Journal of Orthopaedic Case Reports最新文献

Introduction: Unicondylar knee replacement (UKR) is a surgical procedure frequently performed to treat medial compartment osteoarthritis, offering advantages such as quicker recovery and preservation of knee kinematics. However, complications can arise, including periprosthetic fractures. Patella fractures in the context of UKR are particularly challenging due to the presence of the implant. Traditional fixation methods often involve metallic implants, which can be associated with complications and the need for reoperations. This report introduces a novel technique for patella fracture fixation using suture tapes, highlighting its potential benefits in reducing reoperation rates and improving patient outcomes.

Case report: A 68-year-old female patient, with a history of right-sided UKR for medial compartment osteoarthritis and left-sided total knee replacement for grade 4 osteoarthritis, presented with acute right knee pain and swelling after a fall while climbing stairs. An X-ray revealed a displaced transverse patella fracture, although the unicondylar knee implant remained well-fixed. Given the unique complication of a patella fracture in the presence of UKR prosthesis, the patient underwent surgery using a novel fixation technique with suture tapes. This method aimed to provide stable fixation, facilitate early mobilization, and minimize the risks associated with traditional metallic implants.

Conclusion: The successful application of suture tape fixation for a patella fracture in a UKR patient demonstrates an effective alternative to metallic implants. This innovative technique has the potential to reduce reoperation rates, minimize complications, and enhance early mobilization, thereby improving the overall quality of life for patients.

Introduction: Periprosthetic joint infections (PJIs) of the shoulder complicate approximately 0.7% of primary and 15.4% of revision shoulder arthroplasties. Culture-negative PJIs constitute 5-42% of cases, with fungal and mycobacterial pathogens frequently implicated, often following broad-spectrum antibiotics administration prior to tissue sampling. Mycobacteria are isolated in 43% of culture-negative PJIs and associated with advanced age, chronic steroid therapy, immunosuppression, and retroviral infections. Improved diagnostic techniques have increased the isolation and reporting of non-tuberculous mycobacteria. Mycobacterium kansasii infections in native joints and bursae are documented, but only two cases of M. kansasii PJI, both in knee PJI, are reported. This report presents the first case of a shoulder PJI caused by M. kansasii.

Case report: A 66-year-old female underwent right reverse total shoulder arthroplasty for glenohumeral osteoarthritis in November 2015. Post-operative recovery was initially uneventful, but 7 months later, she experienced persistent shoulder pain following a fall. Imaging confirmed proper component placement without loosening. In April 2017, extensive workup yielded negative results, including erythrocyte sedimentation rate and C-reactive protein. The patient returned in November 2018 with exacerbated pain, swelling, night sweats, and chills. Blood tests suggested no overt inflammation, but X-rays raised concerns of glenoid component loosening. January 2019 surgery revealed extensive synovitis and necrosis; a vancomycin and tobramycin-impregnated spacer was placed. Cultures identified M. kansasii, and the patient was treated with rifampin, azithromycin, and ethambutol for 12 months. Persistent pain led to multiple surgeries, with cultures confirming no infection. In January 2021, after consultation, long-term antimycobacterial therapy was initiated due to presumed recurrence. By June 2021, the patient reported no pain, and radiographs confirmed well-aligned prosthetic components.

Conclusion: M. kansasii PJI, though rare, requires distinct diagnostic and treatment approaches compared to common pathogens. Diagnosis is often delayed due to the organism's slow growth and culture time, necessitating advanced techniques such as polymerase chain reaction and next-generation sequencing. Effective treatment involves extended antimycobacterial therapy and multiple surgeries. This case underscores the importance of monitoring for mycobacterial growth in suspected culture-negative PJIs and employing aggressive surgical and medical therapy to minimize complications.

Introduction: Few studies have reported the treatment and rehabilitation of combined fractures of the femur, tibia, and ankle in the same lower limb.

Case report: A 69-year-old man presented to our hospital with a fall injury due to high-energy trauma after falling from a 5 m ladder while painting and landing on both feet. Examination revealed right femoral supracondylar; left tibial plateau; right calcaneal; left ankle crush; first and third lumbar vertebrae burst; sacral; C7, Th1, and Th9 compression; and bilateral acetabular fractures. External fixation of both femurs and tibias was performed on the day of injury. After the patient's general condition had stabilized, a two-stage operation was performed on the 8th day after injury for osteosynthesis of the left tibial plateau and right calcaneus fractures and ilizarov fixation of the left ankle crush fractures. In addition, the right femoral supracondylar fracture underwent osteosynthesis on day 15 after the injury, while the burst fractures of the first and third lumbar vertebrae underwent posterior fixation on day 24. The sacral fracture; C7, Th1, and Th9 compression fractures; and acetabular fractures were treated conservatively with a brace and no weight-bearing until the ilizarov apparatus was removed and gait training started. The ilizarov apparatus was removed 90 days after application.Mild passive and active assist rehabilitation on both toes and knees was started the day after the injury. Wheelchair transfer training was started 51 days after the injury. On day 60, trunk stability and swaying were eliminated and strength training in the sitting position was started. On day 107, the patient transferred without assistance (supervised). On day 121, weight-bearing and short-term standing training (right lower limb only) was started. On day 141, weight-bearing on both lower limbs was started. On day 148, the patient walked approximately 100 m using a walking aid. On day 176, the patient walked twice on parallel bars and 4 m with Lofstrand coupling while wearing a patellar-tendon-bearing orthosis. At 212 weeks, the patient walked long distances and use the Lofstrand for 100 m. The patient could also change direction smoothly.

