Orthopedic Reviews最新文献

Distal radial fractures (DRFs) are prevalent injuries and represent one of the most common fractures seen in the Emergency Department (ED). DRFs often result from falls on an outstretched hand (FOOSH). This case study details a 64-year-old female who sustained a distal radial fracture with dorsal angulations (DRFDA) from ice skating, confirmed via radiographic evaluation. Initial treatment involved immobilization, pain management, and follow-up with orthopedic specialists. Proper diagnosis and management are essential to prevent long-term functional impairments, with treatment ranging from casting to surgical intervention based on fracture severity.

Chronic low back pain is a prevalent and debilitating condition that often resists traditional management strategies such as physical therapy, pharmacotherapy, and interventional procedures. The erector spinae plane (ESP) block, a relatively new regional anesthesia technique, has shown promise in managing various types of pain, including chronic conditions. This case report details the use of the ESP block in a male patient in his late 60's with chronic low back pain unresponsive to conventional treatments, including acetaminophen, muscle relaxants, gabapentin, epidural steroid injections, diagnostic medial branch blocks, and sacroiliac joint injections. Given the refractory nature of his pain, a right-sided lumbar ESP block was performed under fluoroscopic guidance. This case highlights the potential of the ESP block as an effective treatment for chronic lumbar pain, particularly in patients who have not responded to other interventional modalities. The safety profile of the ESP block, coupled with its efficacy in this case, supports its consideration as a viable option in chronic pain management. Further studies and clinical experience will be essential in defining its role and establishing standardized protocols for its use in chronic pain settings.

Medial hamstring snapping knee syndrome is an infrequent clinical entity, with osteochondroma being an exceptionally rare etiology. This report details a case of a 21-year-old female presenting with a 4-month history of persistent left knee pain, snapping, and clicking, which developed following a fall. Despite initial conservative management, the symptoms persisted. Advanced imaging, including MRI, revealed a small osteochondroma on the medial aspect of the proximal tibia, which was the underlying cause of the snapping. A targeted physiotherapy regimen emphasizing quadriceps and hamstring strengthening was subsequently employed, leading to effective symptom management. This case highlights the necessity of a meticulous clinical evaluation and the role of advanced imaging in diagnosing rare etiologies of snapping knee syndrome. Furthermore, it demonstrates the efficacy of focused physiotherapy in managing such conditions.

The authors present a case of a distal phalanx fracture secondary to a nail gun injury. The diagnosis, evaluation and emergency departmetn treatment are reviewed.

Facet joint injections with steroids are a common therapeutic intervention for chronic pain management, particularly in patients with lumbar spondylosis and facet arthropathy. However, many insurance companies do not provide coverage for this helpful intervention. This case series presents four patients who experienced significant and sustained pain relief following therapeutic facet joint injections. The aim of this case series is to highlight the efficacy of facet joint injections with steroids in managing chronic spinal pain and to discuss the potential benefits of this treatment modality in patients who may not be interested in pursuing lumbar radiofrequency neurotomy.

Cervical radiculopathy is characterized by pain, numbness, and weakness in the upper limbs. This is typically caused by nerve root compression. While conservative treatments like physical therapy and oral analgesics are often used, they may not be effective in more severe cases. Cervical epidural steroid injections (CESIs), particularly through the interlaminar approach, may be considered when these initial treatments fail. This case report discusses a female patient with severe left upper extremity pain consistent with C5/6 and C6/7 radiculopathy who did not respond to conservative therapies. An interlaminar CESI was initially performed at the C7/T1 level, but the contrast flow was inadequate for effective drug delivery. Repositioning the needle at the C6/C7 interspace improved contrast distribution, successfully targeting the affected levels. The patient experienced a 90% reduction in symptoms three weeks after the procedure, underscoring the importance of accurate contrast flow assessment and needle placement in CESIs. This case highlights the effectiveness of CESI in treating cervical radiculopathy and the critical role of precise technique in achieving positive patient outcomes.

