Journal of Orthopaedic Case Reports最新文献

Background: Ankylosing spondylitis (AS) is a long-term inflammatory disease that involves the axial skeleton, and new evidence suggests that the temporomandibular joint (TMJ) has been involved. Magnetic resonance imaging (MRI) has been found to be more sensitive in terms of early inflammatory and structural alterations in the TMJ, but the prevalence and clinical associations with AS have not been well documented. Hence, the study was done to determine the prevalence, MRI characteristics, and clinical associations of TMJ involvement in patients with AS compared with healthy controls.

Materials and methods: A case-control study was used, with 60 AS patients (who met ASAS criteria) and 30 age/sex-matched healthy controls. Each of the participants was taken through bilateral TMJ MRI in a 1.5T scanner. Two blinded radiologists decided on the presence of bone marrow edema (BME), synovitis, effusion, erosions, and disc displacement based on imaging. Clinical measures comprised of TMJ pain Visual Analog Scale, maximum mouth opening (MMO), Bath AS disease activity index (BASDAI), Bath AS functional index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).

Results: TMJ deviations were observed in 27/60 (45.0%) AS patients and 1/30 (3.3%) controls (P < 0.001). The most widespread observations were BME (30.0%), synovitis (25.0%), and effusion (20.0%). TMJ involved AS patients had an approximately 5.2 ± 1.8, 38 ± 6 mm, and 4.5 ± 2.1 higher BASDAI score, lower MMO (38 ± 6 mm vs. 45 ± 5 mm, P < 0.001), and higher TMJ pain (4.5 ± 2.1 vs. 1.8 ± 1.2, P < 0.001) as compared to those without. There was no correlation between the results of MRI and CRP/ESR.

Conclusion: TMJ involvement is common in AS patients and is strongly associated with clinical disease activity and functional limitation. MRI is useful in identifying subclinical inflammation of the TMJ, and it should be considered standard in the evaluation of AS.

Introduction: Primary synovial chondromatosis is an uncommon benign disorder characterized by cartilaginous metaplasia of the synovium, leading to the formation of intra-articular nodules. The elbow joint is an unusual site, and neurological involvement, particularly ulnar nerve compression, is exceptionally rare.

Case report: A 42-year-old female presented with progressive pain, stiffness, and weakness of grip in her dominant elbow, accompanied by numbness along the ulnar border of the hand. Radiographs revealed a single calcified nodule in the medial compartment of the elbow, and magnetic resonance imaging (MRI) demonstrated a well-defined intra-articular mass compressing the ulnar nerve. Nerve conduction studies confirmed delayed conduction across the elbow. The patient underwent open excision of the lesion via a medial approach with decompression of the ulnar nerve. Histopathology confirmed primary synovial chondromatosis. At the 6-week follow-up, the patient showed improvement in pain and strength with enhanced ulnar conduction parameters. At 6 months, she regained full motion and complete functional recovery without recurrence.

Conclusion: Solitary synovial chondromatosis of the elbow causing ulnar nerve compression is extremely uncommon. Early diagnosis with MRI and timely surgical decompression can prevent permanent neurological deficits and ensure excellent functional outcomes.

Introduction: Distal tibial comminuted fractures are usually a result of high-energy trauma. The subcutaneous location of the bone pre-disposes to open fractures and decreased vascular supply. All these local and biological factors contribute to increased risk of non-union. Mechanical factors such as stability of the fixation and method of fixation also add to it. Hence, it is prudent to evaluate all these factors in a case of distal tibial non-union and choose optimal method of management of distal tibia non-union. This case presentation is portrayal of one such scenario.

Case report: A 65-year-old male patient presented with non-union of extra-articular distal tibia comminuted fracture with distal tibial locking compression plate and fibular plate in situ. He was treated with ipsilateral fibular bone grafting and retention of the implants about 1 and 1/2 years after the injury. The bone has united within 11 months with uneventful post-operative period and with good functional outcome.

Conclusion: This case shows that even with minimal intervention union can be achieved in notorious distal tibia non-unions if appropriate graft materials are chosen and customized accordingly. Evaluating various biological and mechanical causes of non-union and addressing them is key to favorable outcomes.

Introduction: From a physiotherapist's point of view, helping patients recover from a distal end radius (DER) fracture is a big part of getting them back to their daily lives. This article highlights how important a structured, step-by-step rehabilitation program is for adults, whether their fracture was treated with a cast or with surgery. As physical therapists, our role is crucial in guiding this recovery, working closely with orthopedic surgeons.

