Journal of Orthopaedic Case Reports最新文献

Introduction: To sustain hoop stress, prevent extrusion, and maintaining the function of the meniscus, the posterior root attachment point of the medial meniscus is essential. The purpose of this study is to determine the functional and radiological outcome of conservative therapy and meniscal repair for medial meniscal root tears.

Materials and methods: Prospective evaluations were performed on forty individuals who confirmed a diagnosis of Medial meniscus root tear (MMRT). Among the 40 patients, 20 underwent arthroscopic meniscal repair and 20 underwent conservative management and followed up a period of 2 years. Functional outcome between two groups was measured using Tegner Lysholm score and IKDC score. Radiological outcome was measured using X-rays (medial joint space width, joint space narrowing, K-L grade).

Results: Both group showed improvement in Lysholm score and IKDC. When comparing the clinical outcomes between both the groups, Group A showed significantly better outcome (P = 0.02). About 60% of patients in Group A and all patients in Group B showed K-L grade progression. Of the patients in Group A, 5% had significant K-L grade progression and 10% had severe joint space constriction. Of the patients in Group B, 80% had significant K-L grade progression and 25% had severe joint space constriction. Meniscal repair had considerably superior outcomes for radiologic parameters than conservative care (P < 0.01) when we examined the final results of Groups A and B.

Conclusion: The MMRT repair group had better functional and radiological outcome than the conservative treatment group. Although treatment did not entirely stop the advancement of arthrosis, meniscal repair decreased the rate of arthritic changes when compared to the conservative group.

Introduction: Aneurysmal bone cysts (ABCs) are benign, locally destructive, blood-filled reactive lesions of the bone most commonly presenting as pain or mass effect. Most are frequently located in the proximal humerus, distal femur, proximal tibia, spine, uncommonly the sacrum, and rarely the sacroiliac (SI) joint. We present a rare case of ABC in the SI joint and its recurrence treated with percutaneous intralesional doxycycline ablation and the corresponding outcome.

Case report: A 29-year-old female presented with persistent gluteal pain and radiculopathy and was subsequently diagnosed with ABC in the left SI joint. She underwent intralesional extended curettage with the application of synthetic bone graft substitute over the defect. One year postoperatively, local recurrence of the mass was noted after presenting with similar symptoms of radiculopathy. She then underwent six sessions of CT-guided percutaneous intralesional doxycycline ablation at 2-3-month intervals. Serial monitoring through plain CT scan showed interval development of intralesional osseous formation and decreased lytic spaces. At the latest follow-up of 3½ years after treatment cessation, the patient remained asymptomatic with no recurrence.

Conclusion: This reports the only known local experience using non-invasive treatment for the recurrence of ABC in the SI joint through CT-guided intralesional ablation of doxycycline resulting in relief of symptoms and absence of recurrence at 3½ years post-treatment. This supports previous studies showing doxycycline administration as an effective alternative in the treatment of ABCs in recurrent cases, in challenging cases due to its location, or when located in non-expendable areas such as the SI joint and sacrum. More extensive studies with longer follow-ups are needed to validate these findings.

Introduction: This review of case series and case reports explores conservative management strategies for paraspinal compartment syndrome (PCS), a rare clinical condition. Extremity compartment syndrome has been shown to be managed most effectively with emergent surgical release of the fascial compartment. Given the rarity of PCS and the paucity of research in the literature, some authors have suggested the possibility of conservative treatment. There has been no study to date that has specifically investigated the cases of non-operative management of PCS.

Materials and methods: There are 16 case reports in the literature with 22 cases of PCS treated conservatively. The authors reviewed these cases, specifically viewing the clinical courses, why the decision was made to manage conservatively, and the reported outcomes.

Results: The etiology of PCS varied, with weightlifting being the primary cause in 11 out of 22 cases, followed by strenuous sporting events and postsurgical complications. All patients in this review were male, aged between 18 and 61 years old. Acute presentations exhibited severe back pain, rigid paraspinal musculature, and subjective paraspinal paresthesias. Magnetic Resonance Imaging findings of the spine revealed profound bilateral symmetric intramuscular edema. Among the cases, 8 explicitly reported a return to normal function, while 8 continued to experience symptoms related to the initial injury. Nine cases chose conservative measures primarily because of delayed presentation, seven instances reported successful outcomes with conservative measures; one case cited concerns about infection risk.

Discussion: The probability of underreporting related to PCS may result in a substantial number of cases being omitted from medical literature. Pathologically, PCS is characterized by increased intra-compartmental pressure, triggering rhabdomyolysis due to significant soft tissue damage. Emergent surgical intervention is the treatment of choice for any compartment syndrome; however, conservative management of these cases has shown satisfactory clinical outcomes. Hyperbaric oxygen therapy emerges as a potential adjunctive treatment to enhance tissue viability, though its efficacy and accessibility warrant further investigation in the context of PCS management.

