Journal of Orthopaedic Case Reports最新文献

Introduction: Post-traumatic arthritis following acetabular fracture fixation is the most common cause of chronic hip pain and disability. Following an acetabular fracture, there is a high chance of secondary osteoarthritis; thus, the total hip replacement (THR) serves as a reliable procedure. However, doing THR after prior open reduction and internal fixation (ORIF) of the acetabulum is technically challenging due to scarring, distorted anatomy, implant in situ, and scanty bone stock. The study aims to assess the surgical difficulties, complications, and functional results in patients undergoing THR after acetabular fracture fixation.

Materials and methods: It is a retrospective study conducted in Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India between January 2018 and December 2023. Thirty-one patients who had prior acetabular fixation and subsequently underwent THR were included. The demographics data, fracture pattern, surgical approach, implant type, and complications were recorded. Functional outcomes were assessed by using the Harris Hip Score (HHS) pre-operatively and following subsequent follow-up. Radiological evaluations were done to assess the component alignment, bone graft incorporation, and to determine if any signs of loosening.

Results: The mean age was 52.3 years (range: 38-72), with 21 males and 10 females. The mean follow-up was 18 months. The mean pre-operative HHS improved from 48 to 85 (P < 0.001). However, the major intraoperative difficulties included the previous implant, that is, acetabular plates or screw removal (30%), poor bone stock (20%), and difficult component positioning (26.7%). However, there were minimal complications. One patient had transient sciatic neuropraxia. There were no deep-seated infections, dislocations, or early loosening of implants reported. Both the cemented (11 cases) and uncemented (20 cases) THR provided satisfactory fixation.

Conclusion: THR after the acetabular fracture fixation is technically complex but gives excellent results when performed with meticulous surgical planning and proper implant selection. The cemented THR is done in old patients having osteoporotic bone, while uncemented components are done in younger patients, which gives long-term stability.

Introduction: Radial club hand is a rare congenital condition (1 in 100,000) involving varying deformities on the radial side of the forearm, ranging from thumb underdevelopment to absence of the radius and related structures. It can be isolated or part of syndromes, such as thrombocytopenia-absent radius, Holt-Oram, or vertebral, anal, cardiac, tracheo-esophageal, renal, limb, and is bilateral in 50-72% of cases.

Case report: A 12-year-old right-handed girl presented with an isolated, non-syndromic right radial club hand and flexion deformity at the wrist and elbow, without functional impairment. Her pathology did not fit existing Bayne and Klug or Heikel classifications, as her proximal radius was absent but the distal epiphysis and wrist were developed. A corrective wedge osteotomy with bilobed skin flaps was performed to realign the forearm. No intervention was made at the wrist or musculotendinous units, resulting in an acceptable outcome.

Conclusion: Reasonable outcome could be obtained in a rare case of complex congenital anomaly like radial club hand following a minimalist approach of wedge osteotomy alone to correct the forearm deformity.

Introduction: Fracture healing is a complex biological process influenced by systemic biochemical factors that regulate bone formation and remodeling. Evaluating the association between biochemical markers and radiographic evidence of union may enhance understanding of fracture repair and help predict healing outcomes.

Materials and methods: This prospective observational study included 63 adult patients with tibial shaft fractures managed either surgically or conservatively. Serial assessments of serum calcium, phosphorus, alkaline phosphatase (ALP), Vitamin D, and parathyroid hormone (PTH) were performed at baseline, 6, 12, and 24 weeks. Radiographic healing was evaluated at corresponding intervals using the Radiographic Union Score for Tibial fractures (RUST). Correlation between biochemical parameters and RUST scores was analyzed using Pearson's correlation coefficient.

Results: Most participants were males (74.6%), with road traffic accidents as the predominant cause of injury. Progressive improvement was observed in calcium, phosphorus, ALP, and Vitamin D levels during follow-up, while PTH showed a gradual decline. The mean RUST score increased steadily from early to late follow-ups, indicating continuous radiographic healing. At 24 weeks, ALP demonstrated the strongest positive correlation with RUST (r = 0.61, P < 0.001), followed by Vitamin D (r = 0.46, P < 0.001), phosphorus (r = 0.42, P = 0.001), and calcium (r = 0.38, P = 0.002). PTH showed a weak negative correlation (r = -0.33, P = 0.008).

