Journal of Orthopaedic Case Reports最新文献

Background: Checkrein deformity is a dynamic flexion deformity of the great toe, most often occurring after distal tibial trauma due to flexor hallucis longus (FHL) tethering or contracture. This report presents a rare case of post-traumatic checkrein deformity managed successfully with endoscopic FHL tenotomy.

Case report: A 16-year-old male presented with dynamic hallux flexion deformity, 3 years after internal fixation for a distal tibia and fibula fracture. Clinical examination confirmed checkrein deformity. Endoscopic FHL tenotomy was performed via hindfoot endoscopy. Postoperatively, the deformity resolved, and the patient achieved full function with no recurrence at 6 months.

Conclusion: Endoscopic FHL tenotomy is a safe, effective, and minimally invasive technique for treating checkrein deformity, even in delayed presentations.

Introduction: Split tears of the peroneus brevis tendon (PBT), often associated with superior peroneal retinaculum (SPR) insufficiency, are a frequently overlooked cause of posterolateral ankle pain and instability, particularly in athletes. Accurate diagnosis requires a high index of suspicion and dynamic imaging to detect tendon subluxation and associated pathology.

Case report: We present the case of a 28-year-old athlete with persistent posterolateral ankle pain and instability following an ankle twist. Clinical examination and imaging confirmed a partial longitudinal tear of the PBT with concomitant SPR insufficiency. Surgical management involved tendon debridement, tubularization with side-to-side repair, and SPR reconstruction. Post-operative rehabilitation included progressive weight-bearing, range-of-motion exercises, and structured strengthening protocols.

Conclusion: The patient achieved excellent recovery, with an American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score of 85 at 3 months and a full return to sports without pain or instability. This case highlights the importance of early recognition and comprehensive management of both tendon and ligament pathology to achieve optimal functional outcomes.

Introduction: Hereditary multiple exostoses, also known as multiple osteochondromas, is a rare genetic disorder marked by the formation of osteocartilaginous outgrowths predominantly near the metaphysis of long bones. The knee is a commonly affected joint. Surgical reconstruction of the anterior cruciate ligament in patients with Hereditary multiple exostoses presents unique challenges due to distorted bony anatomy, posing risks to graft harvesting, tunnel positioning, and fixation.

Case report: We present the case of a 17-year-old female football athlete with symptomatic Anterior cruciate ligament deficiency on a background of Hereditary multiple exostoses. Following persistent instability despite conservative management, she underwent arthroscopic Anterior cruciate ligament reconstruction using a tripled peroneus longus tendon autograft. Special precautions were taken intraoperatively to navigate anatomical distortions and ensure precise tunnel placement while avoiding conflict with osteochondromas. Fixation was achieved using a femoral Endobutton and tibial 'T' button.

Conclusion: Anterior cruciate ligament reconstruction in patients with Hereditary multiple exostoses is feasible and can yield excellent functional outcomes when anatomical variations are meticulously accounted for in surgical planning. Peroneus longus graft is a viable option when conventional grafts are compromised or inaccessible due to exostoses.

Introduction: Acromioclavicular joint (ACJ) dislocation combined with an ipsilateral medial clavicle fracture is extremely rare and results from high-energy shoulder trauma. This case report describes a medial clavicle fracture associated with ipsilateral ACJ dislocation, classified as type IV according to the Rockwood classification.

Case report: A 23-year-old male presented for an orthopedic consultation 1 week after a skiing accident in which he sustained direct trauma to his left shoulder upon impact with the ground. Radiographs and computed tomography (CT) scans of the left shoulder revealed a medial clavicle fracture with ipsilateral ACJ dislocation, classified as type IV according to the Rockwood classification. The patient was treated with an anterior 3.5 clavicle plate combined with an ACJ cerclage wire in a figure-eight configuration and a coracoclavicular endobutton placed arthroscopically. After a 6-month follow-up, the patient demonstrated excellent results in shoulder range of motion and function. The patient's Constant-Murley score was 92.

Conclusion: A medial clavicle fracture resulting from high-energy trauma should raise suspicion for a concomitant ACJ dislocation. To confirm this association, additional imaging studies, such as a shoulder CT scan, are essential.

Introduction: Multiligament knee injuries (MLKIs) are complex injuries associated with significant instability and functional impairment. Surgical management is challenging due to controversies regarding timing, staging, and graft selection, particularly in polytrauma patients.

