Case Reports in Orthopedics最新文献

Background: Charcot neuroarthropathy (CN) of the foot is a progressive condition associated with significant deformity and recurrent ulceration. Despite advancements in imaging and classification, management remains challenging. Traditional nonsurgical treatments have shown limited success in preventing disease progression, while surgical interventions often involve prolonged nonweight-bearing periods and high complication rates.

Methods: This study presents an 8-year follow-up of 15 patients (Evidence Level IV) undergoing a novel early surgical intervention for Stage 0-1 CN with preoperative plantigrade alignment. The procedure involved fluoroscopically guided filling of subchondral defects using a flowable calcium phosphate compound and realignment with dynamic circular external fixation in 14 of 15 subjects. Assisted weight-bearing began 3-5 days postoperatively, with fixation removed after 6-8 weeks. Radiographic parameters (Meary's angle, calcaneal inclination angle, talar declination angle, and cuboid height) were assessed preoperatively and at final follow-up.

Results: Thirteen of 15 subjects survived the 8 years. No surgical complications, ipsilateral CN, or midfoot ulcerations occurred. Radiographic alignment remained stable over 8 years (p < 0.01 for all parameters).

Conclusion: Early surgical intervention with subchondral defect filling and external fixation appears to stabilize osseous architecture, prevent midfoot collapse, and expedite recovery in CN. Larger prospective studies are warranted to validate these findings.

We report three patients-a 35-year-old female, a 19-year-old female, and a 36-year-old male-who presented with recalcitrant knee arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) and prior lysis of adhesions (LOA). Each patient underwent a multistep treatment approach including revision arthroscopic LOA followed by low-dose irradiation, performed at 26, 8, and 6 months, respectively, after the index procedure. All patients experienced improved range of motion and better outcomes compared to prior interventions. In patients with recalcitrant arthrofibrosis after ACLR who have not responded to standard management, a revision LOA and low-dose irradiation can be safely performed, offering a moderate success rate for the most challenging cases.

Introduction: Anterior shoulder dislocations are the most common major joint dislocation encountered in clinical practice. Although typically reducible, chronic irreducible anterior dislocations are rare and pose significant diagnostic and management challenges. Contributing factors include rotator cuff pathology, soft tissue interposition, and bony fragments. Vascular complications, while infrequent, must also be considered, particularly in chronic presentations.

Case report: We report the case of a 61-year-old female who sustained an anterior shoulder dislocation after falling on ice 8 weeks prior to presentation. She had a history of a previously canceled rotator cuff repair 3 years earlier. Multiple closed reduction attempts in the emergency department and operating room were unsuccessful. Magnetic resonance imaging (MRI) revealed a chronic massive rotator cuff tear with subscapularis interposition and the humeral head abutting the neurovascular bundle. Computed tomography angiography (CTA) demonstrated axillary vein compression without contrast opacification distal to the axilla. The patient was evaluated by vascular surgery prior to intervention, and an in-clinic venous duplex ultrasound confirmed the chronicity of the occlusive thrombus. Due to the risk of intraoperative complications, a vascular surgeon remained on standby during arthroplasty. Given the irreducibility, chronicity of rotator cuff pathology, and vascular involvement, a reverse total shoulder arthroplasty (rTSA) was performed with vascular surgery support. The patient experienced pain relief and modest improvements in range of motion and Patient-Reported Outcomes Measurement Information system (PROMIS) outcomes postoperatively, though persistent limitations necessitated a revision rTSA.

Conclusion: This case underscores the importance of considering vascular compression in chronic irreducible shoulder dislocations. While axillary artery injury is well-documented, chronic axillary vein compression and thrombosis remain underreported. Advanced imaging, particularly CTA, should be utilized when the humeral head lies in close proximity to vascular structures. Such complex cases require management in a tertiary care setting with access to vascular surgery. Multidisciplinary planning, timely diagnosis, and appropriate surgical intervention are essential to optimize outcomes in these high-risk patients.

In recent decades, arthroscopic meniscal repair has been increasingly indicated for meniscal tears in the last decades. Although literature generally reports favorable surgical outcomes, it remains unclear whether the repaired meniscus maintains its function over the long term while performing its chondroprotective function without recurrent tear after clinical healing. A 43-year-old Japanese man who underwent meniscal repair for a bucket handle tear of the medial meniscus (MM) at the age of 15 years presented with right knee pain and catching symptoms without a preceding traumatic event. Physical examination revealed joint line tenderness and a catching sensation with rotating motion in the medial aspect of the knee. Plain radiographs showed no apparent osteoarthritic changes. Magnetic resonance imaging (MRI) showed infiltration of joint fluid at the interface between the MM and the joint capsule. Based on the patient's history and the examination results, a retear of the MM was diagnosed, and revision MM repair was conducted using the inside-out technique. At the 2-year follow-up, the patient remained asymptomatic, physical examination revealed no meniscal symptoms, and radiological examination showed no signs of osteoarthritic progression. The present study details a case involving a retear of a repaired meniscus without an inciting traumatic event after a 28-year asymptomatic period is reported. The long-term results of meniscus repair surgery performed more than 20 years ago have rarely been reported in the literature. This case report indicates that the long-term preservation of articular cartilage following successful meniscal repair can be attributed to the maintenance of meniscal function. On the other hand, even after clinical healing has been achieved, there is a possibility that the risk of meniscal retear will continue over time.