Conclusion: Serum biochemical parameters, particularly ALP and Vitamin D, reflect the biological progression of fracture healing and correlate significantly with radiographic union. Routine biochemical monitoring, in conjunction with radiographic evaluation, can serve as a valuable adjunct in assessing the healing potential of tibial fractures.

Introduction: A spinoglenoid cyst is a ganglion cyst that compresses the suprascapular nerve in the spinoglenoid notch. On failure of the conservative treatment, surgical decompression is the treatment of choice. The arthroscopic method helps to decompress the cyst intra-articularly through the labral tear and also allows repair of the labral tear. This study aims to bring out the functional outcome of arthroscopic Spinoglenoid Cyst Decompression with labral repair.

Materials and methods: This study is a case series of eight symptomatic Spinoglenoid cysts with labral tears which were treated with arthroscopic cyst decompression and labral repair over 5 years from January 2018 to December 2023. The American Shoulder and Elbow Surgeon's score (ASES), Constant Murley (CM) score, and Visual Analog Score (VAS) were used to assess the patients preoperatively and postoperatively at regular intervals.

Results: All the patients had good to excellent results. There was a significant improvement in the ASES from a mean pre-operative 61.5 to a mean 1-year follow-up of 90.3, while the CM score improved from a mean pre-operative 66.8% to a mean 1-year follow-up of 93.4%. The VAS decreased from a mean pre-operative 6.3 to a mean 1-year follow-up of one.

Conclusion: Spinoglenoid Cyst is usually seen in individuals and athletes who are involved in an overhead activity. Arthroscopic decompression of the cyst and labral repair is a simple and effective treatment and gives excellent functional outcomes.

Introduction: The study aimed to investigate the correlation between advanced magnetic resonance imaging (MRI) parameters of articular cartilage and subchondral bone with histopathological changes in patients with early knee osteoarthritis (OA), to assess the utility of MRI in detecting early degenerative changes.

Materials and methods: A prospective observational study was conducted in 40 patients aged 40-65 years with clinical and radiographic evidence of early knee OA (Kellgren-Lawrence grade I-II). All patients underwent 3.0 Tesla MRI, including morphological sequences, T2 mapping, and T1ρ mapping, to evaluate cartilage integrity and subchondral bone lesions. Cartilage and subchondral bone samples were obtained during arthroscopy or planned surgical procedures and analyzed histologically using Hematoxylin and Eosin and Safranin-O/Fast Green staining. Cartilage degeneration was graded using the Mankin scoring system, and subchondral bone changes were assessed for marrow edema, trabecular remodeling, and fibrosis. MRI parameters were correlated with histopathological scores, and statistical analysis was performed using Pearson's/Spearman's correlation and Cohen's kappa statistics.

Results: MRI detected early cartilage degeneration, predominantly in the medial femoral condyle and tibial plateau, with elevated T2 (42.8 ±6.2 ms) and T1ρ (48.6 ± 7.1 ms) values in affected regions. Histopathology revealed early degenerative changes with mean Mankin scores of 4.2 ± 1.5 and subchondral bone alterations, including marrow edema (40%), trabecular remodeling (30%), and fibrosis (25%). A strong positive correlation was observed between T2/T1ρ relaxation times and Mankin scores (r = 0.72 and r = 0.69, respectively; P < 0.001). Semiquantitative MRI assessment of bone marrow lesions showed moderate agreement with histopathology (Cohen's kappa = 0.61).

Conclusion: Advanced MRI techniques, including T2 and T1ρ mapping, accurately reflect early cartilage degeneration and show moderate correlation with subchondral bone changes. These findings support the use of MRI as a non-invasive diagnostic tool for early detection and assessment of knee OA, particularly in the medial compartment. However, the findings should be interpreted with caution due to the small sample size and the cross-sectional design of the study.

