Journal of Orthopaedic Case Reports最新文献

Introduction: Developmental dysplasia of the hip (DDH) describes a spectrum of disorders affecting the neonatal hip. Trachyonychia or twenty nail dystrophy refers to thin, brittle nails with excessive longitudinal ridging affecting all twenty nails. Alopecia universalis congenita (ALUNC) is a rare anomaly affecting skin and appendages. It shows a genetic preponderance with its autosomal recessive variety being the most common and severe variety.

Case report: We report a case showing idiopathic DDH in a female child with a rare epidermal syndrome consisting of Trachyonychia and ALUNC. The cutaneous symptoms show familial inheritance in the form of autosomal dominant inheritance.

Conclusion: This case report highlights the fact that DDH can be associated with other syndromes which require multidisciplinary evaluation and research.

Introduction: Spinal tuberculosis (TB) is a significant health problem. While chemotherapy is the primary treatment, surgery is necessary in some cases. This study investigates the posterior approach for treating thoracolumbar spinal TB with neurological involvement.

Materials and methods: This prospective observational study included 75 patients with thoracolumbar TB and neurological deficits. All underwent posterior decompression and stabilization using pedicle screw fixation. Pre and post-operative neurological status, pain scores, and kyphotic angle were assessed.

Discussion: The posterior approach demonstrated advantages over the traditional anterior approach. It facilitated decompression, improved neurological function, and corrected spinal deformity. Posterior fixation allowed early mobilization, reducing complications from prolonged bed rest. These findings align with previous research supporting the posterior approach for spinal TB.

Conclusion: The posterior approach with decompression and pedicle screw fixation is a safe and effective surgical method for thoracolumbar spinal TB with neurological involvement. It offers good clinical outcomes, minimizes complications, and facilitates faster patient recovery.

Introduction: Most patients with these injuries are taken to hospitals frequently for specialized orthopedic treatment. However, because quackery is a common practice in the many regions, it is common in underdeveloped nations, particularly in rural India, for these injuries to be initially overlooked. This study aimed to assess the efficacy of open intramedullary nailing in the treatment of patients with neglected bilateral fracture shaft femurs in terms of union achievement and functional outcomes.

Case report: The first presentation was a 27-year-old male patient with bilateral untreated malunited shaft femur fractures that had occurred 10 months prior. The patient had a history of a car accident that resulted in bilateral shaft femur fractures. We aimed to treat both fractures simultaneously in a single setting with open reduction and femoral nailing. The patient has followed up for 10 months after surgery with full weight bear walking without support and can sit cross legged and squat.

Conclusion: The prognosis is typically poorer for neglected femoral shaft fractures than for those that are treated immediately. Any surgeon who works in low facilities setting needs to be aware of difficulties in the management of neglected or non-union shaft femur fracture.

Introduction: Death is the most common outcome of longitudinal atlanto-occipital dissociation (L-AOD). Even though rare, survival is commonly seen in the pediatric population. This study reports a successful outcome of a pediatric patient with an L-AOD without neurodeficits, immobilized in a visor (head-neck-chest) orthosis.

Case report: A 9-year-old boy came off his motorbike during a jump at ~50 kph. He was transferred from the primary hospital with spine precautions and a cervical collar with multiple injuries with neurologically intact on presentation. The computed tomography (CT) spine demonstrated a widening of the basion-dens interval, estimated approximately at 16 mm (normal <10 mm), with the widening of the atlanto-occipital articulations with occipital condyles and atlas facet distance markedly widened approximately at 7 mm (normal <5 mm). Considering intact neurology and no complete tear of the tectorial membrane, the decision was made to immobilize in a visor (head-neck-chest) orthosis for controlled vertical cranial settling to occur. Periodic cervical spine imaging over 3 months was done to assess the reduction. At the end of 3 months, dynamic cervical spine X-rays and CT scans confirmed atlanto-occipital articulations with the basion-dens interval and intercondylar distance within normal limits.

