Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2a.173
Risa Reid, Paul Pottanat, Glenn Gaston, Dane Daley
A 4-year-old boy (Case 1) with history of amniotic band syndrome and a 50-year-old man with history of traumatic amputation to right thumb (Case 2) both underwent thumb lengthening procedures with metacarpal osteotomy with distraction osteogenesis. Post operatively, both were noted to have CMC joint instability with volar dislocation in Case 1 and dorsal subluxation in Case 2, which were treated with observation and CMC arthroplasty, respectively. Complications after thumb metacarpal lengthening have been well described throughout literature. Here we present the only reports of CMC subluxation or dislocation following first metacarpal distraction osteogenesis. Clinicians should be aware of this rare but associated complication in patients undergoing this procedure.
{"title":"Carpometacarpal subluxation and dislocation following first metacarpal distraction osteogenesis","authors":"Risa Reid, Paul Pottanat, Glenn Gaston, Dane Daley","doi":"10.22271/27078345.2023.v5.i2a.173","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2a.173","url":null,"abstract":"A 4-year-old boy (Case 1) with history of amniotic band syndrome and a 50-year-old man with history of traumatic amputation to right thumb (Case 2) both underwent thumb lengthening procedures with metacarpal osteotomy with distraction osteogenesis. Post operatively, both were noted to have CMC joint instability with volar dislocation in Case 1 and dorsal subluxation in Case 2, which were treated with observation and CMC arthroplasty, respectively. Complications after thumb metacarpal lengthening have been well described throughout literature. Here we present the only reports of CMC subluxation or dislocation following first metacarpal distraction osteogenesis. Clinicians should be aware of this rare but associated complication in patients undergoing this procedure.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135851627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2b.177
Kosuke Kita, Shigenori Nagata, Hironari Tamiya
Multiple osteolytic lesions in elderly patients are usually metastatic bone tumors, while brown tumor is a rare disease featuring osteolytic lesions associated with hyperparathyroidism. In this report, we present the case of a 62-year-old male with hyperparathyroidism-induced multiple osteolytic lesions that mimicked multiple metastatic bone tumors. At initial presentation, the radiographic images were compatible with metastatic bone tumors; therefore, we performed a needle biopsy on the iliac lytic lesions, which revealed no evidence of malignancy. Furthermore, we performed an operation on the left radial pathological fracture and obtained sufficient sample for histological examination, which again showed no evidence of malignancy. Hence, while investigating for other diseases, we found a tumor in the left thyroid and high levels of intact-parathyroid hormone (PTH), which was a strong clue to the diagnosis of PHPT caused by a parathyroid adenoma. After the resection of the parathyroid adenoma, intact-PTH and calcium levels returned to normal. In conclusion, clinicians including orthopedic specialists should consider the possibility of brown tumors in case of aforementioned clinical features.
{"title":"Osteolytic lesions caused by hyperparathyroidism mimicking multiple bone metastases","authors":"Kosuke Kita, Shigenori Nagata, Hironari Tamiya","doi":"10.22271/27078345.2023.v5.i2b.177","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2b.177","url":null,"abstract":"Multiple osteolytic lesions in elderly patients are usually metastatic bone tumors, while brown tumor is a rare disease featuring osteolytic lesions associated with hyperparathyroidism. In this report, we present the case of a 62-year-old male with hyperparathyroidism-induced multiple osteolytic lesions that mimicked multiple metastatic bone tumors. At initial presentation, the radiographic images were compatible with metastatic bone tumors; therefore, we performed a needle biopsy on the iliac lytic lesions, which revealed no evidence of malignancy. Furthermore, we performed an operation on the left radial pathological fracture and obtained sufficient sample for histological examination, which again showed no evidence of malignancy. Hence, while investigating for other diseases, we found a tumor in the left thyroid and high levels of intact-parathyroid hormone (PTH), which was a strong clue to the diagnosis of PHPT caused by a parathyroid adenoma. After the resection of the parathyroid adenoma, intact-PTH and calcium levels returned to normal. In conclusion, clinicians including orthopedic specialists should consider the possibility of brown tumors in case of aforementioned clinical features.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135857758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2b.174
Dr. Momanyi Oyagi Alex, Antonio Marcelo G Souza, Dr. Cicero Feitosa, Dr. Emily Bergamasco
Introduction: Maffucci syndrome is a rare congenital chondrogenic disease characterized by multiple cartilaginous tumors (central enchondromas) associated with multiple cutaneous hemangiomas (spindle cell subtype). The patients have a high incidence of malignant transformation and 100% risk of skeletal/extraskeletal malignancy. Study Design: Case reports of two patients and updated literature review. Objective: The purpose of this study was to perform an updated review and present our experience with two cases of mafucci syndrome, including ongoing treatment strategies and followup concerns. Methods: A detailed description of a cases and an updated literature review. Results: Both patients under review demonstrated classical signs of maffucci: multiple enchondromas with polyostotic dysplasia and quadrimelic hemangiomas. One patient had been on follow-up for 17 years. It was interesting to find both patients had a left limb deformity and hemangioendothelioma predominance. Recent literature proposes proteomic biological analysis and karyotyping for IDH1/2 mutations.Conclusion: Maffucci syndrome cases are aptly rare and patients need close routine follow-up for early detection of skeletal or non-skeletal malignancies.
