Journal of Orthopaedic Case Reports最新文献

Introduction: The occurrence of non-traumatic bilateral femoral neck fractures is exceedingly rare, and their manifestation subsequent to an epileptic attack is an uncommon entity with very few cases reported globally.

Case report: We present the positive outcome of a 68-year-old man who underwent staged bilateral constrained total hip arthroplasty following a fracture resulting from a generalized seizure. This unconventional decision was justified based on several factors, including fracture pattern, bone quality, seizure history, and advanced tribology.

Conclusion: Epileptic patients pose a potential high risk for hip dislocation or fracture neck of femur. In such cases, we advocate for primary constrained arthroplasties as a viable and durable option, considering the specific circumstances and challenges associated with these patients.

Introduction: Thoracotomy through a median sternotomy is considered a risk factor for brachial plexus paralysis. We report a new case of poor prognosis despite lower radiculopathy.

Case report: A 53-year-old female (height 152 cm and weight 41 kg) complained of motor impairment in her left fingers, numbness in her left forearm, and paresthesia after left thoracotomy. A descending thoracic aortic replacement (20 mg J-graft 1 branch) had been performed through a left thoracotomy. After the surgery, she noticed movement disorder, numbness, and paresthesia and was referred to an orthopedic surgeon. Vitamin B12 formulation was administered, and she was followed up. The patient recovered motor function 8 months postoperatively, but numbness in the median nerve region remained 18 months after thoracotomy.

Conclusion: Even if brachial plexus paralysis persists as lower radiculopathy, nerve compression is relatively more severe in petite patients, suggesting that the prognosis may be poor.

Introduction: Total hip arthroplasty (THA) is recognized as one of the most effective surgical procedures for the treatment of end-stage hip arthritis. However, the increasing number of primary THA cases has led to a corresponding rise in the frequency of revision surgeries, which are often more complex and challenging due to severe acetabular bone loss. In such cases, managing Paprosky type 3A and 3B defects requires precise implant design and advanced surgical techniques. Standard acetabular augments and anti-protrusio cages are commonly used, but they often fail to provide the necessary stability, leading to re-revision rates as high as 36% within 10 years. This case series explores the efficacy of custom-made 3D-printed acetabular augments and cages in managing severe acetabular bone loss during revision THA.

Materials and methods: This retrospective case series includes seven patients who underwent revision THA for Paprosky grade 3 acetabular bone loss between January 2023 and April 2024 at two high-volume tertiary care centers. The mean age of the patients was 45 years, with three males and four females included in the study. Pre-operative planning involved advanced imaging techniques, including 3D-computed tomography scans and custom virtual modeling, to design the acetabular components tailored to each patient's specific anatomical requirements.During the surgeries, custom-made 3D-printed titanium augments and cages were used. These implants were fabricated using in-house software, and the turnaround time from the decision to surgery was approximately 10 days. Post-operatively, the planned 3D model was superimposed on post-operative radiographs to assess implant placement accuracy. The Harris hip score at the final follow-up averaged 69.16, with no signs of implant loosening observed.

Conclusion: Custom-made 3D-printed acetabular augments and cages offer a reliable and cost-effective solution for managing severe acetabular bone loss in revision THA. Despite the small sample size and short follow-up period, the results demonstrate the potential of these custom implants to improve outcomes in complex acetabular reconstructions. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings and establish long-term efficacy.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disorder that primarily affects the spine and sacroiliac joints, leading to pain, stiffness, and progressive thoracolumbar kyphotic deformity. A key complication in advanced AS is the development of Andersson lesions (AL), degenerative vertebral lesions resulting from the disease's progression. These lesions can cause significant mechanical pain, often mistaken for the chronic discomfort associated with AS. The exact cause of AL remains unclear, with hypotheses ranging from spinal stress fractures to delays in the ankylosing process. Understanding AL's pathophysiology is essential for timely diagnosis and effective management.

Case report: A 52-year-old male presented with a 20-year history of diffuse abdominal pain, later developing insidious lower back pain over the past 2 months. The pain was aggravated by walking and prolonged standing. Physical examination revealed tenderness in the D11 region of the spine, with limited chest expansion and positive findings on the modified Schober's test. Radiographic studies showed irregularities and erosions at the D11-D12 vertebral levels, and magnetic resonance imaging confirmed the presence of an AL associated with asymmetrical bilateral sacroiliitis. The patient tested positive for human leukocyte antigen-B27, supporting a diagnosis of AS with an AL. Medical management, including methotrexate, sulfasalazine, non-steroidal anti-inflammatory drugs, and corticosteroids, led to significant pain reduction and improved mobility. The patient's condition remained stable with continued treatment over a 2-year follow-up period.