Conclusion: L-AOD is a rare diagnosis with a high rate of neurological deficits and mortality. The advancements in emergency care, diagnostic methods, and treatment options have increased survival rates and overall prognosis of the atlanto-occipital dissociation. A visor (head-neck-chest) orthosis and careful observation could be one of the treatment options for L-AOD.

Artificial intelligence (AI) is revolutionizing various sectors, including health care, with orthopedics being no exception. Orthopedic practice, already familiar with technological advancements such as robotic surgery, is rapidly integrating AI into clinical workflows, enhancing precision in surgical planning, diagnostics, and patient care. However, this evolution raises critical questions, particularly regarding liability when AI systems fail and cause harm. This article delves into the role of AI in orthopedics, exploring its current applications and the potential legal implications that come with its adoption. It examines the global landscape, highlighting the lack of clear regulations around AI liability, especially in India, where the topic remains underexplored in medical literature. With insights into how AI is transforming orthopedic practice, the article addresses the pressing concern of who bears responsibility when AI errors occur. This timely discussion serves as an exploration of a unique and recent topic, urging Indian orthopedic surgeons to balance the benefits of AI with the responsibility they hold, as the legal framework surrounding AI in health care continues to evolve.

Introduction: Cat bites are a remarkably common injury seen in the emergency department setting . Due to the morphology of feline teeth and anatomy of the human hand, seemingly innocuous surface bites can seed infections in deeper structures of the hand that can result in adverse outcomes. We report on a case of a rare complication of a flexor tendon rupture that occurred well after the initial treatment of a superficial infection.

Case report: A healthy 61 year old male presented to the emergency department with concerns for possible infection after sustaining a cat bite to the proximal phalanx of his left long finger 48 hours earlier. The patient was treated for suspected cellulitis and underwent irrigation and debridement within 36 hours. Five months after presentation, it was determined that the patient had suffered a spontaneous rupture of the flexor digitorum profundus tendon of the left long finger. The patient underwent surgical debridement, flexor tendon tenolysis, and tendon reconstruction. Postoperatively, the patient returned to normal activities with good function of his left hand after a course of occupational therapy.

Conclusion: The purpose of this case report is to describe the clinical course of a patient with the rare complication of a flexor tendon rupture after being bitten by a cat, as well as to review the current literature and treatment for feline bite-related hand injuries. We recommend patients who have sustained a cat bite with a suspected infection to present as early as possible for an evaluation by a medical professional, early appropriate empiric antibiotic administration, and early surgical debridement when warranted to help prevent complications.

Introduction: Arthrofibrosis of the knee is an adverse outcome after anterior cruciate ligament (ACL) reconstruction. Definitions and classifications vary widely based on extension and flexion losses, patellar mobility, and location. In general, it is understood as a restricted range of motion (ROM) due to scar tissue, and it is often defined as symptomatic limitation in knee ROM compared to the opposite knee. The frequency of ACL injuries, and consequently arthrofibrosis, is rising among children and adolescents, with an incidence rate ranging from 2 to 14% in the pediatric population. Treatment options for arthrofibrosis include oral corticosteroids, physical therapy, casting, manipulation under anesthesia, and arthroscopic lysis of adhesions, with early recognition being a crucial intervention. To our knowledge, this is the first report in the literature to describe the development of chondromalacia after the resolution of arthrofibrosis with conservative measures in a pediatric patient.

Case report: A 17-year-old male developed arthrofibrosis after combined ACL reconstruction and autologous osteochondral graft transfer. Knee flexion was restored with a high-frequency, intensive physical therapy and home exercise program but at a cost of developing anterior knee and patellofemoral chondromalacia.

Conclusion: Because complications can arise from the greater patellofemoral contact forces observed in arthrofibrosis, orthopaedic surgeons should consider early lysis of adhesions for the management of post-operative arthrofibrosis, particularly involving the parapatellar retinaculum, in adolescents who are non-responsive to conservative measures. In addition, restrictions on high levels of loading should be considered during the initial post-operative period in scenarios in which ROM has not been achieved.

