Case Reports in Orthopedics最新文献

Distal fibula fracture is a common injury of the lower limb. Significantly displaced distal fibula fracture is treated with surgical fixation under general, spinal, or regional anesthesia. We present a case of displaced distal fibula fracture with both the regional anesthesia and operation performed by the same attending orthopedic surgeon. The patient underwent successful ultrasound-guided regional anesthesia as well as open reduction and internal fixation. This case report highlights the technical detail for ultrasound-guided regional anesthesia and surgical fixation by surgeon.

The following case report demonstrates a case of a chronic irreducible patellar dislocation, age-indeterminate associated with a large medial patellar avulsion fracture that was treated with a vastus medialis obliquus advancement following an extensive lateral release. This case is the only known report of this kind in the literature. The patient is a 41-year-old Caucasian female who presented to the clinic with an age-indeterminate, chronically dislocated patella. She has a past medical history of hypertension and ischemic stroke 1 year prior to presentation, leading to expressive aphasia and lower extremity weakness in addition to patellar instability dating back to age 13. An unsuccessful patellofemoral reduction was performed at an outside clinic, and she was placed in a knee immobilizer and referred to our office. Clinically, the patient had limited knee range of motion with a fixed lateral patellar dislocation that was confirmed on imaging. This case report demonstrates a surgical reduction technique that can be utilized by orthopedic surgeons for chronic patellar dislocations that are not amenable to routine patellar instability surgeries due to the contraction of surrounding soft tissue, chronic bone abnormalities, and position of the chronic dislocation. An extensive lateral release followed by vastus medialis obliquus advancement was performed to center the patella within the trochlear groove and to allow for stable articulation throughout range of motion. The patient was able to regain painless, full range of motion of her knee postoperatively with patellar stability noted on both physical exam and radiographic imaging.

Multiligament knee injuries (MLKIs) frequently require immediate intervention to prevent severe complications, including vascular injury. We present the case of a 51-year-old male who sustained a traumatic right knee dislocation following a motor vehicle accident. The patient exhibited significant tibiofemoral dissociation with Grade 3 instability, classified as Schenck KD IV. Immediate reduction and external fixation were performed, followed by definitive surgical management, which included fibular sling, MPFL and MCL repair, and double-bundle and double-tunnel ACL and PCL reconstruction with looped proximal tibial fixation. The patient showed an excellent early postoperative outcome, with minimal edema, manageable moderate pain, and a full range of motion by the 30-day follow-up. This case underscores the effectiveness of combining fibular sling, MPFL, and MCL, with anatomical double-bundle ACL and PCL reconstruction in the treatment of complex MLKIs. The level of evidence is IV.

This paper presents a surgical technique for the removal of an old universal femoral nail preceding total hip arthroplasty (THA) in a 50-year-old male patient with left hip osteoarthritis. The patient had undergone femur nail insertion approximately 35 years ago. Due to the necessity of nail removal prior to THA, surgery to remove the nail was planned. There are challenges posed by the design of the old universal femoral nail system, particularly its side slot which made engagement of the conical bolt difficult. The successful removal of the nail was eventually achieved, enabling subsequent THA. Individuals who received this old implant years ago may now require its removal as part of osteoarthritis treatment. Given the lack of familiarity among surgeons with this outdated implant, this paper is aimed at providing essential guidance and insights regarding its removal procedure. This literature represents the inaugural documentation of the surgical technique for the removal of an aged femur nail.

Introduction: Revision surgery in the spine poses considerable challenges due to the presence of scar tissue and structural differences, necessitating careful surgical planning and precise techniques. In this technical note, we focus on lumbar unilateral biportal endoscopy (UBE) for single-level reoperations, outlining principles and methods for handling soft tissue in such cases. Materials and Methods: We reviewed our surgical approach for lumbar reoperations with UBE, emphasizing the importance of meticulous preoperative planning and bone-centered manipulation. Our technique involves utilizing biportal endoscopy for enhanced visualization and employing specific strategies for managing scar tissue, including the "pull-and-cut technique." We present two illustrative cases to demonstrate the application of our method. Results: The described approach yielded successful outcomes in both cases presented. Case 1 involved a posterior interlaminar approach for a recurrent disc at the L4-5 level, while Case 2 utilized a far lateral approach for recurrent disc herniation at the L4-5 level. Both surgeries were completed with relatively short operation time, minimal blood loss, and immediate improvement in symptoms postoperatively. Conclusion: Lumbar UBE offers a promising option for safe and effective reoperation in spinal surgery. Our technique, emphasizing bone-centered manipulation and specific strategies for scar tissue management, provides excellent visibility and enables precise tissue handling. Overall, UBE facilitates relatively simple and safe reoperations, contributing to improved patient outcomes in the challenging field of spinal surgery.

