Journal of Orthopaedic Case Reports最新文献

Introduction: Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder characterized by progressive muscle rigidity and spasms. While it predominantly affects adults, pediatric cases are exceptionally rare, often leading to delayed diagnosis due to non-specific early clinical manifestations.

Case report: We report the case of an 11-year-old boy with progressive gait abnormalities and rigidity, initially misdiagnosed as an orthopedic disorder. The patient exhibited a forward-leaning posture, absent lumbar lordosis, and significant muscle tightness, leading to a primary surgical intervention. Despite initial improvement, symptom recurrence prompted further evaluation, ultimately raising suspicion of SPS. The absence of pyramidal or extrapyramidal signs complicated early diagnosis, highlighting the challenges in recognizing SPS in pediatric patients.

Discussion: SPS diagnosis relies on clinical criteria, serological markers, and electromyography. Autoantibodies against glutamic acid decarboxylase (anti-GAD) are commonly associated, although other markers may be present in atypical forms. Pediatric SPS is often misdiagnosed as dystonia, metabolic myopathy, or an orthopedic disorder. The underlying pathophysiology involves autoimmune-mediated dysfunction of GABAergic inhibitory neurons, resulting in loss of muscle control. Treatment strategies include immunomodulatory therapies such as intravenous immunoglobulins and rituximab, alongside symptomatic management with baclofen and benzodiazepines. Long-term rehabilitation is essential to prevent complications and improve functional outcomes.

Conclusion: This case underscores the diagnostic complexity of pediatric SPS and the importance of multidisciplinary management. Early recognition is critical to prevent unnecessary surgical interventions and optimize therapeutic strategies. Greater awareness and further research are necessary to refine diagnostic approaches and treatment protocols in pediatric SPS.

Introduction: Acromioclavicular (AC) joint cysts are rare cysts often linked to degenerative shoulder issues. Although recurrence can limit treatment success, aspiration and corticosteroid injections are commonly used. Surgical removal is effective but may not be suitable for older patients or those with financial constraints. A minimally invasive double-loop suture technique offers a promising alternative.

Case report: An 80-year-old woman experienced painless swelling in her right AC joint measuring 8 × 5 cm for 4 months, as well as restricted shoulder movement and a 15-year history of falling. After a triamcinolone injection and aspiration, the cyst returned within a month. A clinical exam revealed a soft, movable, non-tender ganglion cyst. The outpatient procedure used a minimally invasive double-loop suture technique, placing two non-absorbable silk sutures perpendicularly through the cyst for drainage. Post-procedure care involved only a compression dressing, with no medications needed.

Results: The procedure lasted 10 min and was completed without complications. The patient experienced no immediate complications. The cyst resolved completely at 6 months and we are tracking long-term results and recurrence potential.

Conclusion: The double loop suturing technique is a simple and affordable outpatient treatment for recurrent AC joint cysts, especially for older patients or when surgery is not an option. It may lead to lower recurrence rates and is less invasive and less expensive than the surgical excision.

Introduction: Isolated tophaceous gout of the knee is a rare presentation, requiring a high degree of suspicion to differentiate it from chondrocalcinosis. If left untreated, chronic tophaceous gout can cause internal derangements and cartilage damage to the knee.

Case report: A 32-year-old male presented with a painful, swollen knee joint with stiffness. Magnetic resonance imaging (MRI) showed Arthrofibrosis with features of synovitis. Arthroscopic evaluation showed synovitis with chalky deposits over the chondral surfaces, menisci, anterior cruciate ligament and over synovium, which was typical of chondrocalcinosis, but histopathological analysis revealed uric acid crystals. Arthroscopic debridement of tophi with arthrolysis and partial synovectomy was done. The patient had a reduction in pain, and his range of movements improved.

Conclusion: Isolated tophaceous gout of the knee is rare; a strong index of suspicion is necessary to come to a diagnosis. MRI and arthroscopy findings can be deceiving; hence, histopathology and synovial fluid analysis are necessary to confirm the diagnosis. The arthroscopic management can yield good clinical outcomes.

Introduction: Knee joint dislocation is a rare and limb-threatening injury, which is often missed due to its association with other life-threatening injuries and is particularly challenging to manage in a low-resource setting. Our study is a longitudinal observational study evaluating the functional recovery trends following knee joint dislocation in a tertiary care hospital in the Himalayan Region of India.

Materials and methods: This was a longitudinal study conducted from September 2022 to June 2024. It included a total of 28 patients who presented to the hospital with a dislocated knee joint, of which half were managed surgically, while the other half were managed conservatively post-reduction. Functional outcomes were assessed using the Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) subjective score, and EQ-5D-5L at 6 weeks, 3 months, and 6 months. Statistical analyses were performed using the Statistical Package for the Social Sciences version 29.

Results: Of the 28 patients (22 males and 6 females; mean age 39.3 ± 13.4 years), exactly half were managed conservatively, and the other 14 operatively. Kennedy type A (75%), and Schenck KD I (36%) injuries predominated. Functional scores improved gradually across time points. At 6 months, mean Lysholm scores (conservative 61.7 ± 11.3 versus operative 64.3 ± 10.8, P = 0.53, Cohen's d = -0.24) and IKDC scores (61.2 ± 3.3 versus 54.1 ± 9.4, P = 0.63, d = 0.19) were statistically comparable. EQ-5D-5L indices (0.75 ± 0.09 versus 0.78 ± 0.08, P = 0.40) paralleled these findings. Repeated-measures analysis of variance revealed significant within-group improvement (F = 12.4, P < 0.001) but no group-time interaction (P = 0.72). Sensitivity analysis excluding vascular cases confirmed robustness (adjusted P = 0.61).

Conclusion: Both management modalities yielded equivalent short-term recovery. Conservative management, when feasible and with preserved vascular integrity, can achieve satisfactory functional outcomes along with reduced cost (approximately 40% lower than operative management) in low- and middle-income resource settings such as the Himalayan region. Enhanced rehabilitation access remains essential for recovery and better functional outcomes. Long-term, multicentric research is needed to provide more robust data on this topic.

Patient-centered care (PCC) has emerged as a pivotal approach in healthcare, emphasizing the need to treat patients as active participants in their care rather than passive recipients. It focuses on understanding the unique needs, values, and preferences of individuals, fostering empathy, shared decision-making, and holistic outcomes. This scoping review explores the role of mentorship, feedback mechanisms, and reflective practices in fostering empathy and cultural competence. This article examines the challenges in implementing PCC within the rigid frameworks of medical curricula and proposes actionable strategies for overcoming these barriers. By aligning orthopedic education with PCC principles, medical institutions can cultivate a new generation of orthopedic surgeons who prioritize holistic outcomes, ensuring comprehensive care that meets the physical, emotional, and social needs of patients. The review delves into the concept of PCC within the context of orthopedic training, exploring its relevance, current shortcomings, and strategies for effective implementation. It highlights innovative teaching methods, the role of interdisciplinary collaboration, and the importance of fostering empathy and cultural competence among orthopedic trainees. The integration of PCC into orthopedic education is a transformative step toward achieving holistic outcomes in musculoskeletal health. Adopting PCC in orthopedic education has far-reaching benefits. It fosters stronger doctor-patient relationships, leading to greater patient satisfaction and trust. Patients who feel heard and involved in their care are more likely to adhere to treatment plans and experience improved clinical outcomes. Moreover, PCC equips orthopedic surgeons to address the emotional and social dimensions of recovery, promoting a better quality of life for patients. PCC represents a transformative approach in orthopedic education, bridging the gap between technical expertise and holistic patient outcomes. As healthcare evolves, the role of PCC becomes increasingly significant in addressing not only the physical but also the emotional, social, and psychological needs of patients. Integrating PCC into orthopedic education equips future surgeons with the skills necessary to foster trust, empathy, and shared decision-making, ultimately enhancing patient satisfaction and recovery.

Introduction: Hamstring muscle injuries are among the most common muscle injuries. With about 12% involve avulsion of the proximal origin from the ischial tuberosity.

Case series: We present the outcome of four patients with acute, complete proximal hamstring tendon avulsions treated with a minimally invasive open repair using a double-row knotless suture anchor construct. The surgical technique, post-operative rehabilitation protocol, and clinical outcomes at 4-6-month follow-up are described. All patients achieved complete functional recovery and returned to their pre-injury activity levels without complications or tendon re-rupture.

Conclusion: These results demonstrate the clinical effectiveness of timely surgical repair using a knotless double-row technique for proximal hamstring avulsions.

Introduction: Ganglion cysts are benign soft-tissue lesions most commonly encountered around the wrist and hand, while their occurrence in the knee joint is relatively uncommon. An intratendinous location within the patellar tendon is exceptionally rare. This report describes a unique case of an intratendinous ganglion cyst of the patellar tendon, outlining its clinical presentation, imaging characteristics, surgical management, and histopathological confirmation.

Case report: A 39-year-old male with a history of Osgood-Schlatter disease presented with progressive anterior knee pain. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed, multilobulated cystic lesion within the patellar tendon, consistent with a ganglion cyst. The patient underwent complete surgical excision of the lesion, and histopathological examination confirmed the diagnosis. At follow-up, the patient exhibited full clinical recovery, return to sporting activities, and no evidence of recurrence on control MRI.

Conclusion: Intratendinous ganglion cysts of the patellar tendon are extremely rare and can mimic other etiologies of anterior knee pain. MRI remains the gold standard for diagnosis, whereas surgical excision provides definitive management. Recognition of this entity is essential for accurate differential diagnosis and appropriate treatment planning.