Materials and methods: We understand that there is not one perfect exercise plan for every patient, but starting exercises early is always better. Our main goals are to reduce pain and swelling, improve how much the wrist and hand can move, and build up strength. We also focus on preventing common problems like stiffness or Complex Regional Pain Syndrome. We use tools like the Disability of Arm, Shoulder, and Hand and Michigan Hand Questionnaire scales to see how well patients are improving in their daily activities.

Discussion: The rehabilitation is divided into phases. In the early phase, we focus on protecting the fracture while keeping other joints moving and managing swelling. As the bone heals, we introduce exercises to get the wrist moving more, improve muscle strength, and help with balance and coordination. We use various techniques, from gentle mobilizations to resistance exercises, and sometimes advanced therapies like electrical stimulation or mirror therapy to help patients along.

Conclusions: For patients who have had surgery, the rehab principles are similar, but we adjust the timing of exercises based on the surgeon's advice and the type of fixation. Ultimately, successful recovery is a team effort. When physical therapists and orthopedic surgeons work together, and the patient follows the plan, most people can regain good function and return to their normal activities after a DER fracture.

Introduction: Tenosynovial giant cell tumor (TSGCT), formerly known as pigmented villonodular synovitis, is a rare, benign, locally aggressive neoplasm originating from the tendon, bursa, or synovium. It is broadly categorized into localized TSGCT (L-TSGCT) and diffuse TSGCT types, with the localized form more commonly affecting the tendon sheaths of the hand and fingers. This report describes a rare presentation of a L-TSGCT involving the flexor tendon sheath of the right thumb in a 40-year-old male, managed successfully with complete excision.

Case report: We report a case of a 40-year-old male who presented with a 1-year-old history of a slowly growing, painless mass over the right thumb, along with restriction of movement. Clinical examination revealed a firm, non-tender, mobile mass measuring approximately 3 cm × 3 cm. X-ray revealed a soft-tissue shadow with pressure scalloping and erosion over the distal phalanx of the right thumb. Magnetic resonance imaging (MRI) demonstrated a well-defined lobulated T1 and T2 isointense lesion with erosion of the distal phalanx of the thumb. The patient underwent complete marginal surgical excision along with the use of local adjuvant chemical cauterization of the bony erosion bed with 88% phenol for 1 min to prevent recurrence. Intraoperatively, it was a well-encapsulated, yellowish-brown nodular mass adherent to the flexor sheath without infiltration into the neurovascular bundle. The post-operative course was uneventful, and the patient achieved a full range of motion at 4 months of follow-up.

Conclusion: L-TSGCT of the thumb is uncommon but should be considered in the differential diagnosis of soft-tissue swellings in the digits. MRI assists in delineating lesion extent and planning surgical excision. Histopathological analysis confirms the diagnosis of L-TSGCT. The tumor's characteristic imaging profile and indolent clinical course highlight the need for accurate pre-operative diagnosis. Complete surgical excision, preferably preserving digital function, remains the gold standard, offering a high chance of cure. Use of adjuvants such as phenol might reduce the risk of recurrences, especially in cases of bony involvement. Long-term follow-up is strictly advisable.

Introduction: Both-bone forearm fractures are common in pediatric patients and most often result from a fall onto an outstretched hand. Although rare, nerve entrapments, particularly of the median nerve, can occur, especially following closed reduction.

Case report: We present the case of a 13-year-old male who sustained a both-bone forearm fracture while on vacation in Mexico. The injury was managed with closed reduction and casting. Despite appropriate treatment, the patient developed progressive numbness, tingling, and thenar atrophy in the median nerve distribution. Electromyography and nerve conduction studies confirmed significant median nerve dysfunction. Surgical exploration revealed the median nerve entrapped in dense scar tissue with an hourglass deformity approximately 18 cm proximal to the wrist. The patient underwent successful median nerve neurolysis and open carpal tunnel release. Postoperatively, he experienced steady neurological recovery, with full restoration of motor and sensory function by the 8-month follow-up. This case is notable for the delayed onset of median nerve entrapment symptoms despite proper fracture alignment and management. It highlights the potential for dense periosteal scarring to cause nerve compression even in the absence of radiographic abnormalities. Comparison with similar cases in the literature emphasizes the importance of early recognition and timely surgical intervention.

Conclusion: This case highlights the importance of maintaining a high index of suspicion for nerve entrapment in pediatric both-bone fractures, even when reduction appears satisfactory. Early diagnosis and surgical decompression are crucial to prevent long-term functional deficits.

