Case Reports in Orthopedics最新文献

Background: Exoskeletons may provide quadriceps augmentation to patients with a torn or permanently weak extensor mechanism. Pneumatic exoskeletons utilize pressurized gas to improve gait, but their use and biomechanical impact have not been well described.

Methods: A lightweight pneumatic robotic wearable device was piloted in a clinical gait case report study using four different conditions-no devices, walking stick, inactive brace, and active brace. Walking speed, step length, step time, step width, and hip and knee flexion/extension angles were assessed while walking on a flat, declined, and inclined surface.

Results: Walking speed on a flat surface with the active brace (0.41 ± 0.03 m/s) was 45% faster than walking with no devices (0.28 ± 0.04 m/s). Knee flexion at initial contact (19.0^° ± 0.2^°) and peak knee flexion during stance (19.0^° ± 0.2^°) were greater with the active brace than with no device (-2.3^° ± 1.7^° and -1.3^° ± 0.7^°, respectively). The active brace (0.89 ± 0.07 s) was associated with a 17% shorter step time during incline walking compared to no devices (1.06 ± 0.09 s). It was also associated with a 62% longer step length during decline walking compared to no devices (0.27 ± 0.04 vs. 0.17 ± 0.03 m).

Conclusion: In this case report, a pneumatic robotic knee wearable device improved quadriceps function and increased walking speed while freeing one arm to perform other tasks. A training program that optimizes function and comfort may improve device adoption as patients may need time to become acquainted with external torque delivery to the limb.

Introduction: Ewing's sarcoma of the ulna is rare, and its wide resection poses challenges for preserving upper limb function. Elbow reconstruction must ensure joint stability and forearm mobility. Conventional alternatives, such as bone grafts and prostheses, have limitations, including a high risk of complications.

Objective: This study was aimed at reporting a case of elbow reconstruction using radial neck transposition to the humeral trochlea after ulnar resection for Ewing's sarcoma, evaluating the functional outcomes of this technique.

Methods: A 17-year-old male patient with Ewing's sarcoma in the ulnar diaphysis underwent complete ulnar resection. Radial neck transposition to the humeral trochlea was performed. Follow-up included functional assessment using the Musculoskeletal Tumor Society (MSTS) scale and postoperative imaging.

Results: After 2 years, the patient had an MSTS score of 28/30, with preserved wrist and hand mobility, full pronation, and supination reduced to half. Radiographic follow-up demonstrated proper alignment of the reconstruction, with no instability or bone resorption.

Conclusion: Radial neck transposition proved to be a viable alternative for elbow reconstruction after ulnar resection, providing stability and functional preservation. Further studies are needed to validate its application on a larger scale.

Congenital distal tibiofibular synostosis is quite a rare disease, and little is known about its optimal management. A 6-year-old girl presented to our institution with a deformity of her left lower leg. After years of careful observation, the patient underwent partial resection of a laterally protruding portion of the distal diaphysis of the fibula at age 10 for cosmetic reasons. Since the recurrence of lateral prominence of the distal lower leg was observed following the initial surgery, complete resection of the protruding portion of the distal diaphysis of the fibula was performed at age 14. Although mild varus deformity of the ankle was observed, the ankle joint congruity was good, and there were no associated symptoms or functional limitations. Therefore, we decided to perform a simple resection of the distal fibular diaphysis only for cosmetic improvement. At 1-year follow-up, no recurrence of lateral prominence of the distal lower leg has been observed. There was no difference in ankle range of motion between the left and right sides. The patient reported no pain and was able to participate in sports activities. In patients with preserved ankle function and few complaints about their daily activities, waiting until skeletal maturity and removing only the affected area may provide sufficient outcomes without risking growth potential or ankle function in the treatment of congenital distal tibiofibular synostosis.

Displaced intra-articular calcaneus fractures (DIACFs) are debilitating injuries often resulting from a fall from height or motor vehicle accidents. Traditional fixation methods involve extended incisions that can lead to soft tissue breakdown or necrosis. Novel techniques such as percutaneous fixation augmented by mini-open sinus tarsi approaches are theoretically associated with fewer soft tissue complications while achieving noninferior reduction and fixation. We introduced this technique to our peripheral hospital and completed this study as part of a departmental audit and self-critique. This descriptive case series includes three patients with DIACF who underwent fixation with the aforementioned novel technique and were followed up to observe radiological and clinical outcomes including Bohler's angle correction, pain, return to work and quantitative scoring systems. All patients had much improved Bohler's angle corrections (mean 35°) and were able to return to work following surgery. There were no wound issues. Our study suggests that excellent fixation of DIACFs can be achieved with a limited sinus tarsi incision and percutaneous screw fixation-without any compromise to postoperative function or soft tissue.

Periprosthetic joint infections (PJIs) are severe complications following joint arthroplasty, commonly caused by Gram-positive bacteria, such as Staphylococcus aureus. Infections due to Gram-negative organisms like Salmonella enteritidis are exceedingly rare. In this study, we report a case of a 68-year-old male who developed a late-onset PJI caused by Salmonella enteritidis 10 years after primary total hip arthroplasty (THA). A two-stage revision arthroplasty with an interim antibiotic spacer was performed, followed by 6 weeks of intravenous antibiotic therapy. Three months postoperatively, the patient demonstrated full recovery with normal function. This case highlights the necessity of considering uncommon pathogens like Salmonella enteritidis in PJIs, even in patients without identifiable predisposing factors, and underscores the effectiveness of combined surgical and targeted antimicrobial therapy.