Case report: We report the case of a 60-year-old male who sustained a multiligament injury to the right knee following a road traffic accident, involving complete tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and medial patellofemoral ligament (MPFL), with associated meniscal injuries. After ruling out vascular compromise, the patient underwent single-stage arthroscopic reconstruction. The ACL and PCL were reconstructed using peroneus longus tendon grafts, whereas the MCL was repaired and augmented using a semitendinosus graft. The same semitendinosus graft was strategically utilized for concurrent MPFL reconstruction to address recurrent patellar instability.

Results: Postoperatively, the patient demonstrated satisfactory clinical and radiological outcomes, with restoration of knee stability and progressive improvement in range of motion. Follow-up magnetic resonance imaging confirmed intact reconstructed ligaments, and the patient was able to mobilize with a stable knee at short-term follow-up.

Conclusion: This case highlights that single-stage reconstruction with optimal graft utilization, including combined MCL and MPFL reconstruction using a single semitendinosus graft, is a feasible and effective option in complex MLKIs. This approach restores stability while preserving graft options for potential future revision surgery.

Introduction: Frozen shoulder (FS) is characterized by pain and progressive restriction of motion, with treatment aimed at pain relief, functional improvement, and shortening disease duration. While conservative management is preferred, the best non-surgical modality remains unclear due to heterogeneity in the literature. The current study is to determine the efficacy of patient-specific multi-site landmark-based steroid injection in combination with a standardized physiotherapy protocol followed at our center in the management of Fss.

Materials and methods: In this prospective study, 94 patients with primary FS, confirmed via ultrasound and X-ray, received intra-articular and multisite betamethasone injections (8 mg diluted in 8 mL of 2% lignocaine). A total of 5 mL was injected intra-articularly, while the remaining was divided among the areas of tenderness and inflammation pre-determined clinically or radiologically by ultrasound. Injections were performed by a single shoulder surgeon, followed by an 8-week physiotherapy protocol. Patients were assessed at 2, 4, 8- and 12-weeks using range of motion (ROM), Visual Analog Scale (VAS), American Shoulder and Elbow Scoring system (ASES), and Shoulder Pain and Disability Index scores.

Results: Statistically significant improvements were observed: mean abduction increased from 124° to 173° (P = 0.001), forward flexion from 123° to 174° (P = 0.040), and external rotation from 26° to 55° (P = 0.009). The mean ASES score improved from 28.8 to 92.5 (P = 0.001), VAS decreased from 6.7 to 0.4, and internal rotation improved by 4 vertebral levels.

Conclusion: The results of our study demonstrate that patient-specific multi-site steroid infiltration significantly reduces pain and improves ROM and clinical outcomes in FS patients.

Background: Finger cellulitis, felon, and paronychia may be treated nonoperatively if diagnosed in a timely manner. Delayed or improper treatment may result in progression to more serious conditions, which necessitate intervention by a hand surgeon. This investigation sought to evaluate national demographics and treatment patterns in finger infections.

Materials and methods: The PearlDiver Mariner database, an insurance claims database with 151 million unique patients within the United States, was used to identify patients with finger cellulitis, felon, and paronychia from 2010 to 2015. Billing events were organized by insurance plan, treatment location, and regional geography. Antibiotics prescribed and respective course duration were also analyzed.

Results: A total of 1,937,102 coded events for finger infections, including 1,452,724 cases of cellulitis (7596), 448,548 paronychias (23%), and 35,830 felons (2%), occurred during the 5-year study period. The plurality (38%) of infections occurred in the Southern United States. Ninety- six percent of events occurred in an outpatient setting, most commonly treated by family medicine physicians, and 4% were associated with hospital admission. Seventy-two percent of claims were processed through commercial insurance, 13% through Medicaid, 12% through Medicare, and the remainder through government insurance plans or self-pay. Cephalexin was the most commonly prescribed antibiotic for finger cellulitis and paronychias, with a mean treatment duration of 8.6 and 8.8 days, respectively. Sulfamethoxazole-trimethoprim was prescribed more frequently than cephalexin for felons (32% vs. 30%; Ρ < 0.01 ),with a mean treatment duration of 8.8 days.

Conclusion: Acute finger cellulitis, paronychias, and felons are common infections managed by a diverse group of providers in a variety of healthcare settings. Regional, insurance, and treatment differences exist. Further research is warranted to evaluate the impact of these variations and potentially refine management strategies for finger infections.

