Case Reports in Orthopedics最新文献

Background: Popliteal artery entrapment syndrome (PAES) is a frequently underdiagnosed disease in young patients due to its low incidence and nonspecific symptoms. The disease is classified broadly into two categories: anatomic entrapment or functional entrapment. Prompt diagnosis is crucial due to the potentially limb-threatening nature of this condition should critical limb ischemia develop.

Case: A 16-year-old male soccer player with no past medical history who had 1 week of acute onset right lower extremity calf pain and foot numbness due to right proximal popliteal and tibial artery occlusion in the setting of Type 1 popliteal artery entrapment. Treatment initially included thrombolysis but was complicated by development of compartment syndrome requiring emergent four-compartment fasciotomy. He subsequently underwent thrombectomy of his popliteal, anterior, and posterior tibial arteries before definitive popliteal artery decompression with medial gastrocnemius recession and repositioning.

Discussion: PAES is a rare disease that can lead to devastating complications such as critical limb ischemia as seen in this patient. It is of paramount importance to identify this disease early and implement appropriate treatment. Debate remains as to the necessity of bypass or vascular repair in patients with Type 1 PAES. This patient did not undergo popliteal artery bypass and has been doing well postoperatively thus far.

Episealer metal implants have recently been gaining attention, offering treatment for focal chondral and osteochondral lesions, particularly in the knee joint. These patient-specific implants are precisely made using a detailed MRI analysis of the lesions, bridging a critical gap in the treatment of younger patients with challenging degenerative lesions. This innovative approach provides safe, predictable, and effective measures to preserve the function of the knee joint and maintain its native structure. In this case report, we describe the surgical outcomes of an Episealer femoral twin implantation, focusing on treating a lesion spanning the lateral condyle and trochlear region of the femur. This was performed on a 44-year-old patient complaining of an 8-month history of knee pain after a nontraumatic injury. The patient was found to have a Grade 4 osteochondral lesion on the lateral femoral condyle and elected to receive the Episealer twin metal implant. Postoperative measurements showed an improvement in the range of movement and strength. The patient also reported improvement in pain, knee functionality, and overall quality of life. In conclusion, detailed MRI analysis made it possible to design patient-specific implants, effectively addressing the gap in the treatment of younger patients with focal degenerative lesions.

Introduction: Snapping scapula syndrome is an unusual condition characterized by an audible, grating, and snapping sound upon shoulder movement, often observed in young adults. Clinical severity ranges from gentle friction sounds to louder grating noises or crepitus, which may or may not be associated with pain and limited motion. Multiple etiologies include congenital malformations such as Sprengel's deformity, exostosis, subscapular mass, and scapulothoracic bursitis.

Case presentation: A 28-year-old right-handed male presented a 12-year history of crepitus and snapping of the right scapula, with pain and worsening crepitus in the past year. Clinical examination revealed a symmetrical glenohumeral range of motion with combined scapular dyskinesia. CT scan showed a bony mass near the superior border and superomedial angle of the scapula, resembling a second glenoid with a smaller, less concave surface. The mass included a protuberance that suggested a second coracoid process and spine of the scapula. Surgical excision of the bony mass and surrounding bursa, along with partial resection of the superomedial angle, was performed. The patient fully recovered after 3 months and presented no symptoms of recurrence at the 2-year follow-up. The excised mass consisted of mature bony tissue with interspersed trabeculae, suggestive of exostosis.

Conclusion: Bone masses arising from the scapula vary in origin, presentation, and morphology. We describe a unique bony projection resembling a second glenoid, treated successfully with surgical resection and resulting in complete cosmetic and functional recovery.

Retained periarticular missiles are usually overlooked, though they could lead to several delayed complications, which include infection, mechanical symptoms, synovitis due to lead particle deposition, lead arthropathy, and systemic lead poisoning. Retrieval of this shrapnel could be open or arthroscopic. The study reports a successful retrieval of retained periarticular shrapnel from the posterior compartment of the knee using the minimally invasive posterior approach. It presents the current literature review regarding this approach and various modifications. In conclusion, the minimally invasive posterior approach is a very good option for retrieving retained shrapnel from the posterior compartment of the knee. It offers good exposure, is relatively safe, and leaves a small scar, but it requires some learning to use efficiently.

Penetrating trauma stands out as the predominant cause of vascular injury in the upper extremity, with the brachial artery being the vessel most frequently affected. While in the pediatric population, a traumatic injury to the brachial artery usually results from a distal humerus fracture; such scenarios are exceptionally reported in the adult population. We report the case of a 21-year-old woman who sustained a comminuted displaced distal humerus fracture associated with a weak radial pulse with no other ischemia signs. Only following open reduction and internal fixation did she present all signs of an acute ischemic limb. An emergency surgery showed a complex brachial artery injury over 3 cm of length. The vascular repair using a venous graft yielded a complete recovery of the patient. While brachial artery injury may be associated with distal humerus fractures in the pediatric population, this complication is exceedingly rare in adults. Our surgical case report serves as a call for clinicians to maintain a heightened awareness and suspicion for brachial artery injury, particularly in cases of severe elbow fractures. The absence of full signs of limb ischemia, owing to a rich collateral blood supply, underscores the importance of careful consideration and proactive management to address this serious complication.

