Journal of Orthopaedic Case Reports最新文献

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.

Introduction: Virtual reality (VR) rehabilitation has recently been introduced as an innovative rehabilitation technique combining interactive environments with intensive exercise training. This technology has demonstrated benefits in conditions such as stroke and neurodegenerative diseases. However, evidence regarding the application in spinal cord injury (SCI) remains unclear. Early intervention with VR rehabilitation for SCI may promote spontaneous movement and assist recovery with minimal physical burden. We report a case of cervical cord injury in which VR rehabilitation using mediVR KAGURA® was initiated in the acute phase after injury and resulted in excellent recovery.

Case report: The patient was a 75-year-old male. He sustained a cervical cord injury following a bicycle accident (Frankel grade C1). X-ray and magnetic resonance imaging revealed instability at the C3/4 level and intramedullary signal changes in his cervical spine. He underwent posterior fixation surgery on the day of injury. Stabilization of his cervical spine was achieved, but he suffered from severe muscle weakness, sensory impairment, and marked trunk ataxia. VR rehabilitation using mediVR KAGURA® was started under the supervision of a physical therapist from 1 week postoperatively. The rehabilitation using mediVR KAGURA® was carried out 2-3 times/week, for 20-30 min/day. He performed the program in a sitting position, which encourages active use of the upper limbs and trunk, providing multisensory feedback. He achieved independent sitting within 1 week of starting rehabilitation using mediVR KAGURA® and was able to walk with a walker by the 2nd week. He achieved independence in activities of daily living by 4 months postoperatively, and he was discharged home. At 1 year postoperatively, he had slight residual numbness in the fingertips but lives without any limitations in daily activities. No adverse events occurred during the course of treatment.

Conclusion: This case demonstrated that VR rehabilitation using mediVR KAGURA® could be performed safely and effectively in a patient with cervical cord injury. Early initiation of rehabilitation with mediVR KAGURA® may facilitate voluntary limb activity and enhance functional recovery.

Introduction: Patellar tendon rupture is a serious injury affecting the knee extensors and often requires surgical repair with graft augmentation, which lengthen return to sports not sooner than 6 months.

Case report: We, hereby, describe a case of an active male presenting with sudden knee pain and inability to flex the knee during a soccer match. Clinical examination and imaging were positive for complete patellar tendon rupture. Surgical treatment consisted of tendon repair and side-to-side augmentation with Gore-Tex membrane. Weight-bearing was allowed from day 1, knee flexion after 1 month, and weightlifting and running after 2 months. In 3 months, return to sport was achieved, a time shorter with respect to conventional techniques.

Conclusions: This case report highlights the possibility of shorter return to sport with this new technique.

Introduction: Medial epicondyle fractures of the humerus, account for ~12-20% of pediatric elbow fractures and are often associated with elbow dislocations. Management is debated, especially for moderately displaced injuries. Conventionally, displaced fractures were sometimes treated non-operatively, yielding acceptable function but high rates of fibrous non-union. Recent evidence shows surgical fixation provides ~9-fold higher union rates without significant differences in long-term pain or nerve function. We present five patients treated with different fixation techniques to highlight management considerations and outcomes.

Case series: Five patients (ages 15-70; 4 male, 1 female) with acute medial epicondyle fractures (presentation within 2 weeks post trauma) underwent open reduction and internal fixation using varied methods: (1) percutaneous Kirschner-wires (K-wires), (2) a single cannulated cancellous (CC) screw, (3) an antiglide plate, (4) combined K-wire plus screw, and (5) a CC screw. Surgery was performed for displacement >5 mm or instability, in line with current recommendations.Post-operative immobilization ranged 2-4 weeks (shorter for screw fixation, longer for K-wires), followed by physiotherapy. At final follow-up (12-36 months), all fractures united (mean ~12 weeks), and patients resumed full activities. Elbow range of motion was near-normal (flexion ≥130°; one transient 5° extension lag resolved after hardware removal). No growth arrests or chronic instability occurred. Functional outcomes were excellent: Mayo Elbow performance scores 90-100 (mean ~96), and quick disabilities of the arm, shoulder, and hand scores (QuickDASH) indicated minimal disability. No non-union, deep infections, or redislocation were seen, consistent with published results.

Conclusion: Medial epicondyle fractures can be effectively treated with various fixation strategies tailored to fragment size, age, and injury pattern. Rigid fixation (screws, plate) enables early mobilization and reliable union, while K-wires remain useful for smaller apophyseal fragments. All methods in this series restored elbow stability and excellent function. Fixation choice should balance fragment anatomy and potential complications: screws enhance purchase but often require removal, whereas K-wires spare the growth center but necessitate longer immobilization. This series emphasizes that diverse fixation approaches - from K-wires to plating - can achieve excellent outcomes when applied judiciously. Surgical fixation in displaced or unstable cases promotes union and allows early return to activity.

