Journal of Orthopaedic Case Reports最新文献

Introduction: Elbow dislocation is usually treated conservatively with a good outcome. When there is associated injury to the capitellum, "Osborne-Cotterill Lesion," then the clinical course is less predictable and controversial. In this article, we attempt to define the critical point on the capitellum surface that, when breached, forebodes potential engagement of the radial head in the defect and imminent dislocation.

Case report: We present two cases of fracture and fracture dislocation of the elbow with "Osborne-Cotterill lesion." They were treated with fracture reduction and fixation. In the first case, a posterior plate was utilized for the olecranon, and in the second case, cannulated screws were employed for the capitellum fracture. In both cases, a posterior humeral plate was applied to counteract the "Osborne-Cotterill lesion" with bone grafting of the defect.

Conclusion: When the critical point of the capitellum is breached (roughly a quarter of the capitellar articular surface or less when the radial head is injured),we recommend bone grafting the defect and plating the posterior capitellum to impede potential dislocation.

Introduction: A rare but difficult condition to treat is neglected posterior dislocation of the hip. A delayed presentation results in soft-tissue contractures, poor bone stock, altered anatomy, and fibrous tissue formation in the acetabulum, all of which make reduction challenging. Despite the considerable risks and technical difficulties, total hip arthroplasty (THA) is frequently the recommended course of treatment in such chronic cases.

Case report: We report the case of a 48-year-old man who had a 1.5-year-old posterior hip dislocation that had been neglected. After undergoing closed reduction and skin traction at a nearby hospital, the patient experienced a secondary displacement shortly after being released. He was treated conservatively at several local centers since he lacked access to definitive care. The patient had a 7 cm limb shortening with fixed flexion, adduction, and internal rotation deformity when they arrived at our facility. Imaging showed a deformed anterior wall, a fragmented posterior acetabular wall, and a femoral head with total loss of articular cartilage.

Surgical procedure: A total hip replacement (THR) using cement was planned, and several backup plans, such as structural grafts, acetabular cages, dual mobility cups, and subtrochanteric osteotomy, were ready for any intraoperative difficulties. A posterior strategy was applied. Fibrous tissue and malformed bony walls covered the acetabulum; to medialize and stabilize the cup, careful dissection and gradual reaming were done. Osteotomy was performed on the femoral head. A medial calcar fracture was discovered during surgery, and cerclage wiring was used to treat it. The implant was a cemented stem with a highly porous acetabular cup.

Results: Recovery from surgery went smoothly. The patient's limb length and function were restored along with a stable hip fixation.

Discussion: In developing nations, where delayed presentation is common due to limited orthopedic access and reliance on traditional bone setters, neglected posterior hip dislocations with acetabular fractures present significant reconstructive challenges. In these situations, THR necessitates careful pre-operative planning, cautious intraoperative technique to prevent neurovascular damage, and methods to deal with bone loss and soft-tissue contracture.

Conclusion: THA, which provides pain relief and functional recovery, is the recommended treatment for chronic posterior hip dislocation with acetabular involvement. However, because of its technical complexity, it requires careful planning and execution.

Introduction: Osteochondromas are the most common benign bone tumors, typically arising from the metaphyseal regions of long bones. However, their occurrence in flat bones, particularly the scapula, is rare. We report a case of a large solitary osteochondroma arising from the dorsal aspect of the scapula in a pediatric patient, which was successfully treated with surgical excision.

Case report: A 12-year-old female presented with a progressively enlarging bony swelling over the right scapular region since the age of 7 years, recently associated with difficulty in lying over the affected side. Radiological evaluation, including X-ray and computed tomography scan confirmed a large osteochondroma arising from the inferior angle of the right scapula. This case is unique as the osteochondroma extends from dorsal to ventral aspect through the lateral aspect of scapula making it difficult for the child to lie on both supine and right lateral positions. The patient underwent en bloc excision, resulting in complete resolution of symptoms and had no recurrence at follow-up.

Conclusion: Though uncommon, osteochondroma should be considered in the differential diagnosis of bony swellings over flat bones, such as the scapula. Earlier surgical management may yield the best functional and cosmetic outcomes.

