JournalTOCs School of Mathematical and Computer Sciences Heriot-Watt University Edinburgh, EH14 4AS, UK Email: journaltocs@hw.ac.uk Tel: +00 44 (0)131 4513762  Your IP address: 3.239.59.31 |
JournalTOCs School of Mathematical and Computer Sciences Heriot-Watt University Edinburgh, EH14 4AS, UK Email: journaltocs@hw.ac.uk Tel: +00 44 (0)131 4513762 Your IP address: 3.239.59.31 |
Hybrid journal (It can contain Open Access articles)
Case: We report the case of acute gouty arthritis mimicking infection in a 59-year-old woman who had an extensive history of periprosthetic joint infection (PJI) and multiple revisions. Initial laboratory testing, examination, and recency bias suggested recurrent PJI, but aspiration revealed an acute gout attack without superimposed infection. The patient’s examination and serological markers improved off antibiotics, and she subsequently avoided an unnecessary revision surgery.Conclusion: Although rare, acute gouty arthritis should be considered in every patient, and complete workup should be performed, regardless of infectious or rheumatologic history.
Case: A 69-year-old woman presented with a type IIIB left proximal humerus fracture with a 500-square-centimeter soft tissue defect, 10-cm bone defect, and radial nerve laceration after a tiger attack. The surgical intervention included proximal humeral replacement with muscular integration, radial nerve repair, and latissimus dorsi flap coverage.Conclusion: This case presents an exceedingly rare injury mechanism resulting in a significant soft tissue and bone defect. Its novelty lies in the complexity of the injury, which required a well-coordinated multispecialty treatment approach. This strategy applies to injuries with similar extensive soft tissue and bone defects.
Case: A young polytrauma victim of a road traffic accident was diagnosed with comminuted articular fracture of the left distal tibial pilon and open segmental fracture of the fibula. The comminuted distal tibial metaphysis was translocated into the interosseous space and, hence, was irreducible. He underwent single-stage closed Ilizarov device stabilization and gradual postoperative closed reduction to obtain good functional outcome at 9 months. The lung and scapular injuries were treated conservatively.Conclusion: Acute complex irreducible tibial pilon fracture can be treated according to principles of deformity correction with the Ilizarov device.
Case: A 24-year-old elite female rugby player complained of prolonged symptoms after a surgical repair of the deltoid ligament performed 2 years previously. Ankle arthroscopy revealed an osteochondral lesion in the tibial plafond at the medial gutter, with the fibers of the soft suture anchor exposed in the joint. The anchors were removed, and the cysts were filled with autogenous cancellous bone. The patient returned to the elite-level rugby games 5 months after the operation without any symptoms.Conclusion: We must be aware that even soft anchors can cause arthritis if improperly positioned.
Case: A 32-year-old woman with genu valgum recurvatum presented to clinic complaining of long-standing anterior knee pain. Radiographs demonstrated a 13° anterior tibial slope and 15° valgus malalignment. She underwent a single-stage 2-level osteotomy at the distal femur and proximal tibia to simultaneously correct genu valgum and recurvatum. This procedure achieved precise correction in both planes. At 1 year, the patient was pain-free and ambulated without restriction.Conclusion: This procedure should be considered among the available surgical options when treating genu valgum recurvatum because it produced excellent results for the studied patient.
Case: A 38-year-old man with a tibial plateau fracture required treatment for elevated blood lead level (BLL) from retained bullet fragments in the same knee from a gunshot wound 21 years earlier. Oral succimer presurgery and postsurgery decreased the BLL from 58 to 15 μg/dL.Conclusion: Parenteral chelation has been previously recommended to mitigate an increase in BLLs during surgical intervention to remove bullet fragments. Oral succimer was an effective and well-tolerated alternative to intravenous chelation. Further research is needed to determine the optimal route, timing, and duration of chelation in patients with elevated BLL in need of bulletectomy.
Case: A healthy 24-year-old woman developed rhabdomyolysis and acute bilateral thigh compartment syndrome after 10 minutes of spin class. She was successfully managed with early recognition, aggressive fluid resuscitation, and prompt bilateral surgical decompressive fasciotomy.Conclusion: Rhabdomyolysis with acute compartment syndrome is a rare but devastating combination of conditions. A high suspicion for rhabdomyolysis and progression to acute compartment syndrome is warranted for any patient presenting with increasing pain even with a limited history of trauma or exertion. Early recognition and medical and surgical treatment are paramount to preventing permanent damage.
