One year postoperatively, the patient showed a good outcome with no recurrence of symptoms.

Conclusion: Chronic juvenile massive OCD may achieve fusion with fixation, even when bone fragments consist only of cartilage.

Introduction: Pediatric forearm fractures are very common. The distal radius growth physis contributes the majority of the radial length and nearly half of the entire upper extremity. Although growth arrest associated with physeal fractures is rare but the sequelae can be very detrimental and challenging. Partial or complete distal radius physis arrest can lead to radial shortening, alteration of radial tilt or inclination, distal radioulnar joint (DRUJ) incongruity, ulnocarpal abutment syndrome, and injury to the triangular fibrocartilage complex. Post-traumatic distal radius physis arrest is a serious complication that can lead to several disabilities. These disabilities could be devastating as it is related to the functional status of the wrist. In the literature, there are few studies reported post-traumatic distal radius growth arrest. Our case is bilateral post-traumatic distal radius growth arrest with positive ulnar variance that is limiting the patient's wrist function.

Case report: A 13-year-old boy presented to the outpatient department with bilateral wrists pain and deformities, 6 years after sustaining bilateral distal radius fractures, which was managed conservatively at that time. On examination, the patient had obvious bilateral wrists deformities and limitation of range of motion (ROM). Radiographic investigations showed: Bilateral central distal radius physeal osseous bar in the background of positive ulnar variance and dorsal subluxation of the DRUJ. After discussing treatment options with his parents, the patient was treated surgically, starting with the left side by ulnar shortening osteotomy and temporary DRUJ fixation. After 8 weeks from the surgical operation, the patient was referred for physiotherapy for gradual supervised sessions to regain full ROM and strength. One year follow-up, the patient showed near normal wrists activity with satisfactory outcome for him and his family, so the same surgical operation was done to the right side.

Conclusion: The treatment of these types of injuries is highly controversial. Options could vary from case to case. We do believe that ulnar shortening osteotomy with temporary DRUJ fixation should be considered in treating late presenting distal radius physeal injury in adolescent patients, aiming for an absolute great outcome.

Introduction: Humeral shaft non-unions can pose a difficult challenge to orthopedic surgeons. There are various techniques to approach these injuries, but some require microsurgical techniques or staged procedures.

Case report: A 41-year-old woman presented with a 5-year-old humeral shaft non-union after previous open reduction and internal fixation complicated by infection. This was successfully treated surgically using a combination of proximal tibia cancellous autograft and structural allograft. Postoperatively, she had pain-free range of motion that was symmetric to her contralateral side.

Conclusion: Chronic humeral shaft non-unions may be successfully treated with a combination of tibial cancellous autograft and structural allograft.

Introduction: Total knee replacement in valgus knees is more challenging than in varus knees, which needs meticulous handling and decision-making from the surgical approach to the rehabilitation protocol. In this case, we report an iatrogenic fibula head fracture during total knee replacement for a valgus knee with no concomitant common peroneal nerve palsy. This is the first report of this kind in the literature.

Case report: We report a case of a 67-year-old male with fixed valgus and flexion deformity of the right knee, who underwent total knee arthroplasty by lateral para-patellar approach and sustained an iatrogenic fibula head fracture without common peroneal nerve palsy. The probable cause could be excess pressure exerted by the assistant holding the Hohmann retractor on the posterior aspect of the tibia and/or during the maneuvers to expose the posterolateral part of the tibia through the lateral para-patellar approach. He had no neurovascular defects postoperatively and has followed the regular rehabilitation protocol with good functional recovery and showing signs of radiological union in progress of the fracture at 2-month follow-up.

Conclusion: Gentle handling of rigid multiplanar deformity valgus arthritic knees is mandatory to prevent complications. A fibula head fracture could be one of the methods of lateral contracture release in rigid valgus knees.

Introduction: Neurofibromatosis Type 1 (NF1) is a genetic disorder that may lead to the development of plexiform neurofibromas (Pns). Selumetinib, a selective mitogen-activated protein kinase (MEK1/2) inhibitor, has shown clinical benefit in shrinking inoperable PNs. However, its long-term effects on the skeleton remain unclear. This case describes impaired bone healing and pathological fractures following limb lengthening in a child with NF1 receiving prolonged selumetinib therapy.

Case report: A 5-year-old boy with genetically confirmed NF1 and left lower limb PN-induced overgrowth presented with a 4.5 cm limb length discrepancy. The patient had been receiving selumetinib (20 mg twice daily) without a clinically significant reduction in the size of the PNs. Lengthening was performed on a short healthy lower leg with an external fixator that did not include the femur. A distal femoral fracture occurred 3 weeks postoperatively on the same side as the lower leg lengthening was performed, and was treated with K-wire fixation. Despite healing, a refracture occurred 2 months later. In addition, delayed bone healing was observed for the tibial lengthening regenerate, and progressive valgus deformity and fibular migration developed. Selumetinib was discontinued due to adverse effects and suspected contribution to impaired bone healing.

Conclusion: In pediatric NF1 patients treated with selumetinib, fracture and impaired bone healing may be rare side effects, especially during limb lengthening. These findings highlight the importance of closely monitoring bone health in NF1 patients on MEK inhibitors, particularly when undergoing orthopedic procedures.