Introduction: The scope of this research was to examine the radiographic healing and functional results in OTA/AO type 12A and 12B humeral diaphyseal fractures (HDFs) treated surgically either by anterior minimally invasive plate osteosynthesis (MIPO) or by open reduction plate osteosynthesis (ORPO) along the posterior cortex of the humerus.

Materials and methods: In this prospective cohort observational analysis, experienced orthopedic surgeons performed two different surgeries in two non-randomly allocated groups of 30 patients each. Outcomes measured radiographic healing, defined as cortical bridging on orthogonal radiographs, and shoulder and elbow functional scores at multiple intervals over 1 year using the University of California at Los Angeles (UCLA), the mayo elbow performance index (MEPI), and the disabilities of the arm, shoulder and hand (DASH) scores comparing the outcomes between both interventions using different statistical methods.

Results: The study found insignificant variations in the age, sex, or AO/OTA fracture types between the groups. MIPO group had a significantly shorter time to healing (13.1 ± 3.1 weeks vs. 18.1 ± 4.7 weeks; P = 0.03), a better functional result of the shoulder and elbow (UCLA: 34.2 ± 2.7 vs. 32.8 ± 3.1; P = 0.05; MEPI: 90.3 ± 10.8 vs 88.7 ± 9.8; P = 0.04), and a lower DASH score (15.8 ± 3.1 vs. 17.9 ± 5.8; P = 0.03) than ORPO. Complications included two non-unions in ORPO and one in MIPO; radial nerve palsy occurred in four cases treated with ORPO.

Conclusion: Anterior MIPO is a biologically favorable and skill-dependent approach for managing HDFs. While not simply a replacement for ORPO, it affords earlier radiographic union, reduced surgical morbidity, enhanced recovery of shoulder and elbow function, fewer secondary interventions, and allows safe avoidance of the radial and musculocutaneous nerves.

Introduction: Bilateral dislocations of the glenohumeral joint are most often posterior, secondary to convulsive seizures. We report a case of bilateral anterior dislocation with fracture of the two major tubercles following a very rare mechanism.

Case report: A 52-year-old patient admitted at the emergency department for bilateral closed shoulder trauma following a tonic-clonic seizure. The patient had a blood pressure of 160/100 mm Hg and a clear consciousness. Symmetrical and bilateral clinical examination of the shoulders shows the signs of bilateral anterior dislocation of the shoulders. The vascular and nerve examinations were normal. Standard shoulder X-ray showed bilateral dislocation in its anterior subcoracoid variety associated with fracture of the major tubercles. The blood test performed showed severe hyponatremia at 113 mmol/L. The dislocations were reduced by the Milch maneuver under sedation. The X-rays showed the reductions. Both shoulders were immobilized with an orthosis and cushion in mild abduction for 4 weeks. The patient stayed in the cardiology department for the management of hypertension and hyponatremia. He benefited the functional rehabilitation sessions after the removal of the orthosis. At the last follow-up at 9 months of the trauma, the shoulders were stable, painless, without recurrence or instability with a normal lifestyle and a muscular strength of 4/5.

Conclusion: This case highlights the importance of general exam and anamnesis in bilateral shoulder dislocations with major tubercles fractures following a tonic-clonic hypertensive convulsion. The treatment is multidisciplinary with orthopedic and cardiological.

Introduction: Floating knee injuries are among the most severe manifestations of musculoskeletal damage. They commonly come in with damaged soft tissues, a lot of blood loss, and people who are about to die from physiological collapse. It is never easy to take care of serious injuries. Every choice tries the delicate balance between biology and stability, especially when open wounds need both caution and urgency.

Case report: A 22-year-old male, a chronic alcoholic with an O-negative blood group, was brought in after a high-velocity road traffic collision. Radiographs showed a Fraser Type I floating knee injury, a distal one-third femoral shaft fracture with a segmental tibial fracture classified as Gustilo-Anderson Grade IIIA. He underwent, in the first stage, retrograde titanium intramedullary (IM) nailing for the femur, combined with ankle-spanning external fixation and meticulous wound debridement, in accordance with the damage-control orthopedics principle. Three weeks later, once the soft tissues had settled, definitive fixation was carried out with closed suprapatellar IM nailing of the tibia. A planned same-level fibular osteotomy was added to encourage controlled compression and biological strain across the tibial fracture. This approach, echoing Wu's concept of fibular osteotomy-assisted dynamization through stabilisation of the fibula (1996, 2001) and later refined as the stress-relieving fibular osteotomy by Vicenti (2019), allows the bone to heal under natural tension.

