Journal of Orthopaedic Case Reports最新文献

Introduction: Although osteoporosis can be diagnosed by many methods like quantitative ultrasound (QUS), peripheral dual-energy X-ray absorptiometry (DEXA), hand X-rays, or clinical examinations but the diseases remain undertreated mainly due to a lack of mechanism to identify individuals who may be at high risk of fracture and might get benefit from the timey interventions. The availability of central DEXA is not uniform in many countries; hence, a reliable, cheap, portable handy equipment is needed. Role of QUS as an alternative to DEXA has been studied for selective population but a very few studies have attempted its utility in the general population for routine use.

Materials and methods: The cross-sectional observational study was done with 283 patients with age more than 40 years with both sexes. Any patient with a history of trauma, infection, surgical infection or immobilization of the lower limb for more than 6 weeks in the preceding 1 year. The left calcaneum was used for calculating T-score by QUS by utilizing 500 kHz ultrasonic frequency for the ultrasound pulse penetration method.

Results: The mean age of the study population was 51.4 ± 10.54 years with 188 female and 95 males. The prevalence of osteopenia was slightly higher among the female population (68.6%) in the current study group in comparison to males (54.7%). The age and symptoms of osteopenia were the two variables which significantly determined the predictive power of QUS in diagnosing osteopenia.

Conclusion: The use of calcaneum QUS proved to be a rapid and efficient method for assessing bone mass density, demonstrating its ability to detect osteopenia, especially in older and symptomatic patients. Given its cost-effectiveness, portability, and safety due to the absence of ionizing radiation, QUS serves as a valuable and attractive alternative for initial bone health assessment, particularly in settings with limited access to central DEXA.

Introduction: Tibial plateau fractures are complex intra-articular injuries that require precise classification for optimal management. The widely used Schatzker classification, based on X-rays, provides a two-dimensional assessment, while the computed tomography (CT)-based three-column theory offers a more detailed three-dimensional analysis. This study aimed to compare the functional outcomes of complex tibial plateau fractures classified using these two systems and treated with locking compression plates (LCP).

Materials and methods: A prospective, observational study was conducted involving 44 patients with closed Schatzker type V and VI tibial plateau fractures. Patients were allocated into two groups: Group A (n = 22) based on CT-based three-column classification and Group B (n = 22) based on X-ray-based Schatzker classification. All patients underwent open reduction and internal fixation using anatomical LCPs. Functional outcomes were assessed using the Rasmussen clinical score at regular follow-ups. Intraoperative variables and post-operative complications were also analyzed.

Results: Group A showed significantly better Rasmussen scores at 6, 12, 24, and 36 weeks (P < 0.05), along with shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications compared to Group B. Joint stiffness and post-traumatic arthritis were notably higher in the Schatzker group.

Conclusion: CT-based three-column classification enables more accurate surgical planning and leads to superior functional and perioperative outcomes in complex tibial plateau fractures compared to the Schatzker classification.

Introduction: Patellofemoral stability is maintained by a complex interplay of osseous, muscular, and ligamentous structures, with the retinacular system playing a central role. While the medial patellofemoral and patellotibial ligaments are well characterized, the lateral patellotibial ligament (LPTL) has been less frequently described, and isolated pathology involving this structure is rarely reported in the literature.

Case report: We report the case of a 23-year-old athletic male presenting with a 2-week history of activity-related lateral knee pain without preceding trauma. Clinical examination revealed focal tenderness at the tibial attachment of the LPTL without effusion, instability, or meniscal signs. Magnetic resonance imaging (MRI) demonstrated linear thickening of the lateral patellar retinaculum extending from the inferolateral patella to the anterolateral proximal tibia, consistent with the LPTL, which appeared thickened compared to the medial counterpart. Associated bone marrow edema at the tibial attachment near Gerdy's tubercle suggested enthesopathy. Other intra-articular structures were normal. The patient was treated conservatively with physiotherapy, activity modification, and non-steroidal anti-inflammatory drugs, resulting in significant symptomatic improvement.