The rectus femoris is a principal muscle in the quadriceps muscle group. It plays a major role in flexion of the hip and extension of the knee joint and works as an important dynamic stabilizer for both joints. This case report details the presentation, diagnosis, and treatment of a high-grade rectus femoris tear in a young physically active patient. Furthermore, we detail the mechanism of injury, clinical signs, and symptoms, in addition to images and findings used to confirm the diagnosis. Different treatment approaches are highlighted. The outcomes of conservative management in comparison with surgical intervention is explored in the literature. The aim of this case study was to contribute more to the understanding of rectus femoris tears and to shed light on various aspects associated with this rare injury.

Post-dural puncture headache (PDPH) is a common and debilitating complication that can arise after spinal or epidural anesthesia, or following the placement of spinal cord stimulation leads due to inadvertent dural puncture. We report the case of a 54-year-old female who developed severe PDPH following a spinal cord stimulator trial, complicated by a failed EBP performed by an outside physician. The patient presented to the emergency department with debilitating bilateral occipital headaches exacerbated by an upright position. Given the failure of the EBP, she was treated with bilateral occipital nerve blocks, which resulted in near-complete and rapid resolution of her symptoms. This case highlights the effectiveness of occipital nerve blocks as a therapeutic option for PDPH, especially in challenging cases where other treatments have proven inadequate. Given the positive outcome observed, occipital nerve blocks should be considered a viable treatment option in the management of PDPH, warranting further study to better understand its role in clinical practice.

Background: There is a paucity of literature analyzing data for return to sport (RTS) and return to work (RTW) in the setting of direct anterior approach (DAA) total hip arthroplasty (THA).

Objective: The aims of this systematic review are to identify existing literature and to aggregate rates of RTS/RTW following DAA THA in a meta-analysis.

Methods: A query of major databases yielded 1819 initial studies. A random-effects model approach was implemented for meta-analysis. Moderator effects were assessed with respect to patient demographics and functional outcomes.

Results: Five studies reporting RTS after DAA THA were identified, representing a total of 204 patients with a mean age of 60.2±7.5 years and mean follow up of 31.8±9.5 months. Pooled rate of RTS was 76%(95% confidence interval [CI], 63%-86%;range 58%-100%). Pooled rate of return to the same sport was 77%(95%CI, 64%-86%;range of 62%-100%). Pooled rate of RTS to the same intensity was 58%(95%CI, 48%-68%;range of 41%-68%). Meta-regression demonstrated no significant correlations between independent variables and RTS characteristics. Three studies reported RTW rates. Rates of RTW within 3-months were 30%, 45%, and 60%. One study reported rate of RTW of 79% at 6-months and 87% at 12-months. One study demonstrated a mean time to RTW of 38±24.8 days.

Conclusion: Pooled rate of RTS is satisfactory following DAA THA and are comparable to rates of RTS aggregated without delineating surgical approach. Data supporting RTW rates following DAA THA limited, and thus more primary studies are needed to establish if this approach confers an advantage of faster RTS/RTW.

Objective: Describe the clinical and paraclinical characteristics of De Quervain Syndrome and the result of the surgery for De Quervain Syndrome after conservative treatment of distal radius fracture.

Subjects and methods: A case report.

Results: De Quervain Syndrome is a condition that involves tendon entrapment affecting the first dorsal compartment of the wrist. It has been reported that De Quervain Syndrome can also develops after distal radius fracture. We report a case that the patient was diagnosed with De Quervain Syndrome after conservative treatment of distal radius fracture. During surgery we noticed that the patient had separated tendon sheaths for abductor pollicis longus (APL) and extensor pollicis brevis (EPB). EPB tendon sheath was released and reconstructed to prevent tendon subluxation. After 6 months, patient was feeling no pain and very satisfied.

Conclusions: De Quervain Syndrome development after distal radius fracture is rare. The successful surgery got the patient came back to work normally.