Journal of Orthopaedic Case Reports最新文献

Introduction: The goal of femoral component positioning in cementless total hip arthroplasty (THA) is accurate restoration of joint biomechanics and a press fit between the implant and the endosteal surface of the proximal femur. We present a case detailing an intraoperative broach fracture during THA and introduce a minimally invasive technique for broach removal.

Case report: A 45-year-old male with left hip osteoarthritis underwent left THA, and the final broach fractured during the extraction attempt. Given the hole in the proximal part of the broach's shoulder, we created a cortical window near the proximal femur to expose the defect. The successful extraction was accomplished using a Kuntscher nail extractor.

Conclusion: Notably, this technique resulted in no morbidity and eliminated the necessity for extending the approach or additional soft-tissue dissection.Surgeons performing THA must be prepared for unexpected challenges and possess the necessary skills to address complications. This report presents a case of femoral broach fracture during THA and describes an effective, economical, and safe solution to resolve the issue.

Introduction: Failed fracture fixation around the hip presents a major challenge in orthopedic surgery. Primary total hip arthroplasty (THA) is often required as a definitive salvage procedure following complications such as non-union, malunion, implant failure, or post-traumatic arthritis.

Objectives: This study aims to evaluate the clinical outcomes, complications, and surgical strategies of primary THA performed as a salvage procedure following failed internal fixation of fractures around the hip, with emphasis on the use of adjuncts such as Prolene mesh, augmentation plates, cerclage wires, and bone grafting.

Case series: This case series was conducted at Government Stanley Medical College and Hospital over a period of 2 years. Ten patients with failed hip fracture fixation underwent THA through the lateral Hardinge approach. Pre-operative imaging included radiographs and computed tomography scans. Post-operative assessments were performed using the Harris Hip Score at regular intervals up to 2 years.

Results: All 10 patients experienced excellent to good outcomes in terms of pain relief and functional improvement. Augmentation implants were used in selective cases. Minor complications included two superficial infections and three cases of transient abductor weakness. No readmissions were reported.

Conclusion: Primary THA is an effective salvage strategy following failed hip fracture fixation, with favorable outcomes when thorough pre-operative planning and appropriate surgical techniques are employed. Augmentation devices play a key role in achieving optimal biomechanical restoration in complex cases.

Introduction: Proximal tibial fractures in elderly patients with coexisting advanced knee osteoarthritis pose a significant treatment challenge. Primary total knee arthroplasty (TKA) has emerged as a viable alternative in selected cases, offering stable fixation, early mobilization, and avoidance of staged procedures. To the best of our knowledge, this is the first reported case of bilateral primary TKA performed for bilateral proximal tibial metaphyseal fractures with bilateral tibial tubercle avulsions in the setting of advanced osteoarthritis.

Case report: We report the case of a 68-year-old male who sustained bilateral proximal tibial metaphyseal and fibular fractures with associated tibial tubercle avulsions and advanced bilateral knee osteoarthritis following a fall. After thorough evaluation, the patient underwent staggered bilateral primary TKA in a single admission. Tibial stem extenders were used to bypass the fracture sites, and tibial tubercle fixation was achieved with low-profile plates. Post-operative rehabilitation included early mobilization, progressive weight-bearing, and structured physiotherapy. At 1-year follow-up, the patient demonstrated excellent functional recovery with good knee range of motion and independent ambulation.

Conclusion: Primary TKA in the fracture setting can obviate the need for complex secondary procedures, reduce complication risks, and restore function more efficiently than conventional fixation in carefully selected patients. Meticulous pre-operative planning, careful patient optimization, surgical expertise, and the adjunctive use of advanced technologies such as robotics are critical to achieving optimal outcomes.

Introduction: Girdlestone excision arthroplasty is a surgical procedure for managing severe hip joint pathology, involving the removal of the femoral head and neck. Despite its utility, the Girdlestone procedure carries significant risks, including vascular complications. This report highlights a previously unreported complication: Post-operative hemorrhage from the superior gluteal artery (SGA).

Case report: A 65-year-old female underwent this procedure after recurrent infections and instability following hip hemiarthroplasty. The patient who underwent a Girdlestone procedure experienced life-threatening hemorrhage likely due to excessive external rotation and femoral shortening during post-operative transfer. A computed tomography scan revealed active SGA extravasation, necessitating emergent embolization by interventional radiology.