Conclusions: This case highlights isolated LPTL enthesopathy as a rare but important cause of lateral knee pain in athletes. Recognition of this entity on MRI is essential to prevent misdiagnosis and to facilitate appropriate conservative management.

Background: The detrimental consequences of untreated meniscal tears or total meniscectomy, including impaired rotatory stability, increased sagittal laxity, and accelerated cartilage degeneration, are well documented, even though meniscectomy is still the most commonly performed procedure. Meniscus allograft transplantation remains the gold standard for meniscal substitution; however, its limited availability highlights the need for safe and effective autologous alternatives. Emerging evidence supports the use of autologous tendon grafts, particularly the semitendinosus tendon, as promising biological substitutes, offering a viable solution to allografts and synthetic implants.

Case report: A 39-year-old woman presented with lateral knee pain and swelling, 29 years after undergoing a subtotal lateral meniscectomy at age 10. Clinical examination revealed lateral joint line tenderness and a range of motion (ROM) of 0°-120°. Radiographs and magnetic resonance imaging showed degenerative changes in the residual lateral meniscus, cartilage defects in the lateral compartment, and intra-articular loose bodies. Following initial arthroscopy and persistent symptoms, a lateral meniscus autograft transplantation using a hamstring tendon was performed. Post-operative rehabilitation included a progressive ROM limitation: 0°-30° (weeks 0-3), 0°-60° (weeks 3-6), and 0°-90° (weeks 6-8). Partial weight-bearing was allowed for 4 weeks, progressing to full weight-bearing at 8 weeks; squatting was restricted for 4 months. Jogging was initiated at 3 months, with return to sport at 6 months. At 1-year follow-up, the patient was asymptomatic with a 15° gain in flexion and significant improvement in all functional scores (Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score).

Conclusion: This case supports the growing evidence that, with careful surgical planning and appropriate patient selection, autologous tendon grafts represent a viable biological option for meniscal reconstruction. This approach may be particularly beneficial in middle-aged patients, in whom joint preservation remains a key therapeutic goal.

Introduction: Tibial tubercle osteotomy (TTO) is an appropriate surgical procedure for patellar instability and chronic patellofemoral pain; however, complications such as proximal tibial fracture occur in 1-1.8% of cases.

Case report: A 19-year-old non-professional dancer underwent TTO with medialization for patellofemoral pain. Postoperatively, rehabilitation followed a structured protocol. At 3 months, radiographs revealed an onset of stress fracture below the TTO site, progressing and involving two-thirds of the tibial diameter on the last follow-up. Surgical fixation with a lateral tibial locking plate was performed to prevent propagation. Ten months after plating, the fracture had fully consolidated, while a Knee Injury and Osteoarthritis Outcome score was 90.5, and the hardware was removed without complications.

Conclusion: Proximal tibial stress fractures post-TTO are rare but require early recognition and intervention. This case highlights the caution required in rehabilitation and the necessity of surgical intervention as a viable treatment to ensure proper fracture healing and successful recovery.

Introduction: Non-union of long bone fractures, particularly of the tibia, presents considerable challenges due to poor vascularity, minimal soft-tissue coverage, and complications such as implant failure or infection from previous surgeries. Tibialization of the fibula remains a viable, though underreported, technique for addressing such complex cases.

Case report: We report a case of a 26-year-old male with a history of poliomyelitis who presented with non-union of the left tibia following implant failure. Clinical evaluation revealed 4 cm limb shortening and varus deformity. Radiographs showed a broken 4.5 mm limited contact dynamic compression plate and multiple loosened screws. Given the intact fibula and adequate vascular and soft-tissue status, the Huntington method for tibialization was selected. The surgical approach included implant removal, debridement of non-union margins, and medial transfer of the fibula using anterolateral and lateral approaches. Postoperatively, the patient experienced transient vascular compromise, which resolved without intervention. At 6 months, radiographs confirmed proximal tibiofibular union, and the patient had regained functional mobility.

Conclusion: Fibular tibialization using the Huntington procedure offers a low-complexity, implant-sparing solution for managing tibial non-union, especially in patients with compromised bone and soft-tissue conditions. This case demonstrates favorable outcomes with minimal complications.