{"title":"Mafucci syndrome case series of 2 patients and current literature update and advances","authors":"Dr. Momanyi Oyagi Alex, Antonio Marcelo G Souza, Dr. Cicero Feitosa, Dr. Emily Bergamasco","doi":"10.22271/27078345.2023.v5.i2b.174","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2b.174","url":null,"abstract":"Introduction: Maffucci syndrome is a rare congenital chondrogenic disease characterized by multiple cartilaginous tumors (central enchondromas) associated with multiple cutaneous hemangiomas (spindle cell subtype). The patients have a high incidence of malignant transformation and 100% risk of skeletal/extraskeletal malignancy. Study Design: Case reports of two patients and updated literature review. Objective: The purpose of this study was to perform an updated review and present our experience with two cases of mafucci syndrome, including ongoing treatment strategies and followup concerns. Methods: A detailed description of a cases and an updated literature review. Results: Both patients under review demonstrated classical signs of maffucci: multiple enchondromas with polyostotic dysplasia and quadrimelic hemangiomas. One patient had been on follow-up for 17 years. It was interesting to find both patients had a left limb deformity and hemangioendothelioma predominance. Recent literature proposes proteomic biological analysis and karyotyping for IDH1/2 mutations.Conclusion: Maffucci syndrome cases are aptly rare and patients need close routine follow-up for early detection of skeletal or non-skeletal malignancies.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135857429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delaminated rotator cuff tear is defined as a tear occurring between rotator cuff layers. Its prevalence is controversial due to substantial variations in its definition. Diagnosing delamination on preoperative imaging can be challenging as conventional MRI has poor yield in identifying them. A 69-year-old man sustained a rotator cuff tear following a fall on outstretch arm. Diagnostic arthroscopy revealed a delaminated full thickness tear (Type 1b) of the supraspinatus which was inconsistent with the preoperative MRI finding. En masse repair of the tear via the double row suture technique was then performed. The patient was pain free and was independent with activities of daily living at 6-month follow-up. Delamination in rotator cuff tear is a negative prognostic factor for post repair outcomes and can be missed if not specifically sought for. This report aims to share our experience on how to improve diagnosis rates for these tears.
{"title":"Delaminated rotator cuff tears can be easily missed! - A case report","authors":"Shawn JS Seah, Cheryl Gatot, Denny Tijauw Tjoen Lie","doi":"10.22271/27078345.2023.v5.i2b.176","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2b.176","url":null,"abstract":"Delaminated rotator cuff tear is defined as a tear occurring between rotator cuff layers. Its prevalence is controversial due to substantial variations in its definition. Diagnosing delamination on preoperative imaging can be challenging as conventional MRI has poor yield in identifying them. A 69-year-old man sustained a rotator cuff tear following a fall on outstretch arm. Diagnostic arthroscopy revealed a delaminated full thickness tear (Type 1b) of the supraspinatus which was inconsistent with the preoperative MRI finding. En masse repair of the tear via the double row suture technique was then performed. The patient was pain free and was independent with activities of daily living at 6-month follow-up. Delamination in rotator cuff tear is a negative prognostic factor for post repair outcomes and can be missed if not specifically sought for. This report aims to share our experience on how to improve diagnosis rates for these tears.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"190 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135857759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2b.175
A De Castro Carrasco, LA Montero Furelos
Currently rapidly progressive osteoarthritis of the hip (RPOH) is an infrequent syndrome that compromises the femoral head and acetabulum described by Forestier in 1957. There is no standardized definition of the characteristics of this disease. Other diseases such as osteonecrosis or inflammatory and infectious arthropaties process may appear similar or present concurrently with osteoarthritis.Clinically it is characterized by hip pain characterized by chondrolysis with massive destruction of the femoral head, with or without acetabular involvement. The associated radiographic changes normally occur within 12 months after the onset of symptoms.The reported incidence is 7.2 to 15.7%. The patient is frequently a woman and the involvement in the vast majority is unilateral. The etiology remains uncertain, but increasing attention in recent years suggesting subchondral fractures as a contributing factor to the development this disease.We described a case review of a male patient with the development of bilateral RPOH.
{"title":"Bilateral rapidly progressive osteoarthritis of the hip: Case report and review","authors":"A De Castro Carrasco, LA Montero Furelos","doi":"10.22271/27078345.2023.v5.i2b.175","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2b.175","url":null,"abstract":"Currently rapidly progressive osteoarthritis of the hip (RPOH) is an infrequent syndrome that compromises the femoral head and acetabulum described by Forestier in 1957. There is no standardized definition of the characteristics of this disease. Other diseases such as osteonecrosis or inflammatory and infectious arthropaties process may appear similar or present concurrently with osteoarthritis.Clinically it is characterized by hip pain characterized by chondrolysis with massive destruction of the femoral head, with or without acetabular involvement. The associated radiographic changes normally occur within 12 months after the onset of symptoms.The reported incidence is 7.2 to 15.7%. The patient is frequently a woman and the involvement in the vast majority is unilateral. The etiology remains uncertain, but increasing attention in recent years suggesting subchondral fractures as a contributing factor to the development this disease.We described a case review of a male patient with the development of bilateral RPOH.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135857261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2a.172
Dr. Carter Zides, Dr. Matthew Macciacchera, Dr. Tayler Declan Ross, Dr. Luke Reda, Dr. Youjin Chang, Dr. Jihad Abouali
Introduction: Rupture of the quadriceps tendon is an uncommon injury with an incidence of 1.37/100000. Incomplete rupture is characterized as having an intact extensor mechanism while complete rupture presents with an inability to extend the knee. Incomplete ruptures are typically treated non-operatively whereas complete ruptures require surgical intervention. Existing literature reporting partial tears of the tendon is limited. Specifically, isolated vastus intermedius tendon injury has been reported in two case reports thus far. The purpose of this report is to outline the rare case of an incomplete quadriceps tendon rupture with complete rupture of the vastus intermedius, treated with early surgical repair that resulted in an excellent patient outcome. Methods: A 35-year-old male truck driver presented with right knee pain, joint effusion, and decreased range of motion following an injury while jumping in a basketball game. Ultrasonography revealed a partial-thickness tear of the quadriceps tendon with complete rupture of the vastus intermedius. MRI confirmed the diagnosis of a high-grade partial-thickness complete tear involving 60% of the quadriceps tendon with significant retraction of the vastus musculature. It is the opinion of the senior author (JA) that this injury pattern combined with his known extensor lag was unlikely to improve without surgical intervention. This was discussed with the patient and they underwent successful quadriceps tendon repair.Results: Six months post-operatively, the patient had no pain with rest or walking. He had returned to work without limitation. On examination, his gait was normal and knee range of motion was full. There was no tenderness to palpation over the quadriceps tendon and no crepitus with movement. Straight leg raise and single-leg squatting were performed without difficulty. The patient’s quadriceps muscle bulk was approximately 80% of the contralateral side and his power was 5/5.Discussion: This report outlines the rare case of complete vastus intermedius avulsion from the quadriceps tendon, with partial tendon rupture. Similar injuries have traditionally been managed non-operatively. We illustrate how surgical repair can be performed successfully with an excellent clinical outcome. An understanding of predisposing factors for partial tears can also be gained through review of the literature.