Conclusion: There are currently no reported cases of this event occurring in the literature. This case underscores the need for vigilance in post-operative monitoring for vascular complications, particularly in high-risk patients. This report emphasizes the importance of recognizing and promptly addressing vascular injuries, as well as prioritizing care-team communications, to improve patient outcomes.

Introduction: Intertrochanteric fractures are common in elderly patients and can lead to significant malunion and varus deformities if untreated. While the dynamic hip screw has been the gold standard, there is a continuous effort to evaluate newer fixation devices. This study assesses the functional and radiological outcomes of intertrochanteric femur fractures treated with the Halifax nail, aiming to provide a contemporary comparison to existing methods.

Materials and methods: This prospective study was conducted at our institution from January 2019 to December 2024. We included patients with intertrochanteric fractures, excluding those with open fractures, pathological fractures, pre-operative neurovascular deficits, or polytrauma with head injuries. All patients underwent surgery under spinal anesthesia on a fracture table. Closed reduction was attempted under C-arm guidance; if unsuccessful, open reduction was performed. The Halifax nail was inserted after a tensor fascia lata and gluteus medius split. This was followed by lag screw insertion with tri-wire guidance, end cap application, and distal locking.

Results: The study included 57 patients (31 male and 26 female). Fracture classifications were 11 AO type A1, 23 AO type A2, and 23 AO type A3. The average surgery duration was 65 min, with an average blood loss of about 200 mL. Patients achieved an average time to union of 11.7 weeks, and the functional outcome, measured by the average Harris Hip score, was 91.

Conclusion: The findings suggest that the Halifax nail provides favorable functional and radiological outcomes for intertrochanteric femur fractures. Its use resulted in good union rates and high patient function, indicating that it is a viable and effective treatment option. Further comparative studies are needed to confirm its role in orthopedic practice.

Introduction: Most frequent injuries of the Upper limb are a distal radius fracture (DRF). If they aren't handled well, they might cause problems for a long time. There are several techniques to treat this issue, but volar locking plate fixation has become increasingly prevalent since it may restore anatomical alignment, provide stable fixation, and allow for early movement. This study aimed to evaluate the functional and radiological results of distal end radius fractures treated with volar locking plate fixation.

Materials and methods: In this prospective analytical investigation, 60 patients with DRFs, ranging in age from 18 to 80 years, were enrolled. Patients were treated with open reduction and internal fixation using volar locking devices. Functional results are evaluated using the Gartland and Werley Demerit Point System and goniometry. Radial length, radial inclination, palmar tilt, and articular step-off were employed to quantify radiological outcomes. Follow-up evaluations were conducted at 2, 4, and 6 weeks, in addition to 6 months. We used the Statistical Package for the Social Sciences version 20 to analyze the data and discovered that P < 0.05 was significant.

Results: Patients exhibited substantial improvement in wrist function across all planes of motion, with plantar flexion rising from 31.6° at 2 weeks to 67.8° at 6 months, and dorsiflexion from 31.7° to 66.4°. Supination and pronation also became a lot better, becoming close to normal levels after 6 months. The radiographic restoration was good, with a mean radial length of 8.8 mm, an inclination of 17.6°, and a palmar tilt of 8.9°. There were very few complications (6.7% arthritis, 6.7% malunion).

Discussion: Our results support previous research showing volar plating offers robust fixation, restores anatomical alignment, and facilitates early mobility. Correlation study revealed that palmar tilt and articular congruity substantially impacted functional recovery, emphasizing the need of meticulous surgical reduction.

Conclusion: Volar locking plate fixation is an effective treatment for DRFs, characterized by low complication rates and excellent functional and radiological outcomes.

Introduction: The Girdlestone resection arthroplasty procedure is one of the options for treating an infected hip arthroplasty. It is a surgical procedure that involves resection of the head and neck of the femur, resulting in pseudarthrosis of the hip joint. This is often kept as a last resort for patients with significant co-morbidities or when other treatments have been ineffective. This procedure should be considered a salvage procedure, primarily aimed at pain relief and infection control.

Case report: We report a case of a 73-year-old male who sustained a fracture of the neck of the femur in 2019 and was operated on multiple times for the same. He presented us with an unstable hip.

Conclusion: We used a novel technique of Girdlestone resection arthroplasty, which involved stabilization of the proximal femur with Prolene mesh.