Introduction: Post-operative cerebrospinal fluid leakage and deep surgical site infection are challenging complications after instrumented lumbar fusion, and their coexistence - especially with multidrug-resistant organisms - increases morbidity while jeopardizing neural integrity and implant stability.

Case report: A 65-year-old woman with diabetes mellitus and hypertension developed persistent wound discharge 1 month after L4-L5 decompression and fusion, with cultures revealing pan-resistant Enterobacter infection. Despite serial debridements and empirical antibiotics, she developed a refractory cerebrospinal fluid leak due to occult dural-tear confirmed intraoperatively with fluorescein localization. Management included repeated meticulous debridement, targeted intravenous and intrathecal colistin therapy, and temporary thecoperitoneal shunting for cerebrospinal-fluid diversion, followed by definitive dural repair with shunt removal that achieved complete infection control and leak resolution. At 2-year follow-up, she was asymptomatic with stable fusion and no recurrence.

Conclusion: Early recognition of deep infection and prompt multidisciplinary intervention are essential to prevent catastrophic sequelae after instrumented lumbar fusion. Tailored antimicrobial therapy, cerebrospinal fluid diversion, and staged surgical repair can clear infection and achieve durable dural healing while preserving spinal instrumentation.

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune condition that frequently results in serious joint deformities, reduced function, and systemic issues. Complicated deformities in major joints such as the hips and knees create considerable management difficulties, particularly when aggravated by osteoporosis and anemia.

Case report: We report a 39-year-old woman with a 15-year history of RA who has severe bilateral deformities in her hips and knees. She could not ambulate independently due to advanced joint destruction, chronic flexion contractures, and functional disability. Pre-operative imaging confirmed end-stage arthropathy, and laboratory workup showed severe anemia and osteoporosis. A multidisciplinary approach led to successful staged bilateral total hip and knee arthroplasty, including robotic-assisted left hip replacement. Post-operative recovery was uneventful, enabling the patient to ambulate independently and restore joint mobility pain-free.

Conclusion: This case demonstrates the success of a staged, multidisciplinary strategy for addressing intricate bilateral joint deformities resulting from RA. The use of robotic assistance along with thorough perioperative planning can enhance surgical precision and support functional recovery, even for high-risk patients.

Introduction: A patient presented with traumatic posterior shoulder dislocation and underwent a diagnostic arthroscopy, where an acute subscapularis anterior leading edge tear was identified. This tear patient is exceptionally uncommon, having only been cited in the literature 5 times as of 2013, and to our knowledge, has no known documented cases since. This report seeks to summarize challenges associated with such a rare diagnosis by presenting a case where this rare presentation was timely diagnosed and treated with an optimal outcome, and to highlight pertinent details of the case that are critical to not miss this diagnosis in the future.

Case report: This patient is a 45-year-old male who suffered a motor vehicle-pedestrian collision and was diagnosed with left posterior shoulder dislocation resulting in shoulder instability. Physical exam demonstrated signs of both shoulder instability as well as cervical radiculopathy. No other workup or history-taking yielded significant results, other than a distant past medical history of acute neurological distress from traumatic brain injury. The treatment plan consisted of diagnostic arthroscopy with the expectation of finding associated soft tissue and labral pathology and possible Bankart and other indicated soft tissue repair for instability. Upon arthroscopic investigation, not only was a posterior labral tear identified, but also an unexpected anterior edge subscapularis tear. The patient demonstrated rapid pain relief in the immediate post-operative period.

Conclusion: Acute posterior shoulder dislocations of the shoulder are seldomly reported in the literature, with even fewer cases reporting on associated rotator cuff tears with this injury. Due to the challenges associated with diagnosing subscapularis tears following posterior shoulder dislocation, we encourage standardization of the variable terminology of subscapularis tear classifications and for surgeons to be aware of the potential of subscapularis pathology with frontal impact injuries. With the increase of motor vehicle accidents, we postulate that this rare scapularis tear patten may become more prevalent and requiring an expanding body of literature on the topic.