Journal of Orthopaedic Case Reports最新文献

Introduction: Plantar fasciitis is a common condition characterized by pain at the heel, particularly in the morning with the first step out of bed and initial steps after a long break. Corticosteroids were the mainstay of treatment for plantar fasciitis, but now other modalities are being tried. One such modality is the multiple puncture technique. The present study aims to compare the efficacy of the multiple puncture technique and corticosteroid in the treatment of plantar fasciitis.

Materials and methods: A total of 38 patients were included in the study. Diagnosis of plantar fasciitis was made clinically based on history and presence of medial calcaneal tenderness. In the corticosteroid group, a 5 mL sterile syringe was taken and 2 mL of 2% lignocaine solution was loaded, while in the multiple puncture technique, 4-5 pricks were made in the plantar fascia close to the area of degeneration.

Results: Mean Visual Analog Scale score and mean American Orthopedic Foot and Ankle Society score improved in both groups at 1 week, 1 month, and 3 months follow-up. The improvement was found to be statistically significant in all three follow-ups (P < 0.01).

Conclusion: Multiple puncture technique is a safe and effective modality of treatment for plantar fasciitis.

Introduction: Humerus fractures can be caused by significant force, minor incidents, or pre-existing bone conditions. They have been historically managed with either conservative or surgical management. Recently, a shift toward surgical management can be seen due to the need for quicker functional recovery. A recent method has emerged back to the surface, and its outcomes are being reported more and more, which is the method of closed reduction and fixation using bundling techniques.

Case report: We present a 68-year-old female who presented with an isolated closed left spiral humerus fracture at the junction of the proximal ⅔ and distal ⅓ following a fall. She was managed with three elastic nails of size 3 mm filling the medullary canal. She was followed closely postoperatively and healed without issues in range of motion, stiffness, or pain.

Conclusion: This case study examines the management of a humeral fracture in a geriatric patient using three free-floating elastic intramedullary nails. The successful outcome of this approach suggests that this treatment option offers adequate stability for humeral shaft fractures in older adults and can be easily implemented in similar fracture patterns.

Introduction: The REGENETEN® bioinductive collagen implant (Smith and Nephew, Andover, MA) has been increasingly used in rotator cuff repair as a biological scaffold to promote tendon regeneration. Clinical studies have shown favorable healing and reduced retear rates, with complications considered rare. We present a rare case of loose body formation within the subacromial bursa following rotator cuff repair with REGENETEN®.

Case report: A 60-year-old man presented with the right shoulder pain. Magnetic resonance imaging (MRI) revealed a partial-thickness tear of the supraspinatus tendon, and conservative treatment was initiated. Due to persistent nocturnal pain, arthroscopic repair was performed 3 months later using a medium-sized REGENETEN® implant secured on the tendon surface. Postoperatively, passive range-of-motion exercises began at 2 weeks, and active exercises at 3 weeks. At 6 weeks, the patient developed recurrent shoulder pain and mechanical catching. Despite continued rehabilitation, symptoms worsened. At 6 months, MRI demonstrated a hypointense structure within the subacromial bursa. Diagnostic arthroscopy revealed a whitish, mobile loose body measuring 16 × 13 mm, containing a medial implant staple encapsulated by fibrous tissue, while the repair site remained intact. The loose body was excised arthroscopically. Histological examination demonstrated fibrin deposition, infarcted necrotic fibrous tissue, and fibrocollagenous proliferation, findings consistent with a foreign body reaction. The post-operative course was uneventful, symptoms resolved within 1 month, and the patient returned to full occupational activity within 2 months.

Conclusion: Although REGENETEN® has been proven safe and effective, rare complications such as implant detachment and foreign body reactions should be considered. Unlike rice body formation, which is associated with systemic inflammatory conditions and necessitates evaluation for underlying rheumatologic disease, the present case represents an implant-derived loose body that was definitively treated by surgical excision. To the best of our knowledge, this is a rare case of loose body formation within the subacromial bursa due to migration of a REGENETEN® implant staple. Awareness of this complication is clinically important in patients with persistent post-operative mechanical symptoms following rotator cuff repair with REGENETEN®.