Conclusion: AL s are chronic, often overlooked complications of AS that can lead to spinal instability and neurological deficits if untreated. Early recognition and management are critical to preventing progressive kyphotic deformities and associated complications. While conservative treatment remains the cornerstone for managing AL, surgical intervention may be required in cases of severe pain, deformity, or neurological involvement. Understanding AL's presentation and treatment options is vital for improving patient outcomes in AS.

Introduction: Medial open wedge-high tibial osteotomy (MOW-HTO) is a standard procedure for treating moderate varus arthritis in active adults. The reason for its popularity is having lesser complications than other types of HTO. However, it is not devoid of challenges. We report tibial nerve injury in a MOW-HTO which is a rare complication not reported much in the past.

Case report: A 56-year-old female was operated with MOW-HTO using TomoFix plate for medial joint arthritis and varus malalignment. She developed signs of tibial nerve injury, namely inability to flex the great toe and paresthesia over posterolateral leg and sole of foot. The nerve conduction velocity study confirmed tibial nerve damage with moderate axonotmesis. The patient was treated conservatively with electrical stimulation, interferential current therapy, physiotherapy, and pregabalin. The osteotomy outcome was good with complete union and good angle correction. At the end of 14 years, the motor function was fully recovered, but the patient still had residual paresthesia. After eliminating all other possible causes, the authors concluded that the etiology of the nerve damage was stretch injury. Smaller incisions are related to excessive retraction leading to unreasonable stretching of the soft tissues and nerves. To avoid such injuries during MOW-HTO, the authors propose an adequate length of incision along with other steps like subperiosteal Hohmann placement to protect neurovascular structures, flexing the knee during the procedure, maintaining posterior position of the plate, and using proper size screws. The main goal of this study is to make surgeons conscious about this rare but possible complication of MOW-HTO.

Conclusion: Surgeons need to be aware about this rare complication in MOW-HTO surgery and should be vigilant in recognizing its post-operative signs.

Introduction: Fibular- and tibiofibular-based reconstructions are the gold standard treatment for posterolateral corner (PLC) injuries of the knee. This is the first report describing a wholly tibial-based PLC reconstruction.

Case report: A 50-year-old female presented with knee instability following proximal fibular resection for a benign tumor, associated with chronic anterior cruciate ligament (ACL) deficiency from a previous injury. Magnetic resonance imaging (MRI) showed fibular collateral ligament (FCL) and distal biceps femoris complete detachment. ACL reconstruction was combined with revision PLC reconstruction, placing the distal grafts, due to lack of fibula, both into the tibia. At 24-month follow-up, the patient reported excellent clinical outcomes.

Conclusion: In cases related to proximal fibula deficiency from resection or congenital causes, a wholly tibial-based PLC reconstruction can effectively restore stability.

Introduction: Road traffic accidents (RTA) account for a sizable portion of morbidity and mortality globally, with a particularly high incidence among young and active individuals. Patients presenting with polytrauma require a multidisciplinary approach guided by protocols for advanced trauma life support.

Case report: We report the case of a 31-year-old female, transferred-in to our center following primary care after an RTA on June 17th, 2023. Initial assessment at the other hospital found multiple fractures accompanying her internal injuries - a right haemothorax and pulmonary contusion, with Grade 3 injuries to the liver, spleen, and kidneys. The patient, who was also found to be pregnant, presented to our facility with hypotension and breathlessness. Stabilization efforts spanned to include ventilatory support following resuscitation in the intensive care unit. Upon achieving hemodynamic stabilization, early definitive fixation was meticulously planned and implemented, leading to intramedullary nailing of the femur, open reduction and internal fixation in the left wrist, and percutaneous fixation of the right acetabulum. Despite landing in post-operative complications such as pleural effusion and subcutaneous emphysema, the patient showed remarkable recovery and was successfully extubated on June 27th, 2023. She was discharged vitally stable, and continued recovery at her residence. The patient managed to regain full range of motion in all joints, with good union of fractures at the end of her 1-year post-operative follow-up period.