Case: A 73-year-old woman presented with wrist pain and loss of extension in the middle and ring fingers. Radiography revealed a dorsally displaced lunate fragment, resulting in a diagnosis of Kienböck disease with extensor tendon rupture. Artificial lunate replacement and tendon transfer were performed as treatment. Two years postoperatively, the pain was relieved, and the extension lag was 0°. The wrist motion and carpal height had also improved.Conclusion: Lunate excision, partial wrist arthrodesis, or proximal row carpectomy are known treatments for Kienböck disease with extensor tendon rupture. Lunate arthroplasty is a novel, useful treatment option for this condition.
Case: We present the unique case of a 73-year-old man who was treated 50 years ago with a hemiarthroplasty (HA) for avascular necrosis after a femoral neck fracture (FNF) of his left hip and who has developed only mild osteoarthritis since and has reported satisfactory clinical and functional outcomes with no acetabular erosion.Conclusion: HA for FNFs can provide durable long-term results and can, therefore, be considered as an option in the treatment of FNFs in younger patients. We describe a case with good results after 50 years, which, to our knowledge, is the longest reported follow-up of HA.
Case: This report describes 3 cases of Langerhans cell histiocytosis (LCH) of the cervical and thoracic spine in patients aged 4 to 10 years. Each patient had painful lytic spinal lesions with vertebral body collapse and posterior involvement suggesting instability requiring corpectomy, grafting, and fusion. All 3 patients were doing well at their most recent follow-up without pain or recurrence.Conclusion: Although LCH of the pediatric spine is usually successfully treated non-operatively, we recommend corpectomy and fusion when there is instability of the spinal column and/or severe stenosis. Posterior element involvement occurred in all 3 cases and may lead to instability.
Case: An 18-year-old woman with a history of congenital pseudarthrosis of the clavicle (CPC) presented with episodes of right upper extremity ischemia. Vascular studies demonstrated an extensive thrombus with complete occlusion of the brachial artery. She underwent urgent thrombectomy. Subsequently, she underwent first rib resection and scalenectomy as well as pseudarthrosis takedown and fixation. Postoperatively, she returned to Division I collegiate soccer with complete symptomatic resolution.Conclusion: We report a case of arterial thoracic outlet syndrome secondary to CPC.
Case: Two patients who sustained multiple injuries after a road traffic accident developed cutaneous mucormycosis after a superficial abrasion. In the first case, the patient was diabetic with poorly controlled glycemic status. In the second case, the patient was young and immunocompetent with no known risk factors.Conclusion: Although there are few case reports of posttraumatic cutaneous mucormycosis, there is no single report describing its occurrence after a superficial abrasion. Cutaneous mucormycosis can be fatal if not identified early and treated aggressively. A high index of suspicion, timely diagnosis, and repeated debridement with antifungal therapy provided good functional outcomes in both patients.
Case: Acute medial collateral ligament (MCL) tears of the great toe metatarsophalangeal joint are rare, leading to sparse literature regarding their management. Suture anchor repair with suture tape augmentation is an effective treatment of thumb ulnar collateral ligament tears, a close analog. This case report presents a 23-year-old professional surfer with an acute hallux MCL avulsion. Management included repair with suture anchor and suture tape augmentation. The patient returned to sport quickly and had no pain or complications at 1-year follow-up.Conclusion: In this case of acute MCL tear of the great toe, suture anchor repair with suture tape augmentation facilitated early mobilization, rapid rehabilitation, return to competitive sport, and sustained good outcome.Level of Evidence: Level V
Case: A 12-year-5-month-old boy presented with a 3-month history of a 2 × 3-cm enlarging painful mass on the medial plantar aspect of his left foot. The radiograph was normal, but the magnetic resonance (MR) images clearly disclosed a foreign body in the shape of a toothpick that had been quiescent for 31 months. Thirty-three months after surgical removal, the patient was asymptomatic and had returned to full activity.Conclusion: A retained wood foreign body can present as an expanding mass, and MR is the modality of choice to image wood foreign bodies.
