Journal of Orthopaedic Case Reports最新文献

Introduction: Bony and ligamentous ankle injuries are some of the most commonly treated injuries by orthopedic surgeons. Open ligamentous ankle injuries without an associated fracture or dislocation are rare and to our knowledge have only sparsely been described in the literature. We present a case and successful treatment of an open lateral ankle injury with capsular rupture and ligamentous damage without fracture or dislocation in a 22-year-old female. Due to the rarity of this injury, there is not a standard treatment protocol.

Case report: A 22-year-old female presented with an open ankle injury while playing volleyball after a sudden varus and inversion force. An X-ray obtained at an outside hospital showed no acute fracture or dislocation of the ankle joint. In the operating room, stress examinations showed a positive anterior drawer and a positive varus stress test. Heavy non-absorbable suture was used to repair the ruptured ligaments with the ankle capsule. Augmentation of the repair was performed with a suture anchor placed in the lateral aspect of the distal fibula with one limb running posterior and distal while the other limb reinforced the repair. Subsequently at 6-months post-operative the patient returned to full weight-bearing and radiographs showed maintenance of ankle alignment with no radiographic or clinical signs of instability.

Conclusion: Open ankle injuries without dislocation or fracture are very rare. Therefore, an ample assessment should always be conducted with an understanding that the extent of the injury may be underestimated via static radiographs. Surgical repair is necessary for treatment and we have described one technique through which treatment of open lateral ligamentous ankle injury is possible.

Introduction: Pressure injuries (PIs) continue to remain one of the most common and debilitating complications seen adding to the financial burden of the patients and caregivers. The available VAC (vacuum assisted closure) systems are expensive. In our case series we have applied low-cost negative pressure dressing (NPD) for sacral pressure injuries in five patients along with individualised rehabilitation protocol which resulted in accelerated healing of their PIs and improved functional outcome.

Materials and methods: Five patients having pressure injuries of Grade IV according to NPIAP classification in whom we applied NPD were included. Pressure ulcer scale for healing (PUSH), reduction of surface area of the wounds were recorded on a weekly basis. FIM (Functional independence measure) score of the patients were evaluated at admission and at discharge. Healing rate by means of PUSH score and surface area were recorded.

Results: Improvement in FIM score from the time of admission till at discharge was calculated to be 42.86% with a standard deviation of 16.84. Healing rate by means of PUSH score was the highest for patient C at 3.57% per week and in terms of surface area for patient C at 5.44% per week.

Conclusion: Low-cost negative pressure device has been observed to be a safe and effective method of managing PIs. It prevents further infection and helps to optimise and accelerate healing in PIs with the additional advantage of being cost effective and easy to apply.

Introduction: Osteochondroma is a bony lesion arising from the surface of the bone. It com-prises a large percentage of all benign bone tumors. A unique feature of this tumor is the conti-nuity of cortical and medullary components between the normal bony tissue and aberrant tissue of osteochondroma. Even though the predominant composition is bone, growth takes place in the cartilaginous portion. The incidence of osteochondroma in flat bones which are ossified by intramembranous type of ossification including the scapula, clavicle, ribs, and pubic ramus is usually rare.

Case report: We report three cases of osteochondroma involving less common and unusual sites. We have included one case of osteochondroma of the medial end of the clavicle, one case of iliac wing osteochondroma, and one case of radial head osteochondroma.

Conclusion: Osteochondroma rarely occurs in unusual sites. Although uncommon, osteochon-droma can involve small and flat bones.

Introduction: Chronic wounds pose a significant burden on patients' physical and mental well-being and significantly raise health-care costs.

Case report: We report healing with VG111 application alone in a case of chronic wound in a patient who sustained a shell injury to the heel 35 years prior in 1988. Despite conventional wound care and multiple surgeries, the wound persisted. Application of VG111 resulted in complete healing of the wound within 3 months and restored the patient's ability to walk normally as shown by repeat X-Ray post 2 years of healing.

Conclusion: The management of non-healing chronic wounds poses major challenges in clinical practice. This novel formulation may offer a potential solution for patients with chronic wounds.

Introduction: Endoscopic spine surgery (ESS) is a minimally invasive technique that allows for direct visualization of spinal pathologies and has become a safe and effective alternative to traditional open spine surgery. Conventionally performed in the prone position, biportal endoscopy can also be done in the lateral position to avoid prone-associated complications. To our knowledge, the use of unilateral biportal endoscopy (UBE) in the lateral position has not been previously reported.

Case report: We present the case of a 53-year-old male who experienced severe low back pain and right-sided radiculopathy due to a disc protrusion at the L4-L5 level. The patient was managed surgically using UBE in the lateral position once the conservative management was ineffective. This innovative approach aimed to minimize the complications associated with the prone position typically used in such procedures.

Conclusion: The successful management of L4-L5 intervertebral disc prolapse using UBE in the lateral position in this case demonstrates the potential of this technique as an effective and minimally invasive alternative to conventional surgical methods. This approach could offer a viable solution for treating degenerative spinal diseases while mitigating the steep learning curve associated with ESS. Further research and clinical studies are necessary to validate and optimize this technique.

Background: In recent years, there has been a growing utilization of minimally invasive (MI) techniques, which provide the potential advantages of minimizing surgical stress, post-operative pain, and hospitalization duration. Nevertheless, the existing body of literature primarily comprises of studies conducted at a single medical site, which are of low quality and lack a comprehensive analysis of treatment techniques exclusively focused on spondylolisthesis. We conducted this systematic review and meta-analysis to compare minimally invasive surgery (MIS) and open surgery (OS) spinal fusion outcomes for the treatment of spondylolisthesis. OS spinal fusion is an interventional option for patients with spinal illness who have not had success with non-surgical treatments.

