Journal of Orthopaedic Case Reports最新文献

Introduction: Scaphoid is the most common carpal to be fractured (60%), caused by fall on outstretched hand, and proximal pole fractures are difficult to manage due to the high risk of non-union and osteonecrosis due to retrograde blood supply. Conservative management of proximal pole fractures leads to high rates of non-union; hence, different surgical techniques have been devised to address bone loss and optimize vascularity at fracture site to promote healing, such as vascularized bone grafting (VBG) and non-VBG. We report the use of proximal hamate as a replacement arthroplasty in the context of proximal pole non-unions with collapse, bone loss, and/or osteonecrosis as an innovative approach.

Case report: A 26-year-old Air Force personnel presented with left wrist pain and difficulty in movement and lifting. He had a fall on an outstretched hand causing a proximal scaphoid fracture, initially treated with Herbert screw fixation, resulting in non-union. A revision surgery with iliac crest bone grafting and Kirschner wire fixation was performed after 6 months, but non-union persisted.

Conclusion: This novel surgical technique of using proximal hamate autograft for reconstruction of osteonecrosis proximal pole of scaphoid has shown promising result with union within 10 weeks and good functional outcome with pain-free near full wrist arc.

Introduction: Osteoarthritis (OA) remains one of the most frequent causes of chronic pain and disability in older adults. Although traditionally described as a degenerative condition, clinical experience increasingly suggests that inflammatory activity may modulate symptom severity and structural damage. This study was undertaken to examine how routinely measured inflammatory markers relate to clinical status and radiological severity in elderly patients with OA.

Material and methods: A hospital-based cross-sectional study was conducted among 134 patients aged 60 years or older with clinically and radiologically confirmed OA of the knee and/or hip. Pain severity was assessed using the visual analog scale, while functional impairment was evaluated with the Western Ontario and McMaster Universities OA Index. Radiographic severity was graded according to the Kellgren-Lawrence (K-L) classification. Laboratory assessment included measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Statistical analyses were performed to explore associations between inflammatory markers and clinical as well as radiological parameters.

Results: The study cohort was predominantly female, and knee involvement was more frequent than hip disease. Most participants fell within the mild to moderate range of radiological severity. Both ESR and CRP levels increased progressively with higher K-L grades. Differences in inflammatory marker levels across radiological grades were statistically significant. Correlation analysis demonstrated positive associations between inflammatory markers and pain scores, functional limitation, and radiographic severity, indicating that higher inflammatory activity was accompanied by worse clinical and structural disease.

Conclusion: In elderly patients with OA, ESR and CRP show meaningful correlations with pain intensity, functional impairment, and radiological grading. These findings support the presence of a low-grade systemic inflammatory component that parallels disease severity and may influence clinical expression.

Introduction: Carpometacarpal (CMC) dislocations are rare and usually result from high-energy trauma. The most frequent direction of dislocation is dorsal, even if the dorsal ligaments are stronger than the volar ones. We report a case of volar CMC dislocation with concomitant thumb interphalangeal injury.

Case report: We report the case of a 30-year-old right-handed male who sustained a left volar CMC dislocation with an associated posterolateral interphalangeal dislocation of the thumb following a motorcycle accident. Clinical examination revealed dorsal concavity of the hand and a thumb deformity with a 2-cm open wound, while finger mobility and sensation were preserved. Standard radiographs confirmed the dislocations. The patient underwent wound debridement and closed reduction under general anesthesia, followed by immobilization with an anterior splint including the thumb. Complete wound healing was achieved by day 12, and the splint was removed at 45 days. Progressive active mobilization started in the 3rd post-operative week. At 3 months follow-up, the patient had full recovery of wrist and finger motion and returned to work at 8 weeks.

Conclusion: Early diagnosis, careful reduction, and structured rehabilitation are key in managing complex volar CMC dislocations with concomitant thumb injuries. Multidisciplinary management ensures optimal functional outcomes and prevents long-term disability.

Introduction: Fungal infections of native joints are exceedingly rare and often present with non-specific symptoms, making diagnosis challenging. Hip involvement is particularly uncommon and may mimic tuberculosis or bacterial septic arthritis. Patients on long-term hemodialysis are at increased risk due to their immunocompromised state and repeated vascular access.