Introduction: Pediatric hip fractures comprised <1% of all pediatric fractures. These fractures are usually associated with high-energy trauma, such as motor vehicle accidents or fall from height. The Delbet classification of pediatric hip fractures is frequently used to describe these injuries and to relate the fracture type to the development of avascular necrosis. Treatment should be given as an emergency basis and monitored according to the type of fracture and the patient's age. Historically, casting was used for such fractures; however, due to the high complication rate, the treatment modality has shifted to early anatomical fixation.

Case report: We present the case report with detailed history, examination, and treatment of a 12-year-old boy with an uncommon site of fracture at right transepiphyseal hip fracture with dislocation. Emergency initial operation was done and followed up for 2-year duration on regular basis. The patient has currently normal gait with painful terminally restricted movements.

Conclusion: Early recognition and operative management of pediatric hip fractures has improved outcomes.

Introduction: Hip fusion surgeries even though uncommon have shown good functional outcomes in patients and have its own advantages over arthroplasty.

Case report: In this case report, we present a 62-year-old female, who underwent right hip arthrodesis using Cobra plate when she was 42 years, with a long-term 20 years follow-up, leading a functionally normal life, good patient satisfaction with acceptable quality of life.

Discussion: Although hip fusion can limit the patient's range of motion, it confers the advantage of better and stable fixation, pain relief, and advantage of future conversion to hip arthroplasty if done within accepted limits.

Conclusion: Hip fusion surgeries have become very rare in recent times due to the advances made in arthroplasty surgeries. Literature evidences of long-term follow-up of hip arthroplasties are very few while hip fusion surgeries have a substantial literature evidence of showing good functional outcomes in patients.

Introduction: Proximal humerus fractures are prevalent, especially among the elderly, and pose significant challenges in treatment, particularly for displaced fractures. Despite the availability of various surgical techniques, outcomes remain inconsistent, often due to poor anatomical reduction and fixation. This study examines the correlation between specific radiographic parameters and functional outcomes, aiming to identify key predictors of recovery. By focusing on these parameters, we aim to refine surgical approaches and improve follow-up strategies, ultimately enhancing patient outcomes.

Materials and methods: A retrospective study involved 40 patients aged 18-75 with proximal humerus fractures, treated with open reduction and plate fixation at Chettinad Hospital between April 2022 and April 2024. All surgeries were performed through anterior deltopectoral approach. Radiographic parameters were evaluated postoperatively, with patients followed for a period of 1 year. Functional outcomes were correlated with radiological parameters using follow-up radiographs and Constant-Murley (C-M) scores.

Results: In this study of 40 patients with proximal humerus fractures, the mean age was 53.24 years, and the majority (60%) were male. The fractures predominantly affected the right side (62.5%), with road traffic accidents and falls being the leading causes. Neer's classification identified 10 patients with two-part fractures, 21 with three-part fractures, and 9 with four-part fractures. The average neck-shaft angle (NSA) was 138.62° ± 11.09°. Four patients with an NSA of ≤120° had fair to good functional outcomes, while those with an NSA >130° and a well-positioned greater tuberosity (GT) generally had better outcomes. The average distance between the GT and the acromion surface (AS) was 6 mm ± 1.4 mm, influencing shoulder abduction and functional results. Patients with an alpha/beta ratio below 1.40 mm, indicating lower bone density, had a higher incidence of screw cut-out. The mean C-M score at 6 months was 80.72, with 87.5% of patients achieving abduction above 90°. Complications occurred in 8 patients (20%), including varus collapse (10%), abduction <90° (12.5%), infection (2.5%), and screw cut-out (5%). Larger head diameters and heights were associated with better functional scores.

Conclusion: Radiographic parameters such as the NSA, GT to AS distance, head diameter, head height, and alpha/beta ratio are crucial predictors of functional outcomes in proximal humerus fractures treated with PHILOS plates. Accurate reduction and medial column stabilization are a key to minimizing complications and improving patient recovery. Despite generally positive outcomes, challenges such as screw cut-out and varus collapse persist, highlighting the need for meticulous surgical technique and thorough post-operative management.