Materials and methods: This systematic review of the literature regarding MI and OS spinal fusion for spondylolisthesis treatment was performed using the preferred reporting items for systematic reviews and meta-analysis guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search of Medline/PubMed, Cochrane Library, and Google Scholar databases yielded 1078 articles. These articles were screened against established criteria for inclusion into this study.

Results: A total of eight retrospective and four prospective articles with a total of 3354 patients were found. Reported spondylolisthesis grades were I and II only. Overall, MI was associated with lower operative time (mean difference [MD], -6.44 min; 95% confidence interval [CI], -45.57-32.71; P = 0.0001) and shorter length of hospital stay (MD, -0.49 days; 95% CI, -0.58 to -0.40; P = 0.000). There was no significant difference overall between MIS and OS in terms of functional or pain outcomes. Rates of complications were not significantly different between the MI group and the OS group, though overall 75 and 153 complications were observed in MI group and OS group.

Conclusion: Available data indicate that MI spinal fusion is a secure and efficient method for managing Grade I and Grade II spondylolisthesis. Furthermore, whereas prospective trials establish a connection between MI and improved functional outcomes, it is necessary to conduct longer-term and randomized trials to confirm any correlation identified in this study.

Introduction: Despite the good clinical outcomes of osteochondral autograft transplantation (OAT), reports of re-arthroscopic findings after OAT have been limited to short-term, and there are no reports of findings after long-term follow-up. This is the first report that describes re-arthroscopic findings long-term after OAT.

Case report: A male patient underwent OAT on the lateral femoral condyle (LFC) of the knee and lateral meniscus (LM) repair at the age of 45. Eighty years after the primary surgery, he underwent re-arthroscopy because of cartilage injury on the medial femoral condyle (MFC) and LM tear. The re-arthroscopic findings showed the retained OAT plugs on LFC and severe damage of LM. After OAT on the LFC and meniscectomy of LM was performed, his knee symptoms improved, so the LFC that had undergone OAT 18 years previously was considered to be on a good clinical course.

Conclusion: OAT plugs were retained at the long-term follow-up while the repaired LM was severely damaged. The structural robustness of OAT was thought to be responsible for good long-term clinical outcomes.

Introduction: Systemic cystic angiomatosis is an exceedingly rare condition characterized by widespread cystic vascular lesions involving multiple organs. Its clinical presentation can be non-specific, often leading to diagnostic challenges. This report discusses the case of a 72-year-old female with a long-standing history of diabetes mellitus who presented with non-specific symptoms, ultimately diagnosed with systemic cystic angiomatosis after an initial misdiagnosis of vascular neoplasia. The role of advanced imaging techniques and a multidisciplinary, individualized management approach is emphasized.

Case report: A 72-year-old female with long-standing diabetes presented with non-specific symptoms, including fatigue, fever, and rashes on the upper limbs. Initial physical examination revealed anemia and severe thrombocytopenia with a leukoerythroblastic blood picture. Despite unremarkable initial imaging studies, a bone marrow biopsy suggested vascular neoplasia. Further evaluation with a positron emission tomography (PET) scan revealed multiple non-avid lytic skeletal areas and cystic liver lesions, leading to a diagnosis of systemic cystic angiomatosis. A conservative management approach with danazol and eltrombopag was adopted. The patient later developed an acute-on-chronic subdural hematoma, a severe complication of the condition.

Conclusion: This case highlights the diagnostic complexity and the necessity for individualized management strategies in systemic cystic angiomatosis. It underscores the importance of considering rare diagnoses when faced with non-specific symptoms and atypical laboratory findings. Advanced imaging techniques, such as PET scans, and a multidisciplinary approach are crucial for accurate diagnosis and effective management of this rare condition.

Introduction: Coronavirus disease 2019 (COVID-19) infection or corticosteroid usage during the COVID-19 pandemic as risk factors for avascular necrosis (AVN) of the femoral head (osteonecrosis of the femoral head/femoral head AVN [FHAVN]), as well as its link to clinical and radiological outcomes, are poorly understood. Osteonecrosis, which results from a disruption in vascular supply to the femoral head, is a prevalent cause of hip joint deterioration and one of the most common reasons for total hip arthroplasty (THA)/total hip replacement in India and other Asian countries. This study will aid in understanding the condition's epidemiology and statistically determining the risk of disease related with pandemic exposure.

Materials and methods: This is a retrospective study of 100 hips diagnosed with osteonecrosis/osteoarthritis of the femoral head that underwent THA at a tertiary care center before and after the COVID-19 pandemic between February 2014 and February 2024.

Results: Late stages of FHAVN, when the diagnosis requiring THA, following the pandemic have increased exponentially. It has also switched from affecting the middle-aged to the younger age groups. Furthermore, the bilaterality necessitating THA has increased considerably. There is a clear shift in the presentation of this disabling illness, as well as the need for THA, which otherwise is rarely carried out on younger people. Furthermore, data on how much corticosteroids were used in the treatment is disturbingly scant, and how it may have contributed to this ailment in India is still questionable.

Conclusion: The COVID-19 pandemic could be the most serious threat, causing late-stages FHAVN (stages 3 and 4 of the Ficat and Arlet classification), in an accelerated manner, necessitating THA and overburdening existing medical care.