Introduction: Anterior cervical discectomy and fusion for single-level degenerative disc prolapse with myelopathy has been traditionally instrumented with an anterior cervical plate with a cage. However, as it has been associated with multiple complications, Zero-profile implants with locking screws have recently been used. The purpose of this study was to analyse the clinical and radiological outcome of Zero-profile devices in treating single-level cervical spondylotic myelopathy in the Indian scenario.

Materials and methods: In this prospective study, 30 patients have been treated by using two types of zero-profile implant: polyetheretherketone (PEEK) and Titanium. Apart from the per-operative parameters, both radiological and functional parameters (Japanese Orthopedic Association [JOA] and Neck Disability Index [NDI]) have been assessed at regular intervals up to a mean follow-up of 1 year. Complications related to the procedures have been documented and taken care of.

Results: Mean operative time was 65 ± 18 min, mean blood loss 60 ± 12 mL. The Cobb angle was significantly improved. Fusion with both types of implant was noted in around 75% cases at the end of 1 year. Subsidence was noted with PEEK implant in 25% cases. Disturbance of pre-vertebral soft tissue was minimum, which was reflected as only 26% cases of mild dysphagia at the end of 2 weeks. Both JOA score and NDI score improved significantly at the end of 1 year. No major complications were encountered.

Conclusion: Zero-profile implants prove to be effective in the treatment of single-level cervical myelopathy due to their biomechanical stability, ability to restore radiological parameters, and capacity to provide long-term functional improvement.Level of Evidence: III.

Introduction: Unstable peritrochanteric fractures of the femur are among the most challenging injuries in orthopaedic trauma, especially in the elderly with osteoporotic bone. The proximal femoral nail (PFN), a cephalomedullary device, offers potential biomechanical and clinical advantages.

Objectives: To assess (1) the functional outcome of PFN in unstable peritrochanteric femoral fractures using the Harris hip score (HHS); (2) the radiological outcome using the radiographic union score for hip (RUSH); and (3) complications associated with PFN fixation.

Materials and methods: A prospective observational study was conducted at the Department of Orthopaedics, Gajra Raja Medical College and J.A. Group of Hospitals, Gwalior (M.P.), from September 2022 to June 2024. A total of 74 patients with unstable peritrochanteric fractures (Arbeitsgemeinschaft für osteosynthesefragen [AO] 31A2.2-A3.3) were operated on using PFN. Functional outcome (HHS) and radiological outcome (RUSH) were evaluated at 6 weeks, 3 months, and 6 months postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences v26 with paired t-tests, considering P < 0.05 significant.

Results: The mean patient age was 54.3 ± 10.7 years; 67.5% were males. The most common fracture pattern was AO 31-A2.2 (40.5%). The mean operative time was 67.5 ± 11.1 min. Mean HHS improved significantly from 57.8 ± 8.9 at 6 weeks to 72.2 ± 4.7 at 3 months and 85.7 ± 6.2 at 6 months (P < 0.001). Radiological union (RUSH >18) was seen in 6.7% at 6 weeks, 54.1% at 3 months, and 98.6% at 6 months. Complications included superficial infection (4.05%), screw back-out (1.3%), reverse Z-effect (1.3%), and non-union (1.3%).

Conclusion: PFN provides stable fixation, early rehabilitation, and high union rates in unstable peritrochanteric fractures. Its minimal soft-tissue dissection and superior biomechanical profile make it a preferred implant, especially in osteoporotic bone.

Background: Testicular dislocation due to trauma is a rare and frequently overlooked consequence of high-energy injuries, particularly those involving pelvic fractures. Early recognition is crucial to prevent complications, such as atrophy, infertility, or persistent discomfort.

Case report: We present two cases of right testicular dislocation managed intraoperatively during anterior Pfannenstiel approaches for reduction and fixation of unstable pelvic ring fractures (Tile C2 and B3) in male patients following motor vehicle accidents. Preoperative computed tomography scans revealed the ectopic location of the test is within the pelvic cavity. Urologic collaboration was obtained intraoperatively in both cases, allowing manual reduction and fixation by orchidopexy. Definitive fracture stabilization was achieved with anterior plating and iliosacral screws.

Results: Both patients showed good urologic recovery. One developed a superficial wound infection that required surgical debridement, with favorable progression thereafter. Follow-up imaging demonstrated correct fracture consolidation in both cases. These cases underscore the need for systematic scrotal evaluation in male pelvic trauma patients.

Conclusion: Traumatic testicular dislocation, though infrequent, should be considered in the evaluation of patients with pelvic trauma, especially when scrotal abnormalities or ambiguous imaging findings are present. Multidisciplinary management involving orthopedic and urologic teams allows appropriate treatment and reduces long-term risks. When well recognized during diagnosis, surgical correction can be performed effectively.