Introduction: Bucket handle meniscus tears (BHMTs) represent a specific pattern of vertical tears wherein the displaced segment of the meniscus lodges into the intercondylar notch. These injuries often present with clinical symptoms including knee pain, intermittent locking, joint instability, swelling, and reduced range of motion. Bucket-handle meniscal tears are frequently observed in conjunction with anterior cruciate ligament (ACL) injuries, with reported incidences varying between 11% and 48%. Meniscus repair aims to alleviate symptoms and restore normal knee joint biomechanics, all while maintaining the integrity of the native meniscus. To the best of our knowledge, this case report is the first to document the fixation of a triple bucket handle tear of the medial meniscus, with clinical results and a 1-year post-operative assessment.

Case report: A woman in her early forties presented with a 10-year history of recurrent knee pain, swelling, and mechanical symptoms, worsened by a recent fall. Clinical evaluation revealed signs of ACL deficiency and medial meniscal injury. Imaging confirmed a complex medial meniscus tear and a near-complete ACL tear, with normal knee alignment on radiographs and scanogram. Diagnostic arthroscopy revealed triple BHMT with complete ACL tear. She underwent ACL reconstruction (ACLR) with peroneus longus graft, triple bucket handle meniscus repair with all-inside, inside out and outside in technique, and lateral extra-articular tenodesis.

Conclusion: Chronic triple bucket-handle meniscal tears present a complex surgical challenge. However, this case highlights that accurate anatomical reduction combined with stable fixation can lead to favorable post-operative outcomes, including improved knee function and enhanced quality of life. In addition, performing meniscal repair alongside ACLR increases the likelihood of successful healing and optimal functional recovery.

Introduction: Histoplasma capsulatum is a thermally dimorphic fungus that is endemic to North and Central America and rarely encountered in Asia. Musculoskeletal involvement is uncommon, particularly in immunocompetent individuals. This report presents a rare case of localized histoplasmosis osteomyelitis involving two skeletal sites in an immunocompetent patient.

Case report: A 53-year-old immunocompetent female presented with a 6-month history of chronic, multifocal osteomyelitis involving the right lateral malleolus and left ring finger. She had no systemic symptoms or history suggestive of immunosuppression. Radiographs revealed osteolytic lesions, and histopathological examination demonstrated granulomatous inflammation with fungal spores confirmed by periodic acid-Schiff and Gomori Methenamine Silvers staining, consistent with H. capsulatum. The patient underwent surgical debridement with autologous cancellous bone grafting and temporary external fixation. Post-operatively, she received intravenous Amphotericin B for 6 weeks, followed by a period of protected mobilization. At 1-year follow-up, the patient had complete recovery with no evidence of recurrence.

Conclusion: Localized histoplasmosis osteomyelitis in an immunocompetent host is extremely rare and may mimic bacterial osteomyelitis. A high index of suspicion, timely histopathological diagnosis, and appropriate antifungal therapy combined with surgical management are essential for optimal outcomes.

Introduction: Femoral neck fractures continue to challenge orthopedic surgeons due to their complex biomechanics, high shear stresses, and risk of avascular necrosis (AVN) or non-union. The Femoral Neck System (FNS) is a relatively newer fixed-angle device designed to enhance stability while minimizing soft-tissue damage. This case series presents our clinical experience with the FNS across a spectrum of femoral neck fractures, focusing on technical nuances and lessons that influenced our patients' outcomes.

Case series: Eight patients (aged 24-66 years) with femoral neck fractures of varying Garden and Pauwel types were managed with the FNS. Fracture patterns ranged from stable valgus-impacted to high-energy displaced fractures, including cases with concomitant pelvic or shaft injuries. Stable, valgus-impacted fractures treated with in situ fixation and minimal compression consistently achieved union and excellent function by 3 months. Displaced and vertical fractures united reliably when near-anatomical or valgus reduction with central implant placement and bi-cortical distal fixation was achieved. Technical errors such as anterior or eccentric bolt placement, unicortical distal locking, or correction of valgus to neutral alignment were associated with complications including varus collapse, implant back out, and neck shortening. One young patient developed AVN following high-energy trauma despite satisfactory fixation.

Conclusion: The FNS offers a stable and minimally invasive option for femoral neck fracture fixation when applied with precise technique and respect for fracture morphology in selected cases. In situ or slight valgus fixation, especially in osteoporotic bone, yields superior outcomes due to the FNS's invasive nature, avoidance of rotational torque to the at-risk head fragment and retention of the inherently stable valgus or neutral alignment. Complications were largely attributable to mechanical and technical factors rather than implant design, highlighting the importance of meticulous surgical planning and execution and careful patient selection.