Conclusion: This study reports the treatment and rehabilitation of an elderly patient with bilateral compound fractures of the lower leg. The patient underwent long-term rehabilitation on the floor using the ilizarov method; however, with appropriate rehabilitation, he recovered to the point where he could walk.

Introduction: Prompt diagnosis and management of septic arthritis are pivotal for early infection eradication, joint preservation, and prevention of quality-of-life impact consequences. Total hip arthroplasty has been introduced for the management of severe destructive septic arthritis with the aims to eradicate infection while preserving hip function. Few case studies have been done on two-stage exchange total hip arthroplasty for treatment of native hip septic arthritis using prosthesis with antibiotic-loaded acrylic cement articulating spacer with generally good outcomes. However, a small percentage of patients electively chose not to proceed with the second-stage exchange arthroplasty. Therefore, 1.5-stage total hip arthroplasty was considered a viable option; however, it has only been established in periprosthetic infection management, but not in native hip septic arthritis. Custom-made articulating spacers are considered an ideal option as has no constraints, are more readily available, and were designed to be a functional single-stage spacer that can remain permanent yet not preclude the possibility of a second-stage exchange surgery if required. Overall, this led to the consideration of 1.5-stage total hip arthroplasty using custom-made articulating spacers for the management of chronic destructive hip septic arthritis.

Case report: We report a 67-year-old patient with functional decline from fully independent without aids to chairbound over 8 months. Work-up revealed raised inflammatory markers and bilateral destructive hip septic arthritis. He underwent bilateral 1.5-stage total hip arthroplasty with antibiotic-loaded custom-made articulating spacers. One-year post-operation, he remains infection-free and is progressing well with rehabilitation - ambulating independently with walking frame.

Conclusion: Management of septic arthritis varies largely depending on infection duration, activity level, and extent of joint destruction. In significantly destructed hip septic arthritis, 1.5-stage total hip arthroplasty using antibiotic-loaded custom-made articulating spacer is a viable option with the benefits of effective infection eradication, good functional outcomes, cost-effectiveness, reduced physical and psychological burden in avoiding a second operation, all whilst not precluding the possibility of a second-stage exchange arthroplasty if required with ease.

Introduction: Primary leiomyosarcoma affecting the bone is an uncommon destructive tumor that primarily affects the elderly. If leiomyosarcoma is discovered in bone, it should be explored as a possible metastasis from a distant tumor. Surgical excision with broad margins is used as therapy.

Case report: A 50-year-old man reported to outpatient department with a 5-month chief complaint of a painful mass involving his left carpus that had grown. No history of trauma was present. Examination demonstrated a painful restriction of wrist motions, and ill-defined, immobile, tender hard mass measuring 5 × 3 cm along the ulnar border of the left wrist. All necessary investigations were done and were diagnosed as primary leiomyosarcoma of the distal ulna. Patient was managed surgically with resection with wide en bloc resection with a margin of at least 2 mm around the tumor and radioulnar stabilization with the help of 1 K-wire (2.5 mm). Post-operative period was uneventful.

Conclusion: Osseous leiomyosarcoma is an uncommon tumor, it should be evaluated in the diagnosis of any solely lytic aggressive osseous lesion in a middle age, Furthermore, the existence of extraosseous main lesions should be ruled out for its diagnosis. At present, surgery is the most effective therapy option.

Introduction: Anterior cruciate ligament (ACL) injury is the most common for athletes.

Materials and methods: ACL injury reconstruction is a pivotal surgical intervention aimed at restoring knee stability and function following ligamentous trauma.

Surgical technique: Advances in surgical techniques and rehabilitation protocols have significantly improved outcomes and patient recovery rates. This paper reviews current trends, outcomes, and future directions in ACL reconstruction using peroneus longus and hamstring grafts and emphasizing innovations in surgical approaches and rehabilitation strategies.

Conclusion: Peroneus longus grafts offer superior outcomes compared to hamstring grafts for ACL reconstruction. They provide enhanced graft strength and stability, potentially reducing the risk of re-injury. In addition, their use can lead to quicker recovery times and improved functional results for patients.

Introduction: Metallosis, characterized by the collection of metallic debris in periarticular tissues, is primarily associated with metal-on-metal bearings in hip arthroplasty. This report presents a rare case of metallosis after metal-on-polyethylene (MoP) total hip arthroplasty (THA), highlighting diagnostic challenges and management strategies. Metallosis following MoP arthroplasty is extremely rare, with only a limited number of documented cases in the literature.