Conclusion: Early recognition and treatment of PCS are critical in preventing chronic pain and permanent complications. Given the limitations identified in non-operative management, further research is imperative to optimize treatment strategies.

Introduction: Bisphosphonates have become the standard drugs for the medical management of patients with moderate-to-severe forms of osteogenesis imperfecta (OI). This study was undertaken to study the effect of parenteral pamidronate or oral alendronate therapy, on bone healing after osteotomies in patients with moderately severe forms (Sillence type 4) of OI.

Materials and methodology: We retrospectively evaluated the effects of bisphosphonate therapy on the healing of seven osteotomies in five patients of OI (Sillence type 4) who underwent Sofield Millar procedure for deformity correction and non-union of long bone fractures.

Results: The patients were evaluated clinically and radiologically for the time taken for osteotomy healing and the radiological pattern of osteotomy healing. The minimum clinico-radiological follow-up period was 2 years and the mean follow-up period was 3.9 years (range 2-7 years). The mean time taken for the osteotomy to heal in the patients receiving bisphosphonates was 10.4 months (range 8-12 months) and the union was achieved without the typical exuberant callus formation. Periosteal new bone formation was uniquely absent.

Conclusion: We infer from our findings that bisphosphonate therapy in OI patients is associated with a different pattern of osteotomy healing and delay in healing of osteotomy.

Introduction: Fibroadipose vascular anomaly (FAVA) was described in 2014 as a distinct entity characterised by intramuscular replacement with fibro fatty tissue along with complex vascular malformation, phelbectesia, venous thrombosis and lymphatic involvement. Somatic mutations in the PIK3CA gene are detected in most lesions which diagnosed the FAVA in our report and occurrence of this mutation seems to be sporadic.

Case report: Common presentation is a painful intramuscular swelling in young women - as was the presentation here in an 11 year girl with the swelling of the right thigh. Imaging features, phleboliths and long standing history of an intramuscular malformation in the young girl that was recalcitrant to treatment at previous attempts led us towards the suspicion of a fibro adipose vascular anomaly.

Conclusion: Surgery with en-bloc mass excision is recommended for good long term curative option for reducing pain and regaining movements. FAVA is a rare, but specific vascular anomaly that is often misdiagnosed with other intramuscular vascular malformations and therefore poses significant management challenges. It is imperative that clinicians have a thorough understanding of FAVA in order to provide proper diagnosis and treatment referrals.

Introduction: The menisci are a pair of fibrocartilaginous structures important for the normal biomechanical function of the knees. Tears are common, and multiple approaches have been used to repair meniscal tears. Of the approaches, the all-inside approach has historically been avoided for tears to the posterior aspect of the lateral meniscus (LM) due to the risk of popliteal and common peroneal neurovascular injury.

Case report: We reviewed the electronic medical records of all patients who underwent all-inside LM repair by our senior author from August 2022 through August 2023. Demographic, injury, and surgical data were collected to characterize surgical success and any complications attributed to the surgical approach. A literature review of MEDLINE was performed to investigate the current data regarding the all-inside approach and identify methods for improving safety and efficacy. Two cases were identified (one male and one female) who underwent all inside repair of the LM. No surgical complications were attributed to suture selection or placement, and no damage to the popliteal neurovascular structures was identified.

Conclusion: The all-inside approach is a safe arthroscopic approach for the repair of the LM. The current literature demonstrates multiple considerations and guidelines to mitigate the risk of neurovascular injury and supports the efficacy of the all-inside approach when compared to other surgical approaches.

Introduction: After the spine, the knee is the second most common location for skeletal tuberculosis. An unusual complication of tuberculosis infection is triple knee deformity. The combination of knee flexion, posterolateral tibial subluxation, and external tibial rotation over femoral condyles manifests as a severe deformity. Currently, a variety of surgical intervention techniques are recommended for knee deformity correction, including the use of an Ilizarov ring fixator or limb reconstruction system, total knee arthroplasty, and arthrodesis with synovectomy.

Case report: A 17-year-old adolescent with a 2-year limping history and left knee flexion deformity and swelling was examined. The patient was treated with anti-tuberculosis therapy for 9 months after being diagnosed as having pulmonary tuberculosis. The results of the left knee synovial fluid aspiration revealed confirmation of tuberculosis knee. The Ilizarov technique was used to treat the patient's 95° fixed flexion deformity of the knee which was associated with painful jog of movements.

Conclusion: The Ilizarov procedure has been regarded as the best way to treat complicated deformities of the knee caused by tuberculosis sequelae because it has great clinical results and few side effects.

