Journal of Orthopaedic Case Reports最新文献

Introduction: The reamer-irrigator-aspirator (RIA) is safe and effective for harvesting intramedullary autograft and tissue for culture. However, mechanical complications such as reamer head dissociation with retained intramedullary debris have been previously reported.

Case report: Techniques to remove the metallic debris have been described, but are technically challenging and inefficient. The authors provide a novel technique to aid in the removal of loose debris using a laparoscopic suction device.

Conclusion: We have utilized this instrument on multiple occasions, and it has demonstrated itself to be safe, reliable, and effective at removing all debris.

Introduction: Discoid meniscus (DM) is a congenital anomaly of the meniscus form that predisposes individuals to symptomatic DM, especially in the lateral meniscus. Arthroscopic meniscal repair has emerged as the preferred treatment approach for symptomatic cases, prioritizing meniscal preservation to maintain knee joint integrity and function.

Objectives: The purpose of this study was to evaluate the radiological and functional outcome of arthroscopic meniscal repair of DM using validated clinical scores and post-operative imaging.

Materials and methods: A prospective observational study was conducted on 40 patients aged 10-40 years at Sree Balaji Medical College and Hospital. Arthroscopic meniscal repair consisted of an all-inside procedure, an inside-out procedure, or an outside-in procedure, based on the involved location. Functional outcomes of the post-operation have been determined, as well as the pre-operative rating systems of the Lysholm Knee Score on functionality. Minimum follow-up of the patients (24 months into the future) was followed to verify short-term healing, besides checking the long-term effects of the patients at earlier patients.

Results: The majority of patients were male (60%) and presented with symptoms such as knee pain and thud (43.33%). The mean pre-operative Lysholm score was 56.20, which significantly improved to 91.29 postoperatively (P < 0.001). According to the Lysholm score grading, 83.3% of patients achieved good outcomes, 3.33% excellent, and 13.3% fair. No poor outcomes were observed. Radiology showed satisfactory joint presentation in all cases.

Conclusion: Arthroscopic meniscal repair for DM leads to significant functional improvement and satisfactory radiological outcomes. This technique is particularly beneficial for young, active individuals, contributing to joint preservation and reducing the risk of early osteoarthritis. Further long-term studies with larger cohorts are recommended to confirm sustained benefits and monitor degenerative changes.

Introduction: Epicondylitis (lateral and medial) is a common tendinopathy that impairs function and quality of life. Corticosteroid injections (CSI) provide rapid but often short-lived symptom relief, while platelet-rich plasma (PRP) is used as a biologic alternative aimed at tendon regeneration. Comparative effectiveness between PRP and CSI remains uncertain in real-world settings.

Materials and methods: We conducted a retrospective cohort study using de-identified electronic health records from the TriNetX Network (2010-2025). Adults ≥18 years with coded epicondylitis and subsequent PRP or CSI were included. Cohorts were 1:1 propensity-score matched on demographics and comorbidities (age, sex, race, type 2 diabetes, obesity, hypothyroidism, nicotine dependence). Outcomes were assessed over a period of 1 year after the index event and included repeat or new medication, opioid exposure, long-term opioid initiation, visits to the emergency department (ED), functional diagnoses (stiffness, weakness, mobility), physical therapy (PT) utilization, and surgical escalation. Hazard ratios (HRs) and risk ratios were estimated.

Results: After matching, 1,064 PRP patients were compared with 1,064 CSI patients. PRP was associated with higher hazards of repeat or new medication (HR 1.33; 95% CI 1.18-1.50; RR 1.21), opioid exposure (HR 1.48; 95% CI 1.20-1.83; RR 1.43), PT utilization (HR 1.52; 95% CI 1.27-1.81; RR 1.41), joint stiffness (HR 1.64; 95% CI 1.04-2.59; RR 1.63), dependence on mobility aids (HR 3.63; 95% CI 1.80-7.31; RR 3.60), and surgical escalation (HR 2.57; 95% CI 1.19-5.56; RR 2.30). No significant differences were observed for ED visits, long-term opioid initiation, abnormal gait, muscle weakness, or contracture.