Conclusion: A well-planned osteotomy of the fibula may alter the course of events in such complicated floating-knee injuries. Well-timed in a staged damage-control setting, it provides a simple, biologically friendly method of promoting healing, fusing science and biomechanical art with surgical restraint.

Introduction: Negative pressure wound therapy (NPWT) has emerged as a highly effective technique for managing chronic non-healing wounds. However, the high cost and limited accessibility of commercial NPWT systems restrict their routine use in resource-constrained settings. This study aims to evaluate the efficacy of an indigenously developed simplified negative pressure wound dressing (SNPWD) for wound management in a low-resource environment.

Materials and methods: This prospective cohort study was conducted on 24 patients with a mean wound size pre-SNPWD being 73.5cm2 in the Department of Orthopaedics at a tertiary care hospital. Final wound area, total duration of SNPWD application, number of dressing changes, and the exudate collection, along with culture report, were documented for outcome comparison with data from existing NPWT literature.

Results: The decrease in mean wound surface area after SNPWD application in our study was 27.2%. The mean duration of SNPWD application, that is, the time taken for development of healthy granulation tissue, ranged from 8 to 27 days, the mean duration being 16.5 days. The mean number of dressings applied per patient was 5.3. The mean amount of exudates collected in the canister decreased by 58% as compared to pre-SNPWD. The post-SNWPD culture report of wounds was sterile in 96% of cases, as compared to only 37.5% sterile culture reports before applying SNPWD.

Conclusion: The SNPWD is a safe, effective, and cost-efficient alternative to commercial NPWT systems. With comparable clinical outcomes and significantly lower cost, SNPWD holds strong potential for widespread use in managing complex wounds, especially in resource-limited settings.

Introduction: Impalement injuries of the upper limb represent a rare and striking form of penetrating trauma, often associated with significant risk of neurovascular and tendinous damage due to the compact anatomical arrangement of the forearm. Despite their alarming external appearance, actual morbidity is determined by the trajectory relative to critical structures. Effective management requires careful pre-hospital stabilization, thorough pre-operative assessment, appropriate imaging, and meticulous surgical extraction under direct visualization to minimize complications.

Case report: A 29-year-old male presented with a trans-forearm impalement injury sustained after falling over a metal gate while under the influence of alcohol. The iron rod, approximately one inch in diameter, entered the volar aspect of the left forearm and exited dorsally near the base of the thumb. Emergency responders appropriately shortened the rod in situ with an angle grinder to facilitate transport without removing it. On arrival, the patient was hemodynamically stable, with intact motor and sensory function in the radial, median, and ulnar nerve distributions, and palpable distal pulses. Plain radiographs confirmed absence of fractures or bony involvement.Surgical exploration under general anesthesia revealed that the rod traversed a superficial subcutaneous plane, sparing major neurovascular structures and tendons. Controlled extraction under direct vision was performed without complication. The wound was irrigated thoroughly with normal saline, povidone-iodine, and hydrogen peroxide, and closed over a glove drain. The patient received broad-spectrum intravenous antibiotics and tetanus prophylaxis per protocol. Post-operative recovery was uneventful, with full preservation of neurovascular function and a complete range of motion at discharge on post-operative day ten and at subsequent follow-up.

Conclusion: This case highlights the critical importance of adhering to established trauma management principles in impalement injuries, including stabilization at the scene, avoidance of pre-mature removal, comprehensive pre-operative evaluation, and extraction under direct visualization. Despite the dramatic presentation, the foreign body followed a superficial trajectory that spared vital structures, resulting in an excellent functional outcome. This report contributes to the limited literature on upper limb impalement with complete neurovascular preservation and underscores the need for a structured, anatomy-respecting, multidisciplinary approach to optimize patient outcomes in such complex trauma scenarios.

Introduction: Ventromedial scapular osteochondroma is an uncommon cause of scapulothoracic impingement and shoulder restriction in children. Because of its deep anatomical location, diagnosis is often delayed, particularly in pediatric patients with minimal symptoms.

Case report: A 9-year-old male presented with a gradually progressive, painless swelling over the left scapular region associated with difficulty in overhead shoulder movements for 1 year. Clinical examination revealed a firm, immobile bony mass over the posterior scapula with terminal restriction of shoulder abduction and forward elevation. Computed tomography demonstrated a pedunculated osteochondroma arising from the ventromedial surface of the scapula. The lesion was excised completely through a posterior approach. Postoperatively, the patient demonstrated marked improvement in shoulder range of motion with return to normal daily activities.

Conclusion: Timely surgical excision restores shoulder function and prevents progression of mechanical symptoms. Although rare, ventromedial scapular osteochondroma should be considered in the differential diagnosis of restricted shoulder mobility with unexplained scapular prominence in children, where it may mimic snapping scapula syndrome.