Case report: We present the case of a 52-year-old male with chronic kidney disease on maintenance hemodialysis for 5 years, who developed progressive left hip pain and functional limitation over 18 months. Radiological evaluation revealed destructive arthritis. He underwent a two-stage procedure: Initial debridement with insertion of an antibiotic cement spacer, during which intra-operative cultures yielded Candida guilliermondii. The patient received six weeks of intravenous Caspofungin. After normalisation of inflammatory markers, a second-stage total hip replacement was performed. Post-operatively, the patient achieved independent ambulation with significant pain relief and improved hip function.

Conclusion: Candida guilliermondii infection of the native hip in dialysis-dependent patients is exceptionally rare. Early diagnosis with culture confirmation, followed by antifungal therapy and staged surgical management, is critical for optimal functional recovery.

Introduction: Femoral shaft fractures represent approximately 1.6% of all bone injuries in children. Angulation, malrotation, and shortening are not always corrected effectively by conservative methods. These also depend on fracture anatomy: Stable (transverse and oblique) and unstable (spiral and comminuted). In recent years, flexible intramedullary nailing has gained wide acceptance for treating pediatric and adolescent femoral fractures because of the lower chance of iatrogenic infection and the prohibitive cost of in-hospital traction and Spica cast care. The present prospective study was designed to evaluate outcomes of stable and unstable diaphyseal femoral fractures in children aged 5-15 years using the titanium elastic nailing (TEN) system. Both subjective and objective parameters were assessed, including pain relief, patient comfort, early mobilization, surgical technique, radiographic union, progression of weight bearing, and post-operative complications.

Materials and methods: Children and adolescents between 5 and 15 years of age with femoral shaft fractures admitted to Teerthanker Mahaveer Medical College and Research Centre, Moradabad, and fulfilling the inclusion criteria were enrolled in the study. All selected patients were treated using TEN for fracture fixation. Post-operative follow-up was conducted over 6 months at 6, 12, and 24 weeks. A total of 90 cases were analyzed, comprising 45 stable and 45 unstable fractures. The results showed favorable outcomes in stable fracture cases, whereas among unstable fractures, three patients developed angular deformities and one patient had limb shortening.

Conclusion: Titanium elastic nails lead to rapid fracture union by preservation of fracture hematoma and limited soft tissue exposure. It also helps in preventing damage to the physis. A stable pediatric femoral diaphyseal fracture has very good results with minimal complications. Unstable pediatric femoral diaphyseal fractures, though they had good results in most cases, had angular deformities in 3 cases, and 1 case developed limb shortening. Based on the findings of this study, alternative surgical methods may be more suitable for severely unstable pediatric femoral shaft fractures. Overall, TEN should be regarded as the preferred treatment option for femoral diaphyseal fractures in children aged 5-15 years.

Introduction: Periprosthetic dislocations remain a prevalent complication following total hip arthroplasty, with heightened risks in elderly patients and those with cognitive impairments. While most cases can be managed with closed reduction, irreducible dislocations are rare and may be due to unusual mechanical or soft-tissue impediments.

Case report: This case report describes an 87-year-old woman with an irreducible prosthetic hip dislocation due to penetration of the femoral head through the gluteus medius musculature after a ground-level fall. After multiple failed closed reduction attempts, the patient developed a foot drop with sensory changes indicating a sciatic nerve palsy. Open reduction was then indicated, along with neurolysis of the sciatic nerve.

Conclusion: The case underscores the challenges of managing complex hip dislocations in older adults and highlights the importance of addressing mechanical and neurological factors during treatment.

Introduction: Paramilitary recruits undergo repetitive high-intensity physical training, predisposing them to overuse musculoskeletal injuries such as stress fractures. Bone mineral density (BMD) and body mass index (BMI) are key determinants of bone strength, yet limited data exist from Indian paramilitary populations. This study aimed to evaluate BMD status and examine its association with BMI and stress fractures among active recruits.