Background: The discoid meniscus is an anomaly caused by a congenital morphological variant of the meniscus, in which the meniscus has an abnormally wide and flat cartilage shape. An arthroscopic partial meniscectomy (saucerization) is the preferred treatment strategy to maintain peripheral stability and functionality of the meniscus. Meniscal repair is indicated as an additional surgical strategy when residual instability occurs after saucerization and in some rupture patterns, such as horizontal tears.

Case report: We present the first case reported in Colombia (Latin America) of a 19-year-old patient with a diagnosis of a bilateral medial discoid meniscus with instability and a horizontal tear in the body, anterior and posterior horns who was managed with meniscal saucerization and repair (each knee at different times) satisfactorily with good 1-year follow-up clinical and functional results.

Conclusions: Saucerization combined with meniscal repair is an effective surgical technique for treating a symptomatic bilateral medial discoid meniscus with a horizontal tear and instability with good short- to medium-term results.

Background: Most lipomatous soft tissue tumors are benign with a low risk of metastasis. Intramuscular lipoma is a very rare subtype with a very high rate of recurrence. When detected late, the differentiation between intramuscular lipoma and liposarcoma on imaging remains challenging.

Case presentation: A 49-year-old male presented with a lipomatous, radiographically lucent, soft tissue lesion in the lower extremity causing occasional numbness and tingling and associated with intralesional calcifications on MRI. The patient underwent a marginal excision of the lesion, which relieved his symptoms. Pathology revealed a lipoma with heterotopic ossification.

Conclusions: Intramuscular lipomas are rare and underreported in the literature. When it is difficult to differentiate a lipoma from malignant liposarcoma, surgical intervention may be necessary. Long-term serial follow-ups are needed to assess for future recurrence.

Case: An 11-year-old female presented with a painful mass in the right proximal leg. Radiographs revealed a geographic osteolytic lesion involving the metaphysis and extending into the diaphysis of the proximal fibula. She underwent extended curettage with adjuvant electrocautery and 95% ethanol for tumor ablation. The resulting defect was reconstructed using morselized talus allograft. At 18 months postoperatively, there was no evidence of local recurrence, bone remodeling was complete, and the patient achieved full functional recovery with an MSTS score of 100%, resuming unrestricted physical activity.

Conclusion: This case highlights the diagnostic and therapeutic complexities associated with chondromyxoid fibroma (CMF) in atypical anatomical sites such as the proximal fibula. The use of extended curettage combined with adjuvant modalities and allograft reconstruction demonstrated favorable oncologic and functional outcomes. These findings contribute to the evolving evidence base for managing CMF in rare locations, underscoring the need for further studies to optimize treatment strategies.

The guide wire plays a crucial role in core decompression procedures for avascular necrosis of the femoral head and fixation of femoral neck fractures using dynamic hip screws (DHSs) or cannulated screws. Although guide wire breakage during surgery is extremely rare, there have been instances where the distal end of the guide wire has fractured and becomes trapped within the fractured femoral head or hip joint. This can occur due to technical errors or poor quality of the guide wire used. The removal of the broken guide wire from the femoral head presents a challenging and complex task that requires precision and efficiency. In this report, we present a safe and efficient method to remove a broken guide wire entrapped within the femoral head and hip joint using alligator forceps. Under the guidance of an image intensifier, the broken guide wire was successfully extracted using this specialized instrument. By sharing this rare case, our goal is to raise awareness among surgeons about the possible complications associated with core decompression procedures and to highlight the importance of preventive measures. Furthermore, we introduce a reliable and alternative technique for removing broken guide wires, providing surgeons with an easier and more efficient approach.

Background: Scapholunate ligament injuries are not uncommon in hand surgery, but they are not described in the sport of arm wrestling.

Case presentation: The patient was a 28-year-old man who experienced wrist pain when he was about to lose an arm wrestling match. Since then, he has had persistent clicking in his right wrist, which was found to be due to scapholunate dissociation. The reason for scapholunate dissociation rather than a humeral shaft fracture in our patient may be a reduction in torque on the humerus due to forced elbow extension, which could be seen in a losing player at the end of the match. This position could concentrate the reaction force on the wrist rather than on the humerus.

Conclusions: Arm wrestling should be recognized as a potential cause of scapholunate dissociation due to its atypical injury pattern, necessitating early diagnosis. Furthermore, the unique biomechanics of arm wrestling warrant attention in orthopedic and surgical literature.