Conclusion: In this large, multi-institutional real-world cohort, PRP was associated with higher short-term utilization and treatment failure risks compared with CSI. While randomized trials suggest mid-term benefits of PRP, our findings highlight an efficacy-effectiveness gap, likely reflecting heterogeneity in PRP protocols and patient selection. Clinicians should counsel patients about the potential for early symptom flare and higher downstream resource use when considering PRP.

Introduction: Giant cell tumor of bone (GCTB) is a benign but locally aggressive lesion, rarely affecting the carpus (<2% of hand GCTs), and is associated with recurrence rates up to 87%. Management of carpal GCT is challenging due to the limited bone volume, risk of damage to articular cartilage, and the need to preserve wrist function.

Case report: A 38-year-old male presented with recurrent GCT of his left wrist 1 year after curettage and bone grafting. He had painful swelling, restricted motion, and an expansile lesion involving the distal carpal row and bases of the 2nd-4th metacarpals. He underwent en bloc excision with extended curettage and reconstruction using iliac crest autograft stabilized by Kirschner wires. Post-operatively, he had good pain relief and maintained good wrist motion. At 12 months, positron emission tomography - computed tomography showed no recurrence or metastasis; Mayo Wrist Score was 85 (Good) and the disabilities of the arm, shoulder and hand score was 8.3.

Conclusion: Recurrent carpal GCTB can be managed with en bloc excision, extended curettage, autografting, and temporary fixation, achieving adequate disease control and preservation of wrist motion. Long-term surveillance remains essential as recurrence is high in lesions of the carpal bones.

Introduction: Interference screws are commonly used implants, particularly in arthroscopic cruciate ligament reconstruction, where they achieve fixation by compression and friction rather than by threads. We report a case of a sunken interference screw, used as a stopper during core decompression and autologous adult live-cultured osteoblast (AALCO) injection for avascular necrosis (AVN) of the hip, which was successfully managed using a minimally invasive instrument-assisted retrieval technique.

Case report: A 67-year-old male with bilateral hip AVN underwent bilateral core decompression and AALCO injection. After track preparation and drilling of the necrotic areas in the femoral head with an 8 mm reamer, an 8 mm interference screw was inserted before injection of the AALCO. The screw migrated into the femoral neck and became sunken, complicating retrieval. Using a combination of standard orthopedic operating room instruments, i.e., without specialised instruments for retained implant removal, the screw was retrieved without additional morbidity. The AALCO was injected as planned, and the patient had an uneventful post-operative recovery.

Conclusion: A sunken interference screw in the proximal femur is a rare but challenging intraoperative complication. Our retrieval method using readily available instruments offers a safe and reproducible solution in such scenarios.

Introduction: Fractures involving the distal third of both bone leg are one of the common long bone fractures with significant concern owing to the amount of soft-tissue damage incurred and poor prognosis with respect to fracture fixation.

Aim: The aim of the study is to evaluate whether fibula fixation is necessary along with internal fixation of extra-articular distal tibia fractures by comparing the clinico-radiological and functional outcome of patients of extra-articular distal third tibia fractures with fibula "fixed" and fibula "not fixed" group.

Materials and methods: A prospective cohort study with a sample size of 30 patients was conducted in Sri Ramachandra Institute of Higher Education and Research between March 2023 and May 2024. Fibula fixation was done in one group, and the fibula was not fixed in the control group. Research methodology includes radiological evaluation for coronal and sagittal plane malalignment, Radiographic Union Score for Tibial fractures (RUST) scoring, and clinically, rotational malalignment and presence of post-operative infection. All cases were followed up for a minimum duration of 6 months to assess union of tibia fractures in both groups.

Results: Tibial bone union rate was better in the fibula not fixed (control) group compared to the fibula fixed group (P = 0.032), confirmed by the RUST scoring (P = 0.047), which was statistically significant.