Introduction: Clavicle neoplasms account for only 1.01% of bone tumors and the possibility of it being a primary aneurysmal bone cyst is incidentally low. Although rare in incidence, most of the cases reported were treated with en bloc resection either as a primary procedure or during recurrence. The rarity of the disease and the lack of medical literature poses a diagnostic dilemma for the treating orthopedic surgeon, radiologist, and pathologist, that could potentially lead to the lesions being diagnosed at a stage when options to salvage the bone can no longer be considered. In our case, early meticulous work-up, prompt surgical intervention, and strict follow-up enabled us to salvage the bone and, more importantly, preserve the acromioclavicular joint; hence, offering better functional outcome for the patient.

Case report: A 23-year-old female presented with complaints of pain in the left collarbone and restricted movement in the shoulder. Clinically, a bony irregularity was palpable over the left clavicle with associated tenderness. Patient was subjected to various radiological imaging and tissue sampling to aid in the establishment of a pre-operative diagnosis. A diagnostic dilemma arose as the investigations opened up a wide plethora of differentials. Considering the age of the patient and the provisional diagnosis of "giant cell lesion," an attempt was made to salvage the bone and preserve shoulder function. The patient underwent extended curettage, cancellous bone grafting, and augmentation plating. Intraoperative samples were sent for histopathology and the lesion turned out to be one among the least likely on the list of possible differential diagnosis - a primary aneurysmal bone cyst. A meticulous follow-up protocol was devised during which functional outcome was found to be excellent and there was no recurrence at 15 months.

Conclusion: Through this case report, we would like to emphasize on the importance of broadening the spectrum of differential diagnosis while investigating tumors at a rare site. This was achieved by devising a meticulous pre-operative radiological and histopathological diagnostic protocol encompassing a spectrum of differential diagnosis. Establishing an early diagnosis gives us an option to opt for surgical interventions for bone salvage and, thus, achieve better functional outcome for the patient.

Introduction: Pertrochanteric femur fractures are common in elderly patients with osteoporosis. Cephalomedullary nails are the standard of care, but the choice between short and long proximal femoral nails (PFNs) remains debated.

Materials and methods: We present a case series of 30 patients with pertrochanteric fractures treated at our institute between January 2023 and December 2024. Fifteen patients were managed with short PFN and fifteen with long PFN. Functional and radiological outcomes were assessed using Harris hip score, time to union, complication rate, and post-operative mobilization. Long PFNs showed faster union (14.6 ± 1.4 weeks vs. 16.3 ± 1.7 weeks), earlier mobilization, and fewer complications (20% vs. 46.7%). Short PFNs had shorter operative times and lower intraoperative blood loss. Illustrative cases are presented, including implant failures requiring salvage with total hip replacement.

Conclusion: Short PFNs are adequate for stable pertrochanteric fractures, but long PFNs provide superior stability and fewer complications in unstable patterns.

Introduction: Fanconi syndrome is a disorder characterized by defective proximal renal tubular reabsorption, resulting in the wasting of glucose, phosphate, bicarbonate, amino acids, and uric acid. While most common in childhood and usually secondary to other conditions in adults, idiopathic cases with adult onset are rare. Skeletal complications such as osteomalacia and fractures may result from chronic phosphate loss and can be the initial presentation in adult cases.

Case report: A 35-year-old previously healthy man presented with chronic back pain and bilateral hip pain, later diagnosed as bilateral femoral neck stress fractures. Laboratory evaluation revealed hypophosphatemia, renal glucosuria with normoglycemia, aminoaciduria, phosphaturia, tubular proteinuria, and proximal renal tubular acidosis. Secondary causes were excluded, and genetic testing was not feasible, leading to a diagnosis of idiopathic adult-onset Fanconi syndrome. The patient was treated with sodium bicarbonate and potassium citrate, resulting in improvement and prevention of further fractures.

Conclusion: This case demonstrates that adult-onset Fanconi syndrome, though rare, can initially present with musculoskeletal symptoms such as stress fractures. Early recognition and interdisciplinary evaluation are essential for timely intervention, which may prevent further complications even in the absence of an identifiable cause.