Introduction: The radial neck fractures in children are uncommon injures and more so in the settings of an associated elbow dislocation. Radial neck fracture, with 90° posterior rotation of the articular surface with respect to its normal axis, is a characteristic feature of rare Jeffery type 2 injury. This injury pattern is reported as sporadic reports or small series in the literature. Most of the reported cases have been managed by operative intervention with either open or percutaneous reduction and K-wire fixation. Despite the fact that isolated radial neck fractures have been managed frequently by the retrograde intra-medullary wire fixation technique as described by Métaizeau, its modified utilization as standalone treatment has rarely been described for Jeffery type 2 injury, to the best knowledge of the authors.

Case report: We, hereby report our experience of a displaced Jeffery type 2 radial neck fracture, associated with the posterior elbow subluxation in a 13-year-old male. The injury was finally treated with open relocation of the displaced radial head to the radius neck followed by retrograde fixation of the radial head with one retrograde intramedullary K-wire as a modified Métaizeau technique. Gradual healing of the fracture, stable elbow, and painless activities of daily living were noted along with normal regain of pre-injury elbow function. No complication or instability was noted and excellent Mayo Elbow performance score in the follow-up of 13 months.

Conclusion: The peculiar injury pattern of Jeffery type 2 radial neck fracture warrants early recognition and appropriate management for the optimal functional outcome and also to avoid complication. Open reduction of the displaced radial head and fixation with Métaizeau technique is viable option for the management of this rare injury.

Introduction: Metacarpophalangeal (MCP) joint dislocation and its pathoanatomy was first discussed in detail in an article written by Kaplan et al . ,in 1957. They had identified certain features of complex, that is irreducible MCP joint dislocation through closed method to differentiate from a simple MCP joint dislocation, that is MCP joint dislocation that can be reduced by closed method. The complex MCP joint dislocations (mostly involving the index finger) are called Kaplan dislocations.Here, we describe two cases of MCP joint dislocations to highlight the differences between complex and simple MCP joint dislocation in their clinical appearances, X-rays, and management protocol.

Case report: In the first case, the injured patient was a 17-year-old young cricketer, who sustained the injury while playing the game. After careful clinical examination and studying the X-rays, we assured the patient and treated his injury by closed reduction method. After undergoing the post-reduction splinting and physiotherapy, the patient has recovered completely and he is back to playing cricket.In the second case, the patient was an elderly lady; she got her left index finger dislocated while trying to forcefully hold a moving object. After careful clinical examination and studying the X-rays, we counselled her and treated her injury through open reduction method. After following the post-operative splinting and physiotherapy, the patient is doing well but her index finger extension is restricted in the terminal ranges.

Conclusion: The MCP joint dislocations have distinctive clinico - pathological patterns and we should carefully study them. We should not hesitate to adopt open reduction techniques in appropriately indicated patients.

Introduction: Supraspinatus tendinopathy is a common reason for shoulder pain, with or without an associated cuff tear. Various modalities of treatment have been described in literature such as physiotherapy, analgesics, corticosteroid injection, surgical repair (open or arthroscopic), and platelet-rich plasma (PRP) injection. Recently, there has been an increasing trend of PRP injection for rotator cuff arthropathy. Hence, we conducted a study to assess the effectiveness of PRP injection under ultrasound (USG) guidance in patients with supraspinatus tear.

Materials and methods: Twenty-eight patients were divided into two groups: Group A (physiotherapy, n = 15) and Group B (PRP injection with USG guidance, n = 13). Pain (Visual Analog Score [VAS]) and function (Oxford Shoulder Score [OSS]) were evaluated at baseline, 1 week, 4 weeks, and 12 weeks.

Results: 28 patients were divided into two groups, i.e., Group A (15 pt) - physiotherapy and Group B (13 pt) - PRP injection. On the basis of the VAS, PRP group has better score at 1 and 4 weeks as the results were statistically significant while insignificant at 12 weeks. On the basis of OSS, PRP group has better score at 1 and 4 weeks as the results were statistically significant while insignificant at 12 weeks similar to VAS score.

Discussion: The findings on pain relief (VAS) generally agree that both methods offer short-term improvement, with PRP potentially having a slight edge. However, the long-term effects (beyond 3 months) are less clear. Similarly, physiotherapy shows promise in improving function (Oxford score) in the short term, while some PRP studies suggest sustained benefits, possibly dependent on the specific PRP formulation. Overall, the discussion highlights the need for further investigation into the long-term efficacy of PRP compared to physiotherapy for managing rotator cuff tears.

Conclusion: Improvement in function and relief in pain were better in PRP group when compared to conservative group but we found that PRP has no superior result as compared to conservative therapy in the management of rotator cuff tear.