Case report: A 70-year-old man presented with post-traumatic hip pain and instability 6 years after an uncemented MoP THA. Radiographs revealed a fractured acetabular cup with metal fragments and displacement of the femoral head. A computed tomography scan confirmed liner failure, cup breakage, and radiodense opacities around the joint. Given the post-traumatic presentation and the risk of heterotopic ossification, the patient underwent revision surgery. Revision surgery involved acetabular component exchange, and clinical follow-up indicated satisfactory outcomes.

Conclusion: This case highlights the atypical presentation of metallosis following MoP THA, emphasizing the significance of early diagnosis and awareness for optimal patient outcomes.

Robotic technology in total knee arthroplasty (TKA) has initiated a paradigm shift in orthopedic surgery, characterized by enhanced precision, patient-specific alignment, and improved outcomes across diverse patient demographics. This editorial explores the rapid advancement from traditional jig-based methods to robotic-assisted TKA, highlighting how systems like the MISSO Robotic System-developed in India-integrate real-time feedback, advanced imaging, and sub-millimeter accuracy to optimize implant placement. These advancements result in better functional outcomes, reduced revision rates, and faster recovery, especially in complex cases. For surgeons, robotic systems offer a reliable way to reproduce optimal surgical outcomes consistently, even in anatomically challenging scenarios. For patients, robotic-assisted TKA provides faster rehabilitation, reduced post-operative pain, and a higher likelihood of long-term implant durability. Hospitals benefit through long-term cost savings, a lower burden of revision surgeries, and the potential for increased patient inflow due to advanced technological offerings. The editorial also discusses the unique positioning of the MISSO Robotic System as a cost-effective solution for South Asian patients, catering to region-specific anatomical challenges such as varied bone densities and joint degeneration patterns. Additionally, by lowering healthcare costs and increasing accessibility, the MISSO system addresses critical needs in high-demand settings. As robotic systems evolve and regulatory frameworks adapt, these technologies are expected to redefine the standard of care in joint replacement surgeries, making high-precision, patient-tailored procedures increasingly available and furthering the commitment to optimal patient outcomes in orthopedic surgery.

Introduction: Alkaptonuria is a rare metabolic disorder that follows an autosomal recessive genetic inheritance pattern. It is distinguished by the buildup of homogentisic acid in tissues due to deficient homogentisic acid oxidase enzyme activity. The excess homogentisic acid is expelled through urine, darkening it on oxidation. Moreover, it deposits in connective tissues, imparting a characteristic blue-black pigmentation. This condition is known as Ochronosis or black bone disease. This accumulation over time renders cartilage brittle, potentially leading to ochronotic arthropathy.

Case report: A 46-year-old lady presented with long-standing bilateral knee pain for 8 years with a predominant focus on the right side. Recurrent swelling and pain episodes in the right knee were noted, occurring without significant traumatic events. Despite various conservative treatments attempted to alleviate her knee pain, the patient experienced minimal relief. On examination, the patient demonstrated difficulty in ambulating, with severe tenderness along the joint line and a restricted range of motion. Standing knee X-rays revealed severe tricompartmental osteoarthritis and a correctable valgus deformity of 5. She underwent total knee replacement. A provisional diagnosis of ochronosis was made intraoperatively, later confirmed on histopathological examination of the tissue, and the patient was evaluated retrospectively.

Conclusion: Ochronotic arthropathies are rare conditions- characterized by articular cartilage damage. They are typically diagnosed post-surgery, often when surgeons observe the dark coloration of cartilage. However, joint replacement surgery can safely and effectively manage these conditions, leading to favorable outcomes, including improved functionality, pain alleviation, and heightened patient satisfaction.

Introduction: Chondromas are benign cartilaginous tumors classified into periosteal chondromas and enchondromas. While periosteal chondromas grow on the bone surface, enchondromas develop within the medullary cavity. Enchondromas constitute 4-8% of all bone tumors, with spinal enchondromas being exceptionally rare, particularly in the cervical region. Despite their benign nature, spinal enchondromas can cause significant clinical symptoms and have the potential for recurrence or malignant transformation.

Case report: A 14-year-old female presented with a swelling on the posterior aspect of her neck, accompanied by dull, aching pain radiating into the right upper limb, and muscle weakness assessed at IV/V. Imaging studies, including computed tomography (CT) and magnetic resonance imaging, revealed a lobulated lesion in the right lamina of the C4 vertebra extending to C5, causing spinal cord and nerve root indentation. The patient underwent a C4-C5 laminectomy with complete tumor excision. Histopathological examination confirmed the diagnosis of enchondroma.

Follow-up and outcomes: At 6 months, the patient experienced complete resolution of pain and significant improvement in neurological symptoms. Follow-up CT scans at 3 years and at 10 years did not exhibit any recurrence, and the patient remained symptom-free throughout the follow-up period.

Conclusion: This case highlights the successful long-term outcome following the surgical resection of a cervical spine enchondroma, demonstrating that aggressive surgical intervention can lead to sustained symptom-free outcomes. The 10-year follow-up provides valuable insight into the long-term prognosis of cervical spine enchondromas, emphasizing the importance of early and complete surgical resection along with extended surveillance.