Materials and methods: A descriptive cross-sectional study was conducted among 200 paramilitary recruits (mean age 26.3 ± 3.88 years). BMD was measured at the calcaneus using a quantitative ultrasound densitometer (CM-300). BMI was calculated using standard anthropometric techniques. Stress fractures were diagnosed based on clinical evaluation, medical record review, and radiographic confirmation when indicated. Dietary pattern, rank, and lifestyle factors were recorded using a structured questionnaire. Associations were analyzed using chi-square tests and correlation statistics, with significance set at P < 0.05.

Results: The mean BMD T-score was -0.676 ± 0.572, with 24.5% of participants demonstrating osteopenia. Stress fractures were documented in 16% of recruits. Abnormal BMI (underweight 2.5%, overweight 13%) showed a significant association with osteopenia (P = 0.029). Low BMD was strongly associated with stress fractures, with 78.1% of fracture cases exhibiting osteopenia (P < 0.01). Assistant commandants had a higher prevalence of low BMD compared with constables (35.5% vs. 17.7%, P = 0.005). Vegetarian recruits demonstrated significantly higher osteopenia and stress-fracture rates (P < 0.01).

Conclusion: Low BMD and abnormal BMI significantly increase susceptibility to stress fractures among paramilitary recruits. The high prevalence of osteopenia despite intensive physical activity highlights the need for routine BMD screening, BMI-focused conditioning, and structured nutritional interventions to enhance bone health and reduce training-related injuries.

Introduction: Subtrochanteric stress fractures are rare and often underdiagnosed due to their subtle clinical presentation and inconspicuous early radiological findings. While these fractures are frequently seen in elderly osteoporotic individuals or those on bisphosphonate therapy, they are uncommon in younger, premenopausal women without significant risk factors. This case highlights a rare instance of a non-displaced subtrochanteric stress fracture in a 45-year-old woman with osteopenia.

Case report: A 45-year-old housewife presented with a progressively worsening, insidious pain in the anteromedial aspect of her left proximal thigh for the past month and a half. The pain, which worsened with activities, such as climbing stairs and squatting, was non-traumatic and unrelieved by rest. Initial radiographs showed no abnormalities, prompting a magnetic resonance imaging (MRI), which revealed a non-displaced subtrochanteric stress fracture with surrounding bone marrow edema. A DEXA scan confirmed osteopenia (T-score of -2.1 at the femoral neck), and laboratory tests were within normal limits.Management and Outcome: Conservative management was initiated, including strict non-weight-bearing for 6-8 weeks, followed by partial weight-bearing, physiotherapy, and calcium and vitamin D supplementation. At 8 weeks, the patient reported significant pain relief and improved functional mobility. A follow-up MRI at 6 months demonstrated complete healing with no signs of delayed union or cortical disruption.

Conclusion: In this case, a non-displaced subtrochanteric stress fracture in a premenopausal woman without bisphosphonate use or antecedent trauma presented as unexplained proximal thigh pain with normal initial radiographs. MRI enabled early diagnosis, and conservative management with non-weight-bearing and metabolic optimization resulted in complete fracture healing without the need for surgical intervention.

Introduction: Intraosseous lipomas and simple bone cysts are mesenchymal bone tumors sharing similar characteristics and a suspected common pathophysiologic basis. Fatty involution of simple bone cysts is rare, especially in the proximal humerus. This report highlights a symptomatic case of fatty transformation in the proximal humerus, emphasizing diagnostic challenges and a novel surgical management approach.

Case report: A 36-year-old male presented with progressive left shoulder pain. Imaging revealed a lytic lesion in the proximal humeral metaphysis. The patient underwent extended curettage, bioabsorbable antibiotic-loaded cement bead application, and autologous bone grafting. Histopathology confirmed fibroadipose tissue with fatty involution. The patient resumed daily activities within 2 weeks, showing significant improvement with disabilities of the arm, shoulder, and hand scores improving from 35 at 2 weeks to 5 at 4 weeks postoperatively.

Conclusion: Extended curettage with bio-absorbable antibiotic-loaded cement beads and autologous bone grafting is an effective option for managing symptomatic fatty involution in the proximal humerus. It provides complete lesion removal and structural reinforcement, offering excellent functional outcomes. Symptomatology should guide treatment decisions rather than imaging characteristics alone.