Introduction: Postoperative C5 paralysis is defined as new-onset and/or progressive muscle weakness with mild or no sensory disturbances occurring as a result of probable neuropraxia of the cervical root due to injury during surgery. Case Report: A 40-year-old female patient underwent endoscopic technique for treatment of cervical foraminal stenosis, level C4-C5. The procedure proceeded without incident in the intraoperative period. In the immediate postoperative period, the patient developed a motor deficit, Grade 2 muscle strength of the right deltoid muscle, and right C5 allodynia. Early and multidisciplinary treatment resulted in complete recovery of the neurological deficit and satisfactory evolution of the presented case. Discussion: Although postoperative C5 palsy is one of the most common postoperative complications after multilevel cervical decompression surgery, its exact mechanism remains poorly understood. Despite the various studies in this field and the possible causes described, there is still no absolute confirmation, so the formulation of hypotheses depends on clinical monitoring and postoperative examinations. The indicated treatment depends on the causal suspicion and pathophysiology and ranges from clinical drug therapy to physical therapies and/or rehabilitation. Conclusion: C5 paralysis after endoscopic surgery, although rare, is a potential complication. The likely pathophysiology is multifactorial: anatomic features of C5, manipulation of the root, and use of the bipolar in the foraminal region.

To prevent limitations in the range of motion after hand surgery, it is crucial to minimize scar tissue formation and adhesions. Thus, it is important to initiate active hand exercises during the early postoperative period. Peripheral nerve blocks (PNBs) may be employed for active hand exercises as they minimize postoperative pain. We reported three cases of pyogenic flexor tendonitis in which PNB was administered postoperatively, and changes in the range of motion were observed. In all cases, a pulp-palmar distance (PPD) of 1 mm was achieved within 1 week after surgery under PNB, and all cases were evaluated as "good" in Flynn's functional evaluation at the last observation. However, PPD worsened at 3 weeks postoperatively, and all patients exhibited limited proximal interphalangeal joint extension at the final observation. Although our method effectively improved the flexion range of motion, additional measures should be taken to improve the extension range of motion.

Introduction: Interpersonal violence victims account for a sizable proportion of trauma cases encountered in South African trauma centers. Open Achilles tendon injuries are more prevalent in male patients, accounting for a high number of all cases. Case Report: A 45-year-old male was brought in a trauma casualty by a paramedic after being referred by a local clinic in severe pain on both ankles, unable to walk or stand, and dressed bilaterally with blood stains. On examination, he demonstrated the triad of Achilles tendon injuries, including Matle's sign, Thompson's test, and a gap on palpation. A surgical operation was performed within 24 h of the patient's admission. Conclusion: This case report is aimed at increasing awareness of a rare case that presented with open bilateral Achilles tendon injuries associated with an alleged assault and received a successful surgical treatment without a skin complication.

Purpose: Our work describes the use of matrix-induced autologous chondrocyte implantation (MACI) for a lateral tibial plateau osteochondral defect, in the setting of a concomitant meniscus repair and anterior cruciate ligament (ACL) reconstruction. To our knowledge, there is minimal research describing the application of MACI for cartilage defects of the tibial plateau, which brings about its own challenges. Methods: A 26-year-old male presented with lateral right knee pain and instability following a soccer injury. A bucket-handle lateral meniscus tear, 2 cm by 2 cm osteochondral defect of the lateral tibial plateau, and complete ACL tear were identified on magnetic resonance imaging (MRI). Our case vignette describes a two-stage MACI procedure for an osteochondral defect of the lateral tibial plateau with concurrent all-inside meniscus repair and ACL reconstruction using bone-patellar tendon-bone (BTB) autograft. Results: Follow up period was 20 months with excellent patient satisfaction and resolution of pain. Outcome measures (International Knee Documentation Committee (IKDC)) and Knee Injury and Osteoarthritis Outcome Score (KOOS) returned to preinjury levels at 8.5 months. Return to sport was achieved at 10 months postoperatively. Conclusion: The miniopen MACI procedure provides a logistically reasonable technique mitigating the anatomic challenges of tibial plateau osteochondral defects and potentially providing improved long-term outcomes. It is our hope that this work will contribute to the current understanding of the treatment options for osteochondral defects of the tibial plateau.

[This corrects the article DOI: 10.1155/cro/5565275.].

We report an unusual case of a tenosynovial giant cell tumor (TGCT) in a patient who received a total knee arthroplasty (TKA) for medial knee osteoarthritis with synovial osteochondromatosis (SO). A 72-year-old woman underwent conventional jig-based simultaneous bilateral bicruciate-stabilized TKA. Four years after the surgery, she came to our hospital with a chief complaint of persistent pain in the right knee only, with recurrent spontaneous hemarthrosis. We performed a synovectomy with open excisional debridement and a polyethylene exchange. Histologic analysis of synovial samples was consistent with TGCT. We present the imaging and pathological details of the first case of de novo TGCT that occurred in the background of SO after TKA.