Introduction: Machine learning (ML) applications in pre-operative templating for total hip arthroplasty (THA) require systematic validation through prediction-verification methodologies to establish clinical utility and safety.

Materials and methods: We conducted a retrospective case series of 9 consecutive THA cases between March and September 2025. A hybrid ensemble ML system performed pre-operative templating using standardized radiographs with magnification correction. Predictions were systematically validated against actual intraoperative component selections through post-operative analysis. Primary outcomes included component-specific accuracy with descriptive statistics. Secondary outcomes included clinical safety and feasibility assessment.

Results: The ML system achieved 85.7% overall templating accuracy across all cases. Component-specific accuracies were stem type 100% (9/9), stem sizing 88.9% (8/9), cup sizing 66.7% (6/9), head sizing 54.4% (5/9), and material selection 95.6% (9/9). High templating accuracy (≥97.7%) was achieved in 44.4% of cases (4/9). The system demonstrated conversion risk prediction capability in one case. Clinical outcomes showed a 100% success rate with zero complications and no reoperations at a mean of 17.2 ± 8.1 weeks of follow-up.

Conclusion: ML-assisted pre-operative templating demonstrates feasibility for THA planning with encouraging accuracy results and excellent clinical safety. These findings support the potential for larger validation studies. The prediction-verification methodology provides a systematic framework for ML validation in orthopedic surgery.

Introduction: Total knee arthroplasty is one of the most common orthopedic surgeries performed worldwide. As a major surgery, it has its own spectrum of complications, one of which is a retained surgical drain requiring prompt management. While traditional imaging modalities have limitations in localizing retained drain segments, 3D computed tomography (CT) offers enhanced visualization capabilities.

Case report: We report two cases with retained segments of surgical drains after total knee arthroplasty. In the first case, a 56-year-old female had a retained drain segment that broke after an attempt to remove it. In the second case, a 69-year-old male experienced drain breakage due to impingement between the patella and the femoral component. Both cases were successfully managed using 3D CT for precise localization, enabling minimally invasive retrieval through targeted suture removal rather than extensive wound exploration.

Conclusion: Three-dimensional CT can play a valuable role in managing these complications. It can help accurately mark the site and measure dimensions from the proximal suture line, ultimately enabling a minimally invasive re-exploration.

Introduction: Osteogenesis imperfecta (OI) is a rare inherited connective tissue disorder caused by defective type I collagen, which predisposes patients to recurrent fractures, skeletal deformities, and long-term disability. Intramedullary nailing is widely regarded as the gold standard for surgical stabilization of long bone fractures in OI due to its load-sharing capacity, deformity correction, and ability to prevent future fractures.

Case report: We describe the case of a 34-year-old female with type IA OI who presented with a spontaneous mid-shaft femur fracture while weight-bearing. She had a history of multiple previous fractures, including bilateral forearm fractures and an atypical femoral fracture, all managed conservatively.

Intervention: The patient underwent closed reduction and internal fixation with a proximal femoral nail (PFN). Under fluoroscopic guidance, a long intramedullary nail was inserted, and proximal and distal locking screws were applied to ensure stability. The procedure was performed with minimal soft-tissue disruption.

Outcome: Radiographic follow-up demonstrated progressive fracture consolidation at 8 weeks, allowing transition to full weight-bearing by 5 months. The patient regained near pre-injury functional status without complications such as implant migration, delayed union, or infection.

Conclusion: This case highlights the effectiveness of PFN in managing femoral fractures in OI patients. PFN provides stable fixation, facilitates early mobilization, and reduces refracture risk. With careful implant selection, surgical planning, and vigilant post-operative monitoring, intramedullary nailing significantly improves functional outcomes and quality of life in OI patients.

Introduction: Scapulothoracic fusion is a procedure used to treat severe cases of scapular instability, most commonly due to facioscapulohumeral dystrophy (FSHD). Patients who undergo scapulothoracic fusion surgery are at risk for neurovascular complications such as brachial plexus (BP) injury.