Introduction: Volar lip fractures of the middle phalanx are uncommon but potentially debilitating intra-articular injuries, typically resulting from axial loading combined with hyperextension or dorsal dislocation. They frequently involve avulsion of the volar base of the middle phalanx along with the volar plate, compromising joint congruity and stability. The management of such fractures ranges from non-operative care for small stable fragments to open reduction and internal fixation, volar plate repair, hemi-hamate arthroplasty, or dynamic external fixation in unstable or chronic cases.

Case series: This series reports five cases of volar lip fractures of the middle phalanx presenting at variable intervals and managed with variable surgical techniques at a tertiary care center which includes: (1) Mini-screw fixation in acute case, (2) mini-screw fixation combined with K-wire stabilization, (3) hemi-hamate arthroplasty, (4) JESS external fixation, (5) mini-screw fixation in a chronic case. Post-operative care included protective splinting for 2-4 weeks, suture removal at 2-3 weeks, and initiation of mobilization with strapping, followed by structured physiotherapy. Comparative analysis revealed that acute cases (Cases 1, 2, and 4) achieved superior outcomes with primary fixation techniques, showing better post-operative proximal interphalangeal joint range of motion, lower Disabilities of the Arm, Shoulder and Hand (DASH) scores, and lower Visual Analog Scale (VAS) pain scores. Chronic cases (Cases 3 and 5) required reconstructive or delayed fixation, yielding restricted motion, higher DASH scores, and higher VAS scores.

Conclusion: Volar lip fractures of the middle phalanx, though rare, have significant functional implications. Early anatomical reduction and fixation provide the best chance for restoring stability, mobility, and hand function. Chronic or neglected injuries often demand salvage procedures such as hemi-hamate arthroplasty, which can achieve functional but limited outcomes. Our case series highlights that timely surgical intervention and structured rehabilitation are key determinants of optimal recovery.

Introduction: Mid-flexion instability and variable gap balancing across the range of motion remain key challenges in achieving optimal outcomes in total knee arthroplasty (TKA). Different robotic systems, as well as traditional methods of gap assessment, are static and subjective, often failing to detect subtle instabilities intraoperatively. We describe a novel technical approach using a computed tomography-based Cuvis joint robotic system to perform real-time, dynamic assessment of coronal plane stability throughout knee motion.

Technique: Using the Cuvis joint robotic system, intraoperative gap assessment was performed in a dynamic fashion during TKA. The robot enabled continuous quantification of medial and lateral gaps across the entire arc of motion (0-120°/maximum possible range) after putting in the trial prosthesis, both in neutral alignment and under controlled valgus and varus stress. The data-driven interface allowed for precise numerical evaluation of joint stability and identification of any mid-flexion or range-dependent instabilities.

Results: The robotic-assisted method provided comprehensive, reproducible, and objective stability profiles, aiding intraoperative decision-making. Adjustments in soft-tissue balancing and component positioning were guided by quantitative feedback, allowing tailored correction of asymmetric or unstable gaps.

Conclusion: Dynamic, robot-assisted intraoperative assessment using the Cuvis joint system offers a promising advancement in TKA, improving the precision of coronal plane balancing across the full range of motion. This technique enhances the surgeon's ability to detect and address instabilities that may be missed with static assessments.

Introduction: Kienböck's disease results from compromised lunate vascularity and often affects young individuals performing heavy manual tasks. Radial shortening osteotomy (RSO) is widely used to reduce lunate loading in cases with ulnar-negative variance.

Materials and methods: Five patients diagnosed with Lichtman stage IIIA Kienböck's disease were treated with RSO. All procedures were performed through a volar approach using locking plate fixation. Pain levels, wrist motion, grip strength, modified Mayo scores, and Disabilities of the Arm, Shoulder, and Hand scores were recorded before surgery and at 12-14 months postoperatively. Radiographs were reviewed for ulnar variance correction and any signs of progression.

Results: All patients showed meaningful reductions in pain, improved wrist mobility, increased grip strength, and higher functional scores at final follow-up. Mayo scores ranged from 85 to 94. None progressed to advanced stages, and no complications occurred.

Conclusion: RSO yielded consistent improvement in symptoms and function while maintaining carpal architecture in this series. Early recognition and timely intervention remain essential for optimal treatment outcomes.