Introduction: Neer Type V distal clavicle fractures are an unstable fracture configuration that is often treated with surgery. Type V fractures are challenging as the integrity of the coracoclavicular ligament needs to be restored by reducing the inferior fragment - a technically challenging endeavor. Multiple heterogeneous surgical techniques have been proposed in the literature to treat unstable distal clavicle fractures without any consensus on best practice. To date, there remains a lack of described effective techniques to aid in reducing the inferior fracture fragment in Neer Type V distal clavicle fractures.

Case report: We employ a novel method of applying a lag screw technique to aid in the reduction of the inferior fragment to solve this notoriously challenging fracture pattern.

Conclusion: This novel technique builds on fundamental trauma concepts. The extended use of a lag screw as a reduction technique in distal clavicle fractures has not been described in the literature before. This reduction technique reduces the need for extensive soft-tissue dissection for coracoid exposure, as described in other techniques (e.g., suture anchor or button fixations), while enabling direct incorporation of the inferior fragment, bone-to-bone healing, and benefits from the stability of a plate-screw construct.

Introduction: The most common site of tumors is the femur in the adolescent group. As the tumour progresses in the proximal and distal metaphysis, the biomechanics of the hip and knee joints are changed, respectively. This case report is a coxa vara in an adolescent boy with fibrosis dysplasia - shepherd crook deformity, and a corrective osteotomy was done with some complications and success.

Case report: A 12-year-old adolescent came with deformity of the right thigh with shortening, and radiograph shows fibrous dysplasia with coxa vara, which was treated with corrective osteotomy and medical management.

Conclusion: A proper clinical examination, pre-operative planning, finding CORA's, anticipating intra-operative difficulties, and choice of implants result in massive efficacy in terms of both decision making and results in both radiologically and functionally.

Introduction: Isolated rupture of the flexor digitorum profundus tendon within flexor zone 3 is exceptionally rare and easily mistaken for the far more common zone 1 "Jersey finger" lesion. To the best of our knowledge, only two such middle-finger cases have been documented over the past six decades. Reporting this case, together with a literature synthesis, highlights the diagnostic pitfalls and supports timely, tendon-preserving intervention.

Case report: A 65-year-old right-hand-dominant White male felt a sudden snap in his right palm while restraining a dog leash, followed by an inability to flex the distal interphalangeal joint of the middle finger. Clinical examination showed loss of the tenodesis effect, but plain radiographs excluded fracture. Initial exploration aimed at tendon reinsertion in zone 1 revealed an intact insertion, prompting proximal extension of the incision. A complete mid-substance rupture was identified in zone 3, approximately one centimeter proximal to the origin of the lumbrical muscle. Primary repair was performed using a four-strand cruciate core technique reinforced with circumferential epitendinous sutures. Post-operative rehabilitation employed early-motion protocols. Twelve months after surgery, the patient regained full strength, achieved a total active finger motion of 230°, and reported 95 percent functional recovery.

Conclusion: This case illustrates how a concealed zone 3 rupture can masquerade as a distal avulsion, emphasizing the need for high clinical suspicion and, when feasible, pre-operative ultrasonography or magnetic resonance imaging to guide incision planning. Early direct repair within days of injury provided an excellent functional result, underscoring that prompt recognition prevents unnecessary grafting or transfer procedures. By adding the first modern case of isolated middle-finger zone 3 rupture and proposing a minimum reporting dataset, this report broadens surgeons' awareness of an uncommon injury and supports evidence-based management strategies that may preserve grip strength and hand function across orthopedic practice.

Academic integrity is crucial in orthopedic surgery research, as patient care relies on the legitimacy and trustworthiness of published research. Plagiarism, or the unauthorized use of intellectual property without proper attribution, jeopardizes musculoskeletal medicine advancement and public trust. The advent of digital publishing platforms, combined with rising priority for academic production, has resulted in both purposeful and inadvertent transgressions of academic integrity norms. Modern plagiarism detection software is crucial for maintaining publication standards, but many researchers lack a comprehensive understanding of effective detection, analysis, and remediation techniques. Effective plagiarism prevention has a direct influence on patient safety, encourages innovation, and preserves the reputation of orthopedic literature in the global medical community.