Conclusion: There was no significant improvement with additional fibula fixation in the healing of distal tibia fractures, but rather causes greater morbidity in terms of wound infections and delayed healing of the tibia. This clearly demonstrates that fibula fixation in extra-articular distal tibia fractures when the fracture does not affect the syndesmosis or ankle mortise is not necessary, and is associated with a higher risk of tibial non-union.

Introduction: Proximal humerus fractures constitute approximately 4-6% of all fractures, commonly affecting the elderly due to low-energy trauma and osteoporotic bones. Two-part surgical neck fractures are the most frequent subtype. In younger individuals, high-energy trauma is a usual cause. However, a proximal humerus fracture in a patient with a history of trapezius muscle transfer for brachial plexus injury is an extremely rare clinical scenario, with limited literature available on its management and rehabilitation.

Case report: A 30-year-old right-hand-dominant male presented with acute pain and swelling in the right upper arm following a non-traumatic event during aggressive physiotherapy. He had a history of brachial plexus injury managed by double Oberlin nerve transfer and later a trapezius transfer due to poor shoulder function. Two months into post-operative rehabilitation, he sustained a surgical neck humeral fracture. Open reduction and internal fixation with a dynamic compression plate and subpectoral biceps tenodesis were performed. A structured post-operative rehabilitation protocol resulted in a functional recovery with 90° of shoulder abduction at 1-year follow-up.

Conclusion: Peri-implant fractures following trapezius transfer are rare and demand careful surgical and rehabilitation planning. This case highlights the importance of cautious, supervised, and graded physiotherapy to prevent such complications and optimize outcomes.

Introduction: Injuries of the pre-pubic aponeurotic complex (PPAC) are a significant cause of groin pain syndrome. These injuries tend to have limited self-healing capacity because the injured area is kept apart by opposing forces exerted by the rectus abdominis (RA) and adductor longus muscles. Recently, botulinum toxin type A (BTX-A) has been successfully used in a case report describing a patient with PPAC injuries. This study aims to evaluate the efficacy of BTX-A in a series of patients with PPAC injuries.

Materials and methods: Ten male athletic subjects with PPAC injuries underwent infiltrative therapy with BTX-A at the level of the RA and adductor longus, followed by an 8-week rehabilitation program.

Results: Ultrasound assessment performed after the rehabilitation program showed that 9 subjects (90%) achieved complete restitutio ad integrum of the PPAC injury area, while 1 subject (10%) exhibited partial repair. At 12 months of follow-up, 9 patients (90%) returned to sports activity, 8 (80%) at the same level, and 1 (10%) at a lower level, but not due to residual pain. No adverse effects were recorded.

Conclusion: BTX-A infiltrative therapy appears to be a safe, effective, and promising treatment for PPAC injuries, enabling a quick return to sporting activity.

Introduction: Frozen shoulder, also known as adhesive capsulitis, is a condition marked by persistent shoulder pain and limited range of motion. Platelet-rich plasma (PRP) has recently gained attention as a biologically active therapy capable of enhancing tissue repair and regeneration.

Objective: This study aimed to assess the impact of intra-articular PRP injections on functional recovery in individuals with frozen shoulder.

Materials and methods: A prospective interventional study was performed involving 30 patients who had not responded to standard conservative therapies. Each participant received a single PRP injection and was monitored at intervals of 1 week, 1 month, 3 months, and 6 months. Pain and functional outcomes were measured using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scores. Subgroup analyses examined the effects of age, diabetes status, and duration of symptoms.

Findings: After 6 months, there was a 75.3% reduction in pain scores and a 72.1% improvement in functional scores. Patients who were younger, non-diabetic, or had symptoms for <6 months experienced more favorable outcomes. Multivariate analysis confirmed age, diabetes, and symptom duration as significant outcome predictors.

Conclusion: Intra-articular PRP injections appear to significantly reduce pain and enhance function in patients with frozen shoulder, with the most pronounced benefits observed in early-stage, younger, non-diabetic individuals. Despite certain study limitations, these results highlight PRP's potential as an effective treatment alternative.