{"title":"Incomplete rupture of the quadriceps tendon with complete rupture of the vastus intermedius: Case report and brief review of relevant literature","authors":"Dr. Carter Zides, Dr. Matthew Macciacchera, Dr. Tayler Declan Ross, Dr. Luke Reda, Dr. Youjin Chang, Dr. Jihad Abouali","doi":"10.22271/27078345.2023.v5.i2a.172","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2a.172","url":null,"abstract":"Introduction: Rupture of the quadriceps tendon is an uncommon injury with an incidence of 1.37/100000. Incomplete rupture is characterized as having an intact extensor mechanism while complete rupture presents with an inability to extend the knee. Incomplete ruptures are typically treated non-operatively whereas complete ruptures require surgical intervention. Existing literature reporting partial tears of the tendon is limited. Specifically, isolated vastus intermedius tendon injury has been reported in two case reports thus far. The purpose of this report is to outline the rare case of an incomplete quadriceps tendon rupture with complete rupture of the vastus intermedius, treated with early surgical repair that resulted in an excellent patient outcome. Methods: A 35-year-old male truck driver presented with right knee pain, joint effusion, and decreased range of motion following an injury while jumping in a basketball game. Ultrasonography revealed a partial-thickness tear of the quadriceps tendon with complete rupture of the vastus intermedius. MRI confirmed the diagnosis of a high-grade partial-thickness complete tear involving 60% of the quadriceps tendon with significant retraction of the vastus musculature. It is the opinion of the senior author (JA) that this injury pattern combined with his known extensor lag was unlikely to improve without surgical intervention. This was discussed with the patient and they underwent successful quadriceps tendon repair.Results: Six months post-operatively, the patient had no pain with rest or walking. He had returned to work without limitation. On examination, his gait was normal and knee range of motion was full. There was no tenderness to palpation over the quadriceps tendon and no crepitus with movement. Straight leg raise and single-leg squatting were performed without difficulty. The patient’s quadriceps muscle bulk was approximately 80% of the contralateral side and his power was 5/5.Discussion: This report outlines the rare case of complete vastus intermedius avulsion from the quadriceps tendon, with partial tendon rupture. Similar injuries have traditionally been managed non-operatively. We illustrate how surgical repair can be performed successfully with an excellent clinical outcome. An understanding of predisposing factors for partial tears can also be gained through review of the literature.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135812558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.22271/27078345.2023.v5.i2a.171
Dr. Vrajesh Shah, Dr. Zalak Patel, Dr. Rajiv Paradkar, Dr. Rucha Parikh
Introduction: Distal Femoral fracture may lead to the development of post-traumatic arthrosis of knee joint because of direct intraarticular injury. Malunion of distal femur fracture, intra-articular osseous defects, limb malalignment and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) and makes it a technically demanding surgery. Here we report our experience regarding this complex knee arthroplasty.Case presentation: We report a case of 72 year old male patient who presented with progressive left knee pain and limited range of motion of left knee joint. Patient had a history of trauma 3 years back which is treated conservatively. Preoperative radiograph indicates severe osteoarthritis of tibiofemoral and patellofemoral joint with multiple osteophytes and malunited distal femur fracture, for which he was treated with primary total knee replacement, which showed good clinical and functional outcome at the end of 6 months.Conclusion: Total knee arthroplasty in patient with malunited distal femur is technically challenging and can require skills, good preoperative planning, templating and good soft tissue balancing. In patients with malunited distal femur, where optimal limb and implant alignment are achieved, results are much more promising and can compete with the results seen with routine primary knee replacement.
{"title":"A case of total knee replacement in a patient with osteoarthritis of knee joint with malunited distal femur fracture with stiffness","authors":"Dr. Vrajesh Shah, Dr. Zalak Patel, Dr. Rajiv Paradkar, Dr. Rucha Parikh","doi":"10.22271/27078345.2023.v5.i2a.171","DOIUrl":"https://doi.org/10.22271/27078345.2023.v5.i2a.171","url":null,"abstract":"Introduction: Distal Femoral fracture may lead to the development of post-traumatic arthrosis of knee joint because of direct intraarticular injury. Malunion of distal femur fracture, intra-articular osseous defects, limb malalignment and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) and makes it a technically demanding surgery. Here we report our experience regarding this complex knee arthroplasty.Case presentation: We report a case of 72 year old male patient who presented with progressive left knee pain and limited range of motion of left knee joint. Patient had a history of trauma 3 years back which is treated conservatively. Preoperative radiograph indicates severe osteoarthritis of tibiofemoral and patellofemoral joint with multiple osteophytes and malunited distal femur fracture, for which he was treated with primary total knee replacement, which showed good clinical and functional outcome at the end of 6 months.Conclusion: Total knee arthroplasty in patient with malunited distal femur is technically challenging and can require skills, good preoperative planning, templating and good soft tissue balancing. In patients with malunited distal femur, where optimal limb and implant alignment are achieved, results are much more promising and can compete with the results seen with routine primary knee replacement.","PeriodicalId":492493,"journal":{"name":"International journal of case reports in orthopaedics","volume":"346 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135807011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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