Stemless anatomic total shoulder arthroplasty (aTSA) offers bone preservation advantages in younger patients, but postoperative instability requiring revision to reverse total shoulder arthroplasty (rTSA) occurs in 20%-32% of cases, representing a major indication for revision surgery. Although stemless rTSA has demonstrated promising early outcomes in Europe since 2005, it remains investigational and not Food and Drug Administration-approved in the United States. We report a 54-year-old female who developed implant dislocation and subscapularis tendon failure 8 weeks after primary stemless aTSA (Sidus system, Zimmer Biomet) for primary glenohumeral osteoarthritis. Given the well-fixed, convertible stemless humeral component and adequate metaphyseal bone quality, off-label conversion to stemless rTSA was performed with component retention. This approach is aimed at preserving proximal humeral bone stock, reducing operative time and blood loss, and potentially decreasing infection risk. At 2-year follow-up, the patient demonstrated excellent functional outcomes, improved range of motion, and stable radiographic findings. To our knowledge, this is the first report describing clinical and radiographic outcomes following revision of a dislocated stemless anatomic shoulder implant to a stemless reverse configuration.

We report a case of tibial insertion avulsion fracture of the anterior cruciate ligament (ACL). A 10-year-old boy who fell from a skateboard was diagnosed with a tibial insertion avulsion fracture of the ACL and was treated arthroscopically. The avulsed fragment was provisionally fixed with guide pins inserted into its four corners, and the lateral view was checked to avoid penetration of the growth plate. Two ultrahigh-molecular-weight polyethylene tapes were passed through the ACL just above its tibial insertion, pulled through the four-corner bone tunnels in an X-shaped configuration, and tightened. The patient was immobilized for 3 weeks, and partial weight bearing was initiated at 4 weeks. Bone union was confirmed at 6 months using plain radiographs, and second-look arthroscopy and implant removal were performed 8 months postoperatively. During arthroscopy, complete union with smooth continuity of the articular cartilage at the fracture site and a stable ACL were observed. The patient had a full knee range of motion and no pain at the final follow-up.

Introduction: Parkinson's disease rarely presents with Pisa syndrome, for which a patient may require corrective surgery because of trunk tilt. Herein, we report a case of lumbar dislocation fracture caused by minor trauma. The patient's trunk tilt progressed, and neurological symptoms worsened, requiring surgical treatment.

Case report: A 73-year-old man with Parkinson's disease fell and gradually developed lower back pain, lower limb pain, and paralysis. Single-segment interbody fusion at the dislocated intervertebral level temporarily improved neurological symptoms. However, 6 months after surgery, the implant had broken, and the trunk tilt had worsened. Salvage corrective surgery involving long-range fixation improved trunk tilt. The patient recovered independence in activities of daily living.

Conclusion: In Parkinson's disease, minor trauma can cause lumbar dislocation fractures, which may worsen Pisa syndrome. Short-segment fixation cannot control deformity progression; therefore, long-range fusion should be considered during the initial surgery.

This case report describes the combined use of the Latarjet procedure with distal tibia allograft augmentation to treat anterior shoulder instability in a 35-year-old female patient with a seizure disorder. The patient had significant bipolar bone loss and coracoid fracture pseudoarthrosis. The procedure involved using both coracoid autograft and distal tibia allograft to address the glenoid bone defect. Postoperative care included a sling for 3 weeks followed by progressive physiotherapy. At 18 months postsurgery, the patient reported high satisfaction, full recovery, and no recurrence of dislocations. Radiographic evaluations confirmed proper graft positioning and bone integration. This combined technique offers a robust solution for managing complex shoulder instability cases with significant bone loss and insufficient coracoid graft.

Background: Subtrochanteric fracture is a recognized complication following osteosynthesis for femoral neck fractures, typically occurring within 1-2 months postoperatively. At the time of onset, incomplete healing of the femoral neck fracture often results in a complex fracture configuration that poses challenges for management.

Case presentation: A 60-year-old woman with schizophrenia sustained a Garden Type I femoral neck fracture after a fall and underwent osteosynthesis with three sliding hip screws. Three months later, she developed marked hip pain without any new trauma. Radiographs revealed a displaced ipsilateral subtrochanteric fracture originating from the distal screw insertion site. The patient was treated with simultaneous open reduction and internal fixation (ORIF) using a polyaxial locking plate and total hip arthroplasty (THA). The postoperative course was uneventful, and the patient regained independent ambulation.

Conclusion: Although intramedullary nailing remains a common option for such fractures, selecting the optimal treatment can be challenging, particularly when fixation stability and femoral head viability are in question. In selected middle-aged or elderly patients, combining joint replacement with fracture fixation can provide both reliable mechanical stability and early functional recovery. This case underscores the importance of considering simultaneous arthroplasty and plate fixation in patients with poor bone quality, incomplete femoral neck healing, or a high risk of avascular necrosis, when revision osteosynthesis alone cannot provide sufficient mechanical stability.