Journal of Orthopaedic Case Reports最新文献

Introduction: Lipomas are common benign soft-tissue tumors typically found in subcutaneous regions. Intra-articular lipomas, however, are exceedingly rare and may present with functional impairment.

Case report: A 27-year-old male presented with chronic right knee pain, limited flexion, and inability to run. Clinical examinations ruled out ligamentous or meniscal injuries. Magnetic resonance imaging revealed a 30 × 10 × 27 mm encapsulated intra-articular lipoma in the inferomedial recess of the anterior knee joint. The mass was excised surgically through a medial parapatellar approach, and histopathology confirmed a lipoma. Postoperatively, the patient regained a full range of motion and resolution of pain.

Conclusion: This case underscores the importance of considering intra-articular lipomas in differential diagnoses for chronic joint pain and restricted mobility. MRI remains pivotal for accurate diagnosis, and surgical excision ensures favorable outcomes.

Introduction: Pediatric osteoarticular infections often present diagnostic challenges, especially in regions endemic to tuberculosis (TB). Misinterpretation of imaging findings may lead to inappropriate treatment, including the unwarranted use of anti-tubercular therapy (ATT).

Case report: We present the case of a 10-year-old child with chronic left ankle swelling and pain for over a year, initially diagnosed with tuberculous arthritis based on magnetic resonance imaging findings. Despite 2 months of ATT, symptoms persisted. Upon referral, further evaluation, including biopsy and culture, revealed a retained foreign body (thorn) within the ankle joint capsule and Pseudomonas aeruginosa infection. ATT was discontinued, and antibiotic therapy, as per culture sensitivity, was initiated, leading to complete clinical recovery.

Conclusion: This case underscores the importance of microbiological or histopathological confirmation before initiating ATT in osteoarticular infections. Reliance solely on imaging may lead to misdiagnosis, delayed appropriate treatment, and potential public health implications. Clinicians should maintain a high index of suspicion for alternative diagnoses, especially in atypical presentations or non-responders to ATT.

Introduction: Total hip arthroplasty (THA) remains one of the most effective surgical interventions for advanced hip pathology, providing reliable pain relief and functional restoration. Despite widespread use, outcomes from different regions and clinical settings continue to be valuable for benchmarking the quality of care.

Materials and methods: A prospective observational study was conducted in the department of orthopedics at a tertiary care center in eastern India. Thirty adult patients undergoing uncemented THA for various hip pathologies were enrolled. All procedures were performed using a porous press-fit acetabular cup through the modified Hardinge approach. Perioperative parameters, radiographic findings, and functional outcomes, including the Harris Hip Score (HHS), were recorded. Patients were followed at 1, 3, 6, and 12 months. One patient was lost to follow-up.

Results: Among the 30 patients, 24 (80%) were male, and 6 (20%) were female. Primary indications included osteoarthritis secondary to avascular necrosis (16; 53.33%), post-traumatic arthritis (10; 33.33%), rheumatoid arthritis (3; 10%), and corticosteroid-induced arthritis (1; 3.33%). The mean pre-operative HHS was 43.33 ± 10.8, categorized as poor. The average operative duration was 87.23 min (range: 60-135), with a mean intraoperative blood loss of 388.67 mL (range: 220-820). Radiographically, none of the 29 evaluated patients demonstrated component loosening in either the acetabular or femoral zones at any follow-up interval (1, 3, 6, or 12 months). Functional outcomes showed statistically significant improvement: mean HHS increased to 80.97 ± 5.1 at 1 month, 86.07 ± 4.0 at 3 months, 90.42 ± 2.9 at 6 months, and 92.59 ± 2.7 at 12 months (P < 0.001 for all comparisons).

Conclusion: Uncemented THA using a porous press-fit acetabular cup demonstrated excellent early outcomes, with no evidence of component migration or osteolysis during 1-year follow-up. Patients experienced significant and sustained improvement in functional scores, with no major complications reported.