Introduction: Large language models (LLMs) such as ChatGPT-5 offer new possibilities for interpreting medical images, but their effectiveness in orthopedic radiograph analysis remains largely unexplored.

Objective: To evaluate the diagnostic performance of ChatGPT-5 in detecting and classifying fractures on shoulder and hip X-rays, specifically proximal humerus and intertrochanteric (IT) femur fractures.

Materials and methods: A retrospective study of 120 anonymized anteroposterior (AP) radiographs (60 shoulder and 60 hip) was conducted. Each case was independently reviewed by orthopedic experts, establishing a reference standard. ChatGPT-5 analyzed the same images using structured prompts and was assessed for fracture detection accuracy, sensitivity, specificity, and agreement on detailed fracture features.

Results: ChatGPT-5 achieved 87.5% sensitivity and 100% specificity in detecting proximal humerus fractures (κ = 0.74), and 100% sensitivity but only 16.7% specificity in IT femur fractures (κ = 0.24). While it identified major fracture patterns and comminution reliably, it frequently hallucinated fractures in normal hip X-rays and missed fine details such as lesser tuberosity fragments and dislocations.

Conclusion: ChatGPT-5 shows high sensitivity for orthopedic fracture detection and produces coherent, structured reports. However, limitations in specificity and fine-detail recognition restrict its autonomous clinical use. It may serve as a triage or educational tool with human oversight or be integrated into hybrid artificial intelligence workflows.

Introduction: Trigger finger is a common orthopedic condition that predominantly affects middle-aged individuals. Treatment modalities range from conservative measures like corticosteroid injections to surgical intervention depending on the severity, clinical presentation, and underlying etiology.

Case report: A 79-year-old female presented with triggering of her middle finger. After conservative treatment failed, further investigation revealed that the condition was caused by a giant cell tumor of the tendon sheath. Surgical excision and reconstruction were performed, resulting in satisfactory clinical outcomes with a full range of motion on follow-up.

Conclusion: This case underscores the importance of considering rare causes for trigger finger, such as tumors, and highlights the need for thorough diagnostic evaluations in persistent or atypical cases of hand pathology.

Introduction: Fungal periprosthetic joint infections (PJI) are exceptionally rare, accounting for <1% of all PJIs. Among them, Candida albicans is the most frequently implicated pathogen, yet its management remains highly challenging.

Case report: We report the case of an 85-year-old female who presented with a draining sinus at the right hip, 4 weeks after revision total hip arthroplasty (THA). Her surgical history included a prior failed revision due to recurrent dislocation. Clinical and laboratory findings suggested PJI. Intraoperative cultures and sonication confirmed multimicrobial and C. albicans infection. Following 4 months of antimicrobial therapy, she underwent debridement and removal of the acetabular component. Postoperatively, she received a 4-week course of trimethoprim-sulfamethoxazole (960 mg 3 times daily) and a 12-week course of fluconazole (200 mg twice daily). The post-operative course was uneventful. At 6 and 12-month follow-up, she remained asymptomatic with a well-healed wound and negative inflammatory markers.

Conclusion: Early recognition and combined surgical-pharmacological management can lead to infection eradication and functional preservation, even in rare polymicrobial fungal PJIs.

Introduction: Giant cell tumor (GCT) (osteoclastoma) is a locally aggressive bone neoplasm with an incidence of 3-8% of all bone tumors, rarely seen (1-2%) in smaller bones of the feet. It is located in the epiphysis-metaphysis of long bones. If inadequately treated, they have a high recurrence rate.

Case report: It is a rare case report of recurrent GCT of the first metatarsal in a 28-year-old female who was previously treated with curettage and bone grafting. After confirmation of the lesion with fine needle aspiration cytology, she underwent en bloc resection of the first metatarsal with vascularized transfer of the second metatarsal to the first metatarsal.

Results: She was initially started with partial weight-bearing walking with elbow crutches, and full weight-bearing was started at 4 months. She was followed for over 12 years without recurrence. Functional outcomes assessed by the American Orthopedic Foot and Ankle Society scoring system showed significant improvement, with midfoot and hallux metatarsophalangeal-interphalangeal scores increasing from 22 to 91 and 30 to 87, respectively.

Conclusion: GCTs of the small bones of the foot, though rare, exhibit aggressive behavior and high recurrence. En bloc resection with vascularized second metatarsal transfer offers a reliable reconstructive option with excellent long-term functional outcomes and minimal donor site morbidity if it involves the entire metatarsal. This technique is a viable limb-salvage alternative to amputation in recurrent GCT of the first metatarsal.