Introduction: This case report describes the procedure and 2-year outcome in a patient with bony patellofemoral ankylosis who underwent robotic arm-assisted patellofemoral arthroplasty (RA-PFA).

Case report: A 21-year-old male with Post-traumatic Patellofemoral Ankylosis with quadriceps contracture underwent RA-PFA with Quadriceps-plasty. Preoperatively, the patient had a flexion deformity of 20° with no further active flexion or extension. Passive knee extension from 20° to 0° was possible. At 2-years follow-up, he was independently ambulant with good improvement in pain and functional clinical scores. He had an improved active flexion of 0°-80° and active extension of 80°-0° with no extension lag.

Conclusion: This case suggests RA-PFA may be an effective intervention to restore knee function in Post-traumatic Patellofemoral Ankylosis despite the grossly altered anatomy.

Introduction: Reverse total shoulder arthroplasty (RTSA) has many indications, including acute proximal humerus fracture or nonunion of such a fracture. However, we are unaware of any reports of the use of RTSA to treat proximal humerus fractures in patients with osteogenesis imperfecta (OI).

Case report: Here, we describe the challenges of RTSA for fracture nonunion in a 67-year-old woman with OI. The humeral component of the prosthesis loosened, and aspiration revealed 2 organisms. She underwent placement of an antibiotic spacer, after which cultures were negative. A second revision was then performed, during which a cemented proximal humeral component was implanted as part of the RTSA system. Subsequently, she fell, fracturing the humerus, which was treated with internal fixation with plates reinforced with a fibular allograft. The RTSA humeral component subsequently loosened, and she was revised to an allograft prosthetic composite. She subsequently healed but died after a fall in her home.

Conclusion: Prompt identification and management of complications are crucial for improving outcomes of RTSA in patients with OI.

Introduction: Tuberculous (TB) dactylitis (spina ventosa) is a rare form of extrapulmonary tuberculosis involving the short tubular bones of the hands and feet, primarily in children. Due to its non-specific presentation, the diagnosis is often delayed.

Case report: We report a rare case of bilateral spina ventosa in a 6-year-old girl who presented with progressive painful swelling of both middle and ring fingers. Diagnosis was confirmed by cartridge-based nucleic acid amplification test, erythrocyte sedimentation rate elevation, positive Mantoux test, and histopathology revealing epithelioid granulomas with Langhans giant cells. The patient received anti-tubercular therapy - isoniazid (10 mg/kg/day), rifampicin (15 mg/kg/day), pyrazinamide (35 mg/kg/day), and ethambutol (20 mg/kg/day) - for 12 months, showing excellent functional and radiological recovery.

Conclusion: Early diagnosis and timely management of TB dactylitis are crucial to prevent deformity and disability. Clinicians should maintain a high index of suspicion in endemic areas when evaluating chronic finger swellings.

Introduction: Osteopetrosis is a rare genetic disorder characterized by increased bone density due to defective osteoclast function, leading to brittle bones prone to pathological fractures. The management of fractures in osteopetrotic patients presents unique challenges due to extreme bone hardness, narrow medullary canals, and increased risk of non-union or implant failure.

Case report: We present two cases of pathological subtrochanteric femoral fractures in young female patients with osteopetrosis. The first case involved a 30-year-old female with bilateral subtrochanteric fractures, managed surgically with open reduction and internal fixation (ORIF) using a distal femur locking plate for the complete right-sided fracture, while the left-sided unicortical fracture was treated conservatively. The second case involved a 29-year-old female with a history of prior femoral fractures, presenting with a subtrochanteric fracture of the left femur and a broken plate, which was also managed by Open reduction internal fixation by an anatomical proximal femur plate. Due to the dense sclerotic bone, modifications to standard surgical techniques were necessary, including the use of low-speed drilling with continuous cooling, pre-tapping for screw insertion, and careful implant selection.

Conclusion: The management of osteopetrotic fractures requires a multidisciplinary approach and specialized surgical techniques. Our cases highlight the challenges and successful strategies for treating subtrochanteric fractures in osteopetrosis, contributing valuable insights to the orthopedic management of this rare condition.