Conclusion: This case highlights the importance of tailoring an approach which was unique to the polytrauma presentation. While damage control orthopaedics is often recommended in unstable patients, early definitive orthopedic care must be considered where patients are successfully resuscitated and stabilized, invariably improving trauma outcomes.

Introduction: Giant cell tumor of bone (GCTB) ranks among the most prevalent locally aggressive tumor lesions, displaying a diverse range of biological behaviors. Recurrence of GCTB is well-documented, often attributed to microscopic tumour remnants remaining after intralesional curettage, with increased concern when infection occurs postoperatively. Studies suggest the limited effectiveness of adjuvants in preventing giant cell tumour recurrence, emphasizing the necessity of complete removal of malignant cells. We describe our experience with a rare presentation of recurrence together with infection in an operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization.

Case report: A 28 year-old female who was operated case of GCTB right proximal tibia with curettage with cementing and plate stabilization in 2020 presented to our outpatient department with complaints pain in right leg while walking for 3 months in October 2021. Plain radiography of the right knee suggestive of lytic lesion over medial aspect of the right tibia around cement with plate in situ and magnetic resonance imaging right knee suggestive of recurrence of the tumor with no breach in joint line and no involvement of neurovascular structures. The patient was planned for implant removal with extended curettage and plate stabilization and cementing with antibiotics (vancomycin and gentamycin) after sending tissues for culture sensitivity and histopathology. Intraoperative cultures showed growth of methicillin-sensitive staphylococcus aureus which was sensitive to cefoxitin, gentamicin, cotrimoxazole, and doxycycline following which pt received 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics as per culture sensitivity with no post-operative wound complications and had satisfactory functional outcome. The patient was followed at regular intervals till 2-year follow-up did not show any signs of recurrence and infection.

Conclusion: The manifestation of GCTB recurrence alongside infection is exceedingly rare with limited literature evidence. Our case illustrates a method to address both issues concurrently during a single procedure, utilizing antibiotic bone cement to tackle infection and extended curettage for thorough removal of neoplastic cells from the surrounding bone.

Introduction: Extreme beak calcaneal fractures (Type 2 Lee's tuberosity avulsion fractures) are rare injuries, accounting for only 1.3-3% of all calcaneal fractures. These injuries are considered as surgical emergency as they can lead to significant functional impairment and soft-tissue compromise if not promptly managed. This study evaluates the efficacy of cannulated cancellous (CC) screw fixation for these fractures.

Materials and methods: A prospective study of 14 patients with extreme beak calcaneal fracture (Type 2 Lee's - tuberosity avulsion fractures) treated with CC screw fixation was conducted in VMMCH, Karaikal, Puducherry between June 2022 and June 2023. Patients were followed for a minimum of 12 months. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale.

Results: The mean AOFAS score at the final follow-up was 89.3 (range 78-98). Radiographic union was achieved in all cases by 20 weeks with a mean union time of 13.09 weeks in closed fractures and 18 weeks in open fractures. One patient developed a superficial wound infection without any alarming signs of hardware issues, which resolved eventually. No hardware failures or need for revision surgeries were observed.

Conclusion: Early intervention with CC screw fixation appears to be an effective and safe technique for the treatment of extreme beak calcaneal fracture (Type 2 Lee's - tuberosity avulsion fractures), resulting in excellent functional outcomes and a low complication rate.

Introduction: Aneurysmal Bone Cyst (ABC) is a benign, non neoplastic, expansile lesion of bone characterized by channels of blood and spaces separated by fibrous septae. ABC of femoral head is an extremely rare condition and is difficult to treat as the surgical approach is a dilemma .

Case report: We hereby report a case of aneurysmal bone cyst in femoral head of a 19 year old female patient. To preserve the vascularity of the femoral head, we approached the lesion by ganz safe surgical dislocation of the affected femoral head, trapdoor procedure of femoral head followed by curettage and bone grafting . The patient was followed up for 6 months & at latest follow up, lesion has healed completely & patient is walking pain free .

Conclusion: In rare cases like ABC of femoral head, a trapdoor osteotomy of femoral head with bone grafting followed by stabilization of the bone graft and osteotomy gives excellent functional and radiological outcomes.