Journal of Orthopaedic Case Reports最新文献

Introduction: Septic arthritis of the wrist is an uncommon condition, representing only a small fraction of all septic arthritis cases.

Case report: This report details the clinical course of a 63-year-old female patient who developed septic arthritis and subsequent osteomyelitis of the wrist following a traumatic laceration. Despite multiple courses of antibiotics and a delayed diagnosis, the patient ultimately required a two-stage surgical approach, including debridement, placement of an antibiotic spacer, and definitive arthrodesis with autologous bone grafting. Microbiological analysis revealed Staphylococcus aureus as the causative organism. The case highlights the diagnostic challenges associated with wrist septic arthritis due to its rarity and non-specific presentation, which can lead to delayed treatment and severe joint destruction.

Conclusion: Prompt recognition, thorough diagnostic workup, including synovial fluid analysis and culture, and early surgical intervention are crucial for optimal outcomes. The report underscores the importance of considering septic arthritis in the differential diagnosis of wrist pain and swelling to prevent irreversible complications.

Introduction: Obesity is an increasing global health burden and a significant contributor to knee joint pathology. Arthroscopic knee surgery in morbidly obese patients poses unique perioperative challenges that may influence surgical safety and functional outcomes.

Aim: The aim of the study was to identify key perioperative challenges encountered during arthroscopic knee surgery in morbidly obese patients and to describe practical, reproducible technical adaptations that facilitate safe and effective arthroscopy in this high-risk population.

Materials and methods: A retrospective review was conducted on 50 morbidly obese patients (body mass index [BMI] ≥35 kg/m2) who underwent arthroscopic knee surgery between January 2021 and December 2024. Demographic data, comorbidities, anesthetic and intraoperative adaptations, and functional outcomes using the Tegner-Lysholm score were analyzed.

Results: The mean patient age was 33.60 ± 11.30 years, with a mean BMI of 40.23 ± 6.67 kg/m2. Anterior cruciate ligament-related procedures were the most common indication (44%). General anesthesia was used in 92% of cases, and obesity-specific operating tables were required in 44%. At a mean follow-up of 19 months, Tegner-Lysholm scores improved significantly from 65.44 ± 13.10 preoperatively to 85.26 ± 10.59 postoperatively (P < 0.001). Perioperative challenges included anesthetic preparation and airway management, patient positioning, accurate portal and tunnel placement, joint manipulation during meniscal procedures, and post-operative rehabilitation.

Conclusion: Arthroscopic knee surgery in morbidly obese patients is technically demanding but can provide substantial functional improvement when perioperative challenges are anticipated and addressed through appropriate surgical and anesthetic modifications.

Introduction: Mandibular fractures in high-performance athletes challenge both structural stability and the rapid restoration of sport-specific function. Standard rehabilitation following open reduction and internal fixation (ORIF) often overlooks neuromuscular re-education, cervical-mandibular coordination, and the demands of elite athletic return.

Case report: A 23-year-old elite judoka from the Romanian National Team sustained a right mandibular angle fracture during training. ORIF was performed using titanium miniplates. At week 3 post-surgery, she presented with severe trismus (maximum interincisal opening [MIO] 15 mm) and significant pain (Visual Analog Scale [VAS] 8/10). A 12-week multimodal rehabilitation program was initiated, combining ultrasound-guided dry needling (masseter, temporalis, pterygoids, suprahyoids, sternocleidomastoid, and suboccipitals), temporomandibular joint (TMJ) manual therapy, and a structured digital home-based program (Healthy TMJ, 20 min daily). Early Transfer of Energy Capacitive and Resistive therapy induced swelling and was discontinued. By week 8, her MIO improved to 43 mm and VAS to 2-3, enabling return to competitive training and a Gold Medal at the Romanian National University Championship. At week 12, MIO reached 55 mm, VAS 1, and full functional recovery was achieved, culminating in a Bronze Medal at the FISU World University Championships.

Conclusion: This case demonstrates that a multimodal, ultrasound-guided rehabilitation approach can promote faster recovery, improve mandibular kinematics, and enable safe early return to elite competition following mandibular ORIF.

Introduction: Robotic-arm-assisted total knee arthroplasty (RA-TKA) has emerged as a promising intervention for degenerative osteoarthritis of the knees. Nevertheless, the accuracy of this intervention is inadequately studied. This study aimed to evaluate the accuracy of bone resections in the distal femur and proximal tibia during total knee arthroplasty (TKA) performed with Stryker's MAKO® robotic arm interactive orthopedic system.

Materials and methods: This single-center, prospective observational study focused on patients with end-stage degenerative knee osteoarthritis who underwent RA-TKA performed by a single surgeon from September 2023 to March 2024. The bone resection accuracy was verified in two steps: In vivo verification using Stryker's planar probe and in vitro manual verification using digital vernier calipers.

Results: Among 55 patients included in the study, 63.6% were males. The mean age of the patients was 59.15 ± 8.31 years (Range: 42-78). Primary osteoarthritis accounted for 92.7% of cases, while secondary osteoarthritis constituted 7.3%. The mean absolute difference for medial and lateral tibial cuts was 0.29 (0.45) mm and 0.38 (0.53) mm, respectively, and medial and lateral distal femoral cuts was 0.16 (0.19) mm and 0.41 (0.51) mm, respectively. Of the total 55 bone resections, 52 (95%) had an accuracy of <1 mm.

Conclusion: The Stryker MAKO® robotic system demonstrated high-level precision in bone resections, with accuracy levels exceeding those reported in the literature for conventional jig-based TKA. Preserving bone stock is crucial for revision surgeries and long-term joint health. These findings validate the system's technical reliability and support the continued integration of robotic technology in knee arthroplasty.

Introduction: Ankylosing spondylitis (AS) predisposes patients to unstable spinal fractures due to spinal rigidity and osteoporosis, often complicated by severe kyphotic deformity.

Case report: A 56-year-old man with AS presented with neck pain after a trivial fall. He had severe thoracic kyphosis, a rigid spine, and impaired horizontal gaze. Neurological examination was normal.Diagnosis, Intervention, and Outcomes: Computed tomography and magnetic resonance imaging revealed an AO Type B2, N0, M3 fracture at C7 in a fused spine. A thoracic vertebral column resection (D5) with long posterior instrumentation was performed to achieve both fracture stabilization and sagittal alignment correction. Postoperatively, the patient demonstrated improved horizontal gaze and standing balance. At 2-year follow-up, correction was maintained without complications.

Conclusion: Remote thoracic osteotomy can stabilize cervical fractures in AS while correcting global sagittal alignment. This approach offers a safe and effective alternative to traditional site-focused strategies.

Introduction: Residual rotational instability may persist after isolated anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) has re-emerged as an adjunct procedure to improve rotational stability. We present a Longitudinal Comparative Study comparing functional outcomes of ACLR performed with and without LET.

Materials and methods: Forty patients with ACL injury were treated surgically between 2022 and 2024. Twenty patients underwent isolated ACLR (Group B) and 20 underwent ACLR combined with LET (Group A). Functional outcomes were assessed using the Knee Society Score (KSS), clinical stability tests, return-to-sport status, and complication profiles over an 18-month follow-up period.

Results: Both groups demonstrated significant functional improvement. Group A achieved higher KSS at all follow-up intervals. A negative pivot-shift test was observed in 95% of Group A compared with 70% of Group B. Return to pre-injury sports was higher in Group A (75% vs. 50%). Complication rates and range of motion recovery were comparable.

Conclusion: The addition of LET to ACLR improves rotational stability and functional recovery without increasing complications. Combined reconstruction may be advantageous in patients at risk of persistent instability.

Introduction: Traumatic avascular necrosis (AVN) of the femoral head is a major issue after acetabular fractures, affecting 20-40% of cases even with precise joint realignment. Performing total hip replacement (THR) as a salvage procedure introduces specific surgical obstacles absent in standard primary THR.

Case report: This report covers a 26-year-old man injured in a motor vehicle collision with an acetabular fracture. After open reduction and internal fixation (ORIF), he had femoral head AVN with superior migration and absorption of superolateral acetabular rim at 18 months, requiring THR. Using a posterior surgical approach to hip, THR was performed by extracting unstable screws and placing cementless acetabular and femoral components. He had an unremarkable recovery, with notable improvements in pain and mobility.

Conclusion: Salvage THR after acetabular ORIF requires expertise, but thorough pre-operative strategy, targeted implants, and effective hardware removal deliver reliable success. Young adults with both-column injuries need ongoing AVN monitoring, regardless of initial perfect alignment.

Introduction: Osteomyelitis of the pubic symphysis is rare, representing less than one percent of all osteomyelitis cases, and is frequently misdiagnosed as genitourinary pathology owing to overlapping symptoms and anatomical proximity. Tuberculous involvement at this site is exceptional, and concurrent infection with methicillin-resistant Staphylococcus aureus (MRSA) remains infrequently documented. This case contributes to orthopedic literature by demonstrating how reliance on blood and pus cultures alone can delay recognition of occult mycobacterial disease in culture-discordant pelvic osteomyelitis, reinforcing the indispensable role of surgical biopsy and histopathology in guiding combined antimycobacterial and antistaphylococcal therapy.

Case report: A 40-year-old South-Asian woman with hypothyroidism and recurrent urinary tract infections presented with 2 weeks of progressive suprapubic pain radiating to both lower limbs and high-grade fever. Examination revealed fever, suprapubic tenderness, and restricted bilateral hip movements. Laboratories showed neutrophilic leukocytosis and elevated C-reactive protein. Blood culture grew MRSA; urine and ultrasound-guided prepubic pus cultures were sterile. Magnetic resonance imaging confirmed bilateral pubic bone osteomyelitis, superior rami involvement, abscesses, and myositis. Symptoms persisted despite intravenous teicoplanin, prompting surgical debridement. Curetted bone histopathology demonstrated necrotizing granulomatous inflammation with acid-fast bacilli, establishing tuberculous osteomyelitis complicated by secondary MRSA bacteremia.

Conclusion: Clinicians managing non-resolving pubic osteomyelitis must pursue tissue diagnosis for mycobacterial infection, even when pyogenic pathogens are isolated, and pus is culture-negative. Prompt initiation of anti-tubercular therapy alongside targeted antibiotics yields rapid recovery. This report advances orthopedic infectious disease practice by providing a reproducible diagnostic algorithm for polymicrobial drug-resistant pelvic sepsis, with immediate relevance to orthopedics, infectious diseases, urology, and gynecology in tuberculosis-endemic regions.