The formation of gouty tophi surrounding the prior surgical site years after an Achilles tendon repair is an extremely rare presentation for which only three previous cases have been documented in the literature. In this case, we report the presentation of a 53-year-old male who had an Achilles tendon repair two and a half years prior and no clinical history of gout, yet during the necessary revision procedure of his Achilles tendon, he was found to have gouty tophi surrounding the nonabsorbable sutures used during his initial surgical repair. This case presentation and the three prior ones all involve the use of nonabsorbable sutures, and these sutures may potentially serve as a nidus for the formation of gouty tophi years after a surgical procedure, even in patients who do not have a clinical history of gout. It is important for clinicians to be aware of this rare clinical presentation as potential sequelae include infectious processes and the need for revision procedures.

Combined medial and lateral posterior meniscal root tears in the setting of an acute anterior cruciate ligament (ACL) rupture are extremely rare. The following case report demonstrates a high school football player who sustained a noncontact knee injury while performing a spin move at practice. The patient is a 17-year-old high school football defensive end who was presented to the clinic 1 week following the injury complaining of persistent knee pain with associated swelling, limited range of motion (ROM), and complaint of instability. During physical examination, the patient was found to have anterior cruciate laxity. Magnetic resonance imaging (MRI) demonstrated a complete midsubstance tear of the ACL and increased signal within the posterior horn of the medial meniscus with no obvious signs of pathology localized to the lateral meniscus. ACL reconstruction (ACLR) was performed and intraoperatively, both medial and lateral root tears were found. A standard bone patellar-tendon bone (BTB) autograft ACLR was performed with combined medial and lateral root repair utilizing a transtibial pull-out method for both. The clinical importance is root tears with associated ACL tears can be hard to diagnose on preoperative MRI, especially laterally, so careful assessment of both meniscal roots at the time of arthroscopy is critical. Furthermore, careful creation of the needed root repair tunnels for transtibial repair is critical to avoid coalescence with the ACL tibial tunnel.

Introduction: Surgical management of intertrochanteric hip fractures is a common surgery with low rates of intraoperative complications. Vascular injuries are exceptionally rare when placing an intramedullary nail without open reduction. There are very few reported cases of direct arterial injury and active bleed at the level of the distal interlocking screw following closed reduction and intramedullary nailing of a hip fracture. We report one such case. Case Presentation: An 88-year-old female presented to the emergency department with a left intertrochanteric hip fracture. Closed reduction with a cephalomedullary nail fixation of the left hip fracture occurred as planned without any obvious intraoperative technical issues. The patient remained stable intraoperatively. No open reduction was required. Postoperatively, the patient developed hemorrhagic shock and required massive transfusion protocol. Angiography demonstrated an intramuscular hematoma at the level of the distal intramedullary nail interlocking screw with active extravasation. The patient subsequently required embolization. Nine days following surgery, she began Eliquis for DVT prophylaxis and was ambulating independently with signs of hematoma resolution. Discussion: Profunda femoris artery injury can stem from various mechanisms during surgery. Atherosclerosis places patients at a higher risk of complication due to rigid vessels. In this case, it is believed that drilling beyond the medial femoral cortex led to the arterial injury. Conclusion: Care should be taken to prevent drills from plunging beyond the medial femoral cortex during surgery. Cautious observation of patient's vitals and clinical course can allow for early detection of vascular complication.

Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.

Background: Patients with congenital absence of a lumbar pedicle and nerve root anomaly presenting with ipsilateral foraminal stenosis are extremely rare. Case Presentation: An 80-year-old man had low back and right thigh pain. Radiographs and computed tomography (CT) showed L3 vertebral body fracture and the absence of the right L3 lumbar pedicle. He was diagnosed with L2-L3 right foraminal stenosis caused by an L3 vertebral fracture and underwent lumbar fusion at L2-L3 and L3-L4. Intraoperatively, we confirmed that an anomalous nerve root was divided from the right L2 nerve root near the dorsal root ganglion (DRG). Conclusions: Patients with congenital absence of a lumbar pedicle are less prone to ipsilateral foraminal stenosis because they theoretically have a large space in the foramen. This rare case was caused because of additional instability due to vertebral fracture under the condition of a nerve root anomaly and lumbar degeneration.