Introduction: Anterior superior irreparable rotator cuff tears (ASIRCTs) are a challenging clinical condition, especially in younger patients and those with high functional demands. Various surgical options, including tendon transfers, aim to restore shoulder stability and function in the absence of a viable rotator cuff.

Case report: A 54-year-old male fisherman with a history of failed rotator cuff repair presented with persistent shoulder pain and significantly limited range of motion (ROM). Radiographic and magnetic resonance imaging findings confirmed ASIRCT with anterior superior subluxation of the humeral head. The patient underwent a combined latissimus dorsi and teres major transfer along with an arthroscopically assisted middle trapezius tendon transfer.

Conclusion: The patient demonstrated substantial functional improvement at 1 year, with increased ROM, strength, and patient-reported outcomes. Radiographic evaluation showed reduced humeral subluxation and stable transferred tendon integration. This dual tendon transfer approach offers a viable surgical option for restoring shoulder function in patients with severe ASIRCTs.

Introduction: Soft-tissue sarcoma (STS) being a rare malignancy, many times it undergoes inadequate surgery at first instance, leading to higher chances of recurrence. Atypical lipomatous tumor (ALT)/well-differentiated liposarcoma frequently undergoes first inadequate surgery leading to higher recurrence rate and sometimes getting converted to higher grade malignancy like dedifferentiated liposarcoma.

Case report: We had a 63-year-old female who presented with recurrent huge (dimension on final histopathology report: 29 × 24 × 11 cm) ALT of thigh after three prior surgeries over the span of 8 years. We resected it with wide margins and did a prophylactic nailing at second stage. Final histopathology report came out to be liposarcoma with foci of low-grade dedifferentiation (FNCLCC Grade 3). Patient received post-operative radiotherapy. At final follow-up of 35 months, our patient is recurrence free, doing all her daily routine activity independently.

Conclusion: Ten percentages of the ALT dedifferentiate into dedifferentiated liposarcoma, which has 15-20% metastatic potential compared to almost nil in ALT which happened in our case. Due to this, we recommend treatment of ALT and all STS at a tertiary cancer care center by a multidisciplinary team as it requires adjuvant treatment also apart from surgery with adequate margins.

Introduction: Fracture dislocations of the second and third carpometacarpal (CMC) joints are a rare injury, often associated with high-energy trauma that can lead to significantly compromised hand function if missed.

Case report: A 23-year-old female presented with a subacute right second and third CMC fracture dislocations after a rollover ATV accident. Open reduction and fixation of the second and third CMC fracture dislocations with a bridge plating construct was performed. At 12 weeks postoperatively, there were no complaints of pain. Hardware was removed at 5 months postoperatively. One year postoperatively, the patient had no significant stiffness, pain, or functional deficits.

Conclusion: Despite the subacute presentation and concern for devitalized bone, repair of the second and third CMC base fracture dislocations with bridge plating is a safe option for the CMC joints without fusion with good results.

Introduction: Background: The incidence of associated cartilage and meniscal pathology with anterior cruciate ligament (ACL) tears varies widely in the literature. Lateral meniscus posterior root tears (LPRTs) were more likely to occur with an ACL tear than medial meniscus posterior root tears, which were more likely to have concomitant knee chondral defects than LPRTs. The medial femoral condyle is the most common location reported overall; however, lateral femoral condyle defects are also reported in both acute and chronic cases. Repair of meniscal root injuries is the treatment of choice with the aim of restoring joint kinematics, contact pressures, and delaying the development of osteoarthritis. Articular cartilage injury associated with ACL reconstruction possibly has the greatest single effect on long-term subjective outcomes. However, compared with meniscal pathology, the volume of literature focused on treatment of chondral defects in conjunction with ACL reconstruction is significantly inferior.