Case report: A 35-year-old right-hand-dominant female with FSHD who underwent scapulothoracic fusion that was complicated by a BP injury, which did not improve with reoperation for scapular repositioning.

Conclusion: We performed a novel treatment of dorsal claviculectomy, after which the patient experienced near complete recovery of her BP injury. Dorsal claviculectomy can be considered as a treatment option for BP injury following scapulothoracic fusion to relieve BP stretch and promote neural recovery.

Introduction: The report describes hook plate fixation for an isolated, displaced pisiform fracture characterized by a small proximal fragment.

Case report: A 64-year-old woman presented with ulnar-sided wrist pain after a fall. Radiography and computed tomography revealed intra-articular displacement with mild comminution. Open reduction and internal fixation using a 1.2-mm hook plate resulted in a stable anatomical reduction without the need for fragment excision. Postoperatively, the wrist was immobilized in a volar splint in neutral position for 3 weeks, after which progressive mobilization was initiated. At 12-month follow-up, the patient was pain-free with wrist extension of 85° and flexion of 75°. Grip strength was 29.6 kg on the operated side, while 24.3 kg on the contralateral side. Patient-reported outcomes were excellent, indicating satisfactory functional recovery and pain relief. Radiographs confirmed bone union and anatomical alignment, with no evidence of pisotriquetral degenerative changes.

Conclusion: Hook plate fixation may represent a feasible joint-preserving alternative for select comminuted pisiform fractures with small fragments, offering stable fixation and enabling relatively early rehabilitation.

Introduction: Pancreatic neuroendocrine carcinomas are rare, high-grade malignancies accounting for <2% of pancreatic cancers. They frequently metastasize to the liver and lymph nodes, while skeletal involvement is uncommon. Spinal metastasis as the initial manifestation is exceedingly rare and poses a diagnostic challenge, especially for orthopedic surgeons who often encounter such lesions under the suspicion of infection or primary bone tumor.

Case report: A 20-year-old male presented with acute-onset paraparesis and loss of bladder control. Radiographs and magnetic resonance imaging revealed destructive lesions at D1-D2 with epidural compression and additional vertebral deposits. Emergency decompression was done. Histopathology showed sheets of small round cells, and immunohistochemistry demonstrated positivity for Pan-cytokeratin, synaptophysin, CD56, CK20 (dot-like), and a high Ki-67 index (50-60%), confirming high-grade neuroendocrine carcinoma. A whole-body positron emission tomography-computed tomography identified a metabolically active pancreatic tail mass with multiple hepatic, nodal, and skeletal metastases. The patient received four cycles of cisplatin-etoposide, followed by capecitabine and temozolomide for an incomplete response. Post-operative neurological function improved, and the patient remains ambulant with stable disease on serial imaging.

Conclusion: Spinal cord compression may exceptionally rarely be the presenting feature of pancreatic neuroendocrine carcinoma. For orthopedic surgeons, early recognition of atypical spinal lesions, timely decompression, and prompt multidisciplinary referral are critical for achieving functional recovery and improving quality of life even in advanced systemic malignancy. High suspicion, tissue diagnosis, and timely decompression are essential for functional preservation.

Introduction: Prosthetic instability remains a major challenge in total hip replacement (THR), which can result in dislocation, reduced mobility, and prosthetic loosening, requiring revision surgery. The forced drop leg test (FDLT) introduces a proactive approach by assessing hip stability under forced flexion, adduction, and rotation mimicking real-world dislocation mechanisms.

Technique: Standard exposure and trial implants are utilized to evaluate fit and alignment. With the trial components in place, the leg is abducted to 30-40°, then forcefully dropped into a sterile pouch in front. The hip joint is subsequently examined for dislocation or subluxation. In case of any dislocation or subluxation, reassessment of the component size and position is necessary.

Conclusion: Preliminary evidence suggests that FDLT enhances existing stability checks, although broader clinical validation and protocol standardization are necessary to confirm its effectiveness.