Introduction: Bennett's fracture is an intra-articular fracture-dislocation at the base of the first metacarpal. If inadequately treated, it may lead to malunion and subluxation of the carpometacarpal joint, resulting in pain, stiffness, and functional impairment.

Case report: We report the case of a 28-year-old male software professional who presented 7 months after sustaining a left thumb injury with persistent pain, stiffness, and difficulty in thumb use. Radiographs revealed a malunited intra-articular fracture of the first metacarpal base with joint subluxation. The patient underwent intra-articular corrective osteotomy with fixation using screws and a trans-articular K-wire to restore joint congruity. At 12 weeks, he achieved full, pain-free thumb movements, and at 10 months, radiographs confirmed fracture union with a Kapandji score of 10/10.

Conclusion: Intra-articular corrective osteotomy is a viable and effective treatment for symptomatic Bennett's fracture malunion, particularly when performed before the onset of degenerative changes, leading to excellent pain relief and restoration of thumb function.

Introduction: Pediatric tibial plateau fracture-dislocations are extremely rare but can involve serious neurovascular and growth complications, requiring prompt evaluation, appropriate fixation, and long-term monitoring. This is the first case report of a tibial plateau fracture-dislocation in the pediatric population.

Case report: A 13-year-old male fell off a motorized scooter, sustaining a tibial plateau fracture-dislocation. He underwent urgent reduction and application of external fixator with subsequent extraphyseal fixation. He had an excellent outcome at both 1-year and 5-year follow-up.

Conclusion: This unusual injury pattern requires thoughtful and comprehensive evaluation, followed by appropriately timed open reduction and stable internal fixation to allow for the early joint range of motion and optimized function. The management of this case serves as an example of how to best approach a rare injury such as this. Patients should be followed until skeletal maturity for potential leg-length discrepancy or malalignment.

Introduction: Severe knee osteoarthritis associated with anterolateral femoral bowing presents unique challenges for achieving accurate alignment during total knee arthroplasty (TKA). Extra-articular deformity may prevent proper positioning of the femoral cutting block, increasing the risk of malalignment. This case is important because it illustrates a simple and accessible technique to manage substantial femoral bowing without relying on navigation or robotic technology.

Case report: We report the case of an 84-year-old woman with end-stage left knee osteoarthritis and marked anterolateral femoral bowing, treated with cemented posterior-stabilized TKA. A key technical adaptation was the use of a deliberately lateralized femoral intramedullary (IM) entry point, allowing alignment of the IM guide with the patient's mechanical axis despite the deformity. The patient recovered uneventfully and demonstrated progressive improvement. At 6 months, she walked independently without walking aids and had full functional recovery.

Conclusion: In cases of significant femoral bowing, intentional lateralization of the femoral entry point is crucial for achieving accurate mechanical alignment using conventional instrumentation. This technique is practical, reproducible, and particularly useful when advanced computer-assisted systems are unavailable.

Introduction: Concomitant femoral head osteonecrosis and hip joint septic arthritis is rare. Membranous nephropathy is an immune-mediated glomerular disease producing nephrotic syndrome in adults. Patients take glucocorticoids or immunosuppressants during treatment of this condition. We report the first case of a patient with nephrotic syndrome during treatment developing concomitant hip septic arthritis and femoral head osteonecrosis with an opportunistic pathogen seen in gastrointestinal tract.

Case report: A 37-year-old gentleman on treatment with high-dose prednisolone and mycophenolate for nephrotic syndrome developed bilateral hip pain and was diagnosed as osteonecrosis of femoral head. He underwent core decompression of both hips. Suspected concomitant septic arthritis noted in the magnetic resonance imaging was missed. Post decompression Citrobacter species was aspirated from the left hip and was then managed by debridement and antibiotics. Five years later, he developed secondary osteoarthritis with protrusio-acetabuli subsequent to septic sequelae and underwent total hip replacement without any reactivation till last follow-up.

Conclusion: Concomitant septic arthritis with femoral head osteonecrosis should be considered when treating patients on steroids or immunosuppressants. An elevated erythrocyte sedimentation rate and C-reactive protein in a patient with osteonecrosis warrants additional investigations, including ultrasound-guided aspiration and culture, before core decompression or any surgical intervention even in immunocompetent patients.

Introduction: Reverse total shoulder arthroplasty (RTSA) has shown promise as a solution for individuals with rotator cuff tear arthropathy (CTA). However, RTSA has demonstrated limited improvement in internal rotation (IR) range of motion (ROM) and strength, potentially affecting patients' ability to perform essential daily tasks such as toileting, a crucial factor that significantly influences overall patient satisfaction.

Case report: A 69-year-old female patient presented with a complaint of chronic pain and weakness in her right shoulder. The patient exhibited rotator CTA with irreparable subscapularis. As the owner of a fish restaurant, the patient underwent lateralized RTSA combined with pectoralis tendon transfer. By the post-operative 1 year 6 months, the patient's strengths of forward elevation (FE) and IR had improved from 14.2N to 20.2N and from 15.4 to 26.2N, respectively. The ROM increased from 80° to 150° for FE, from 70° to 150° for abduction, from 25° to 35° for external rotation, and from L5 to L1 for IR at the back. With no significant complications, the patient was able to return to her workplace.

Conclusion: Primary RTSA combined with pectoralis major tendon transfer could be a viable option for restoring both ROM and strength in FE and IR, particularly in cases of rotator CTA with irreparable subscapularis tears.