Case report: A case of 37-year-old male patient presented with pain and instability of the left knee since past 3 month following twisting injury of knee while slipping off stairs. Clinically, he was having medial joint line tenderness, positive Lachman and anterior drawer test, positive grade 2 pivot shift, and full range of motion (ROM) of knee. He underwent arthroscopic ACL reconstruction with semitendinosus graft, medial meniscus root repair by suture pull out technique, and mosaicplasty (2 plug, 6 mm) for medial femoral condyle cartilage defect of size (1.5 × 1.5 cm, International Cartilage Repair Society grade 4). Post-operative knee ROM was started from day 1 and he was kept on non-weight-bearing walking for 6 weeks. He was followed at 1 month, 3 month, and 6 month. Visual analog scale (VAS) score and International Knee Documentation Committee (IKDC) score were recorded at 3 and 6 months.

Result: His VAS score at 3 and 6 month was 2 and 0, respectively. IKDC score pre-operative was 34.5 which improved to 86.2 at 6-month follow-up.

Conclusion: Single-stage ACL reconstruction along with meniscal and chondral injury repair to be done to achieve good functional outcome. Meniscal root repair also prevents ACL reconstruction failure. Despite these observations, further study is needed to know the complex factors involved in optimizing patient outcomes in the setting of ACL insufficiency with concomitant meniscal or chondral injury.

Introduction: Metallosis is a rare but recognized complication following total knee replacement (TKR). It is characterized by metallic particle deposition within periprosthetic tissue, triggering chronic inflammation, progressive osteolysis, and implant loosening.

Case report: A 63-year-old female with bilateral TKRs, performed 12 and 15 years earlier, presented with pain, swelling, and restricted flexion of the right knee following a fall. She had a history of recurrent instability and locking for 3 years. Imaging revealed extensive osteolysis, polyethylene liner dissociation, and loosening of the tibial component. She underwent one-stage revision with implant removal, synovectomy, and implantation of a constrained modular revision prosthesis. Postoperatively, she showed stable function without recurrence.

Conclusion: Although uncommon in knee arthroplasty, metallosis can lead to catastrophic implant failure if undetected. Timely recognition and revision surgery with thorough synovectomy are essential to restore function and prevent further bone loss.

Introduction: A debilitating side effect of comminuted elbow or forearm fractures and their surgical treatment is proximal radioulnar synostosis (PRUS), which is defined by heterotopic bone bridging between the radius and ulna and nearly total loss of forearm rotation. The standard treatment for established PRUS is surgical removal of the synostotic mass; nevertheless, unless a long-lasting interposition barrier is employed, recurrence persists as a threat. Autologous tensor fascia lata (TFL) grafting has been shown to restore rotation with minimal donor-site morbidity and serves as a biologic interposition.

Aim: Excision with TFL interposition for post-traumatic PRUS following proximal ulna plating: a comprehensive, critically updated review and original cohort experience with a focus on technique, functional results, recurrence, graft integration, heterotopic ossification (HO) prophylaxis, and rehabilitation plan.

Materials and methods: This retrospective observational study examined a consecutive cohort treated between 2017 and 2024, demonstrating radiologic graft integration, low donor-site morbidity, uncommon recurrence, significant improvement in pronation-supination and functional scores, and confirming - consistent with larger series - the effectiveness of TFL interposition when combined with complete extraperiosteal excision, circumferential graft fixation, early controlled mobilization, and targeted HO prophylaxis.

Conclusion: Following proximal ulna fixation, excision combined with autologous TFL interposition is a dependable method of restoring rotation following PRUS. The establishment of standardized scheduling, graft selection, and preventive regimens requires multicenter prospective trials with prolonged follow-up.

Introduction: Aneurysmal bone cysts (ABCs) are most commonly found in the metaphysis of long bones but are reported to have been found in other locations as well. While presentation of a swelling in a short bone is unlikely to be an ABC, the possibility should be kept in mind, especially with supporting radiological findings.

Case report: In this case report, we present the case of a young female who presented to us with complaints of pain and swelling over the dorsal aspect of her right foot. Radiological investigations pointed toward a diagnosis of ABC of the talus bone, which was confirmed on histopathological examination. The patient was managed conservatively using percutaneous polidocanol injection and was relieved of her symptoms soon after.

Conclusion: Although ABC is most commonly found in long bones, it can be considered a differential in other bones as well. Sclerotherapy may be considered over curettage as a treatment modality due to its numerous advantages.