Case: We report the case of a 34-year-old African man who presented with severe symptoms of recurrent left carpal tunnel syndrome (CTS) and left hand swelling after previous open decompression. Considering the recurrent unilateral affection of the left hand in a patient working in a slaughterhouse in an area with a moderate burden for tuberculosis, tuberculous infection was suspected. Open surgery and biopsy revealed tuberculous tenosynovitis of flexor tendon sheath and shiny white rice bodies.Conclusion: Tuberculous tenosynovitis should be considered as a differential diagnosis of the CTS when there is evidence of proliferative tenosynovitis in patients from an endemic area for tuberculosis.
Case: We present a young patient with malunion of the Type IV distal humeral coronal shear fracture and post-traumatic arthritis of the elbow joint. He was treated with a frozen osteochondral allograft transplant using CT-based preoperative 3D planning. At 64 months after surgery, both the clinical and radiological results were satisfactory and no complications had been reported.Conclusion: The precision of computer-aided surgical planning could assist in preoperative designing and preparation of a personalized elbow osteochondral allograft. Even in a chronic situation, a personalized treatment approach can allow for osseointegration and satisfactory clinical results.
Case: In a 54-year-old man, imaging findings suggested a malignant bone tumor having 2 distinct components of the left ilium. Histopathologically, the resected tumor was diagnosed as dedifferentiated chondrosarcoma (CS) arising in secondary peripheral CS.Conclusion: Dedifferentiated CS consists of a high-grade noncartilaginous sarcoma adjacent to a preexisting low-grade CS, among which the peripheral type is extremely rare. Because the bimorphic imaging findings reflected the dedifferentiated area and the CS area, they were considered useful for diagnosis. In addition, the dedifferentiated area was localized to the tumor’s edge, suggesting that the dedifferentiation originated from the cartilage cap.
Case: Immunoglobulin G4 (IgG4)-related spinal hypertrophic pachymeningitis (IgG4-RHP) is a rare disease characterized by diffuse inflammatory fibrosis of the spinal dura mater that can cause myelopathy and neurological deficits. Here, we report 2 cases in which both patients presented with myelopathy and paraplegia. They underwent decompressive laminectomy, and the diagnoses were confirmed through histopathologic examination. Both patients received prednisolone postoperatively, which was subsequently switched to methotrexate for maintenance.Conclusion: Two cases of IgG4-RHP were successfully treated with decompressive laminectomy and combined therapy with steroids and other immunosuppressive agents.
Case: A 62-year-old man presented with a 10-year history of isolated melanonychia striata of his dominant thumb. Surgical biopsy ruled out subungual melanoma but revealed foreign plant material causing chronic infectious melanonychia from multiple pathogens, including Pseudomonas aeruginosa, Escherichia coli, and Candida spp. After removal of the nail plate and thorough debridement, the melanonychial streak resolved completely at 12 months of follow-up.Conclusion: Bacterial infection is a rarely reported cause of melanonychia, and in addition to surgical pathologic specimens, intraoperative fungal and bacterial cultures should always be obtained for accurate diagnosis of melanonychia striata.
Case: We report a case of a rare “floating fibula” ankle injury characterized by dislocation of the proximal tibiofibular joint (PTFJ), syndesmosis disruption, complete deltoid disruption, and tibiotalar dislocation without fibula fracture in a 44-year-old man. Imaging includes preoperative and postoperative radiographs and CT scans. Treatment involved reduction and screw fixation of the syndesmosis and PTFJ with planned screw removal. A successful clinical and radiographic outcome was achieved at the 15-month follow-up.Conclusion: This case highlights the unique features of the “floating fibula” injury and shows that reduction and intraoperative assessment may be more challenging than a typical Maisonneuve injury.
Case: Posterior hip dislocations are classically associated with posterior acetabular wall fractures. We report the case of a 29-year-old man presented after a motorcycle accident with an unusual combination of injuries that included posterior hip dislocation, anterior column acetabulum fracture, femoral head fracture, and sciatic nerve injury. At the final follow-up, excellent outcomes were obtained with complete recovery of the sciