Journal of Orthopaedic Case Reports最新文献

Introduction: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy, often leading to significant impairment, especially in patients with bilateral involvement. When conservative trials fail, surgical options such as open, mini-open, and endoscopic carpal tunnel release are considered. This report highlights the use of single-stage bilateral mini-open carpal tunnel release, emphasizing its efficiency, reduced recovery time, and cost-effectiveness.

Case report: A 58-year-old female with hypothyroidism presented with a history of numbness and tingling in the thumb, index, and middle fingers of both hands. Despite conservative management, symptoms persisted. The patient opted for a single-stage bilateral mini-open carpal tunnel release to save time and costs. The patient resumed daily activities within 2 weeks, showing significant improvement in disabilities of the arm, shoulder, and hand and Boston CTS questionnaire scores.

Conclusion: The mini-open technique for single-stage bilateral carpal tunnel release is an effective and efficient option for managing bilateral CTS. It provides adequate exposure and meticulous decompression, offering the benefits of both open and endoscopic methods while minimizing their drawbacks. This approach significantly improves patient outcomes and satisfaction.

Introduction: Osteochondromas are the most common benign bone tumors, typically occurring during growth. However, their occurrence in the distal radius is rare, and presentation with carpal tunnel syndrome (CTS) symptoms in pediatric patients is even rarer.

Case report: Here, we describe a unique case of an 8-year-old female who presented with CTS symptoms and was simultaneously diagnosed with an osteochondroma of the distal radius. Surgical excision of osteochondroma of the distal radius was performed, resulting in the complete resolution of symptoms.

Conclusion: This case highlights the importance of considering osteochondromas as a possible etiology of CTS symptoms, even in pediatric patients.

Introduction: Tibial plateau fractures, which constitute approximately 1% of all fractures with an incidence of 10.3/100,000 annually, result from varus or valgus forces combined with axial loading in the knee. These fractures display a bimodal distribution, affecting younger individuals through high-velocity trauma and older individuals through low-energy trauma. Proper management is critical due to the tibial plateau's role as a load-bearing surface; inadequate treatment can lead to functional impairment and early osteoarthritis. Utilizing the Schatzker classification, this study categorizes tibial plateau fractures to streamline treatment and reproducibility.

Objectives: The objective of the study was to assess the functional and radiological outcomes in the patients operated with arthroscopic assisted reduction and internal fixation (ARIF).

Materials and methods: This prospective analytical study conducted at a tertiary care hospital evaluates the functional and radiographic outcomes of 20 patients with Schatzker Type 1-4 tibial plateau fractures treated using ARIF. Patients excluded were those with Schatzker Type 5 and 6 fractures due to the increased risk of compartment syndrome from fluid extravasation during arthroscopy. Surgical procedures aimed to achieve anatomical reduction, proper alignment, stable fixation, early mobilization, and minimal soft-tissue damage.

Results: The study conducted in the cohort which constituted of 20 patients with a mean age of 44.3 years with 9 males and 11 females and fracture distribution being Schatzker 1/2/3/4: 3/5/10/2, respectively, found ARIF advantageous in diagnosing and treating articular cartilage and soft-tissue injuries, minimizing soft-tissue dissection, and reducing the need for extensive arthrotomy. The results demonstrated good to excellent outcomes in 85% of patients, with no depression in 70% of cases and no varus/valgus malalignment in 80% of cases after 18 months. However, the technique posed challenges such as increased operative time and a steep learning curve.

Conclusion: ARIF had favorable radiological and functional outcomes in the patient who was selected after careful evaluation.

Introduction: Although posterior dislocation of the hip is common, bilateral posterior hip dislocation in children is an infrequent presentation. Early diagnosis and treatment are of paramount importance to prevent complications. Here, we report a case of traumatic bilateral posterior hip dislocation following a high-velocity motor vehicle accident.

Case report: A 13-year-old boy was brought to the emergency department following high-energy trauma due to a motor vehicular accident. He was in considerable pain with both hips in flexion, adduction, and internal rotation. There was a restriction to the range of movement at bilateral hip joints. Clinical and radiological examination revealed a bilateral posterior hip dislocation.

Conclusion: Posterior hip dislocation is the most common type of hip dislocation. However, bilateral posterior hip dislocation is quite rare. This clinical presentation in the pediatric population is rarer still with very little published literature. Diagnosis and emergent treatment of the same is essential to prevent complications.

Introduction: Kingella kingae has become an increasingly significant cause of osteoarticular infection in children under the age of 4. The bacteria is infrequent in adults. Previous reports have indicated its association with infections, primarily affecting immunocompromised individuals. Only a few cases of isolated septic knee arthritis in immunocompetent patients caused by K. kingae have been reported.

Case report: We present a case involving a 64-year-old male with an unremarkable medical history diagnosed with septic arthritis in the knee attributed to K. kingae. He was treated with antibiotic therapy and joint irrigation and discharged with outpatient follow-up on the 9th day. The diagnosis led to an unexpected finding of multiple myeloma prompting further treatment.

Conclusion: This case confirms that K. kingae can cause septic arthritis in adults and physicians and microbiologists should be alert to the possibility, especially in adults with an underlying disease.

Introduction: Extra-articular deformity is that located proximal to the femoral epicondyles or distal to the neck of the fibula. In patients with gonarthrosis associated with extra-articular deformity, a different evaluation and approach will be necessary at the time of planning the arthroplasty. 3D planning and printing techniques have had a major impact on pre-operative planning, allowing the production of custom guides at low cost and in an accessible way. To our knowledge, this is the first report of combined 3D-guided extra-articular femoral osteotomy and total knee arthroplasty (TKA) for the treatment of extra-articular deformity and knee osteoarthritis.

Case report: We present the case of a 48-year-old caucasian male with gonarthrosis and a history of supracondylar femoral fracture with vicious consolidation. The pre-operative scan images were used for planning in collaboration with the engineers of the 3D planning and printing unit of our hospital. Two guides were designed and printed using biocompatible resin. The first one has a cannulated cylinder attached to a template of the patient's distal femoral surface to locate the entry point to the intramedullary canal. The second one fits the anterior cortex of the femur, over the fracture callus, and has six cannulated cylinders attached; four of them guided K-wires through the plane of the osteotomy and the other two guided position K-wires that would ensure canal alignment in the next step. A fixation and control plate was designed to maintain the corrected alignment until the definitive fixation with a retrograde femoral nail. After corrective osteotomy and fixation, TKA was performed. Six months after surgery, the patient is independent, pain-free, and does not use mechanical aids for walking. X-ray shows consolidation of the osteotomy and restoration of the mechanical axis of the limb.

Conclusion: The use of home 3D printers and open-source software, as well as the creation of a multidisciplinary 3D unit with orthopedic surgeons and bioengineers, makes it possible to obtain customized guides or implants with satisfactory clinical results at minimal cost.

Introduction: There are numerous causes of flatfoot, among them osteonecrosis of the navicular bone, a rare disease known as Mueller-Weiss syndrome, also leads to deformity.

Case report: A 53-year-old male presented to our Outpatient Department with pain and swelling over bilateral foot for 3 years with increased severity in the left. Physical examination as well as footprint revealed a bilateral flat foot, and there was tenderness as well as swelling over the dorsomedial aspect of bilateral foot. After a detailed physical examination and radiological assessment, the case was diagnosed as Mueller-Weiss syndrome. He was treated with non-steroidal anti-inflammatory drugs, custom ankle-foot orthotic brace for 6 weeks, and activity modification and symptoms were relieved and he was able to do daily activities without any discomfort.

Conclusion: MW syndrome is a rare condition, where conservative treatment provides better results if it is diagnosed and treated early, whereas late cases require surgical intervention.

Introduction: Rupture of the flexor carpi radialis (FCR) tendon is a rare phenomenon that is often described in the setting of rheumatoid arthritis or following trauma. Pseudotendon formation is seen commonly among extensor tendons of the antebrachium, typically as a sequelae of traumatic injury, spontaneous rupture in rheumatism, or postoperatively. Less frequent is the presence of pseudotendon in flexor tendons of the forearm. The development of a pseudotendon tends to result from the preservation of the tendon sheath with subsequent fibroblast proliferation. This results in a functionally deficient structure, often incapable of effective tension resistance.

Case report: We present a case of painful pseudotendon of the FCR in a patient with no identifiable common risk factors. A partial tear was identified on magnetic resonance imaging at the level of radiocarpal articulation and the patient was treated with debridement of tenosynovium and excision of the FCR tendon. The patient subsequently achieved 100% pain relief at 3 months follow-up with complete preservation of sensory and motor function and strength, and no functional complaints. We discuss the etiology of painful pseudotendon of the FCR and discuss relevant literature.

Conclusion: The significance of this report stems from the evidence that pseudotendon may form through non-classical pathways idiopathically. Our case demonstrated successful removal of tenosynovium, the pseudotendon sheath and FCR tenotomy is safe, effective, and demonstrates minimal clinical deficits.

Introduction: We experienced a rare case in which a bilateral snapping knee was caused by rheumatoid arthritis accompanied by Sjögren's syndrome (SS), and the symptoms were resolved by arthroscopic surgery.

Case report: A 43-year-old Asian male presented at another hospital with finger, shoulder, and knee pain and was diagnosed with rheumatoid arthritis accompanied by SS. Two months later, he developed the snapping phenomenon in both knees and presented at our hospital. The patient was positive for rheumatoid factor, anti-Smith antibody, and anti-SS-A antibody. Arthroscopy revealed a hard scar-like tissue in the lateral patellofemoral joint in both knees. The scar-like tissue was excised arthroscopically. Post-operatively, the snapping phenomenon and pain during flexion of the bilateral knee joints had been resolved.

Conclusion: In the present case, rheumatoid arthritis accompanied by SS caused inflammation of the knee joints and degeneration of the articular capsules, and snapping of the bilateral knees was caused by impingement of the scar tissue in the patellofemoral joints.

Introduction: Elbow joint is the most common affliction in upper limb tuberculosis (TB). A review of literature shows varying clinical presentations of TB in the elbow, with and without detectable primary foci.

Case report: We report a rare case of post-traumatic reactivation of latent TB of elbow which mimicked septic arthritis, in a healthy adult who suffered an elbow contusion injury following an road traffic accident. It was misdiagnosed as septic arthritis elsewhere and was going non-responsive to broad-spectrum antibiotics. At our center, we suspected TB and magnetic resonance imaging done showed joint destruction and fibrous ankylosis. He underwent joint debridement with removal of fibrous tissue and synovectomy. The synovial biopsy and polymerase chain reaction were consistent with TB. At 1-year follow-up on anti-tuberculosis treatment, he was relatively pain free and regained functional range of movement.

Conclusion: Post-traumatic reactivation of TB in joints, though a rare entity, should be kept in mind in patients who are non-responsive to routine antibiotics, especially in endemic areas. Early and accurate diagnosis prevents progression to articular destruction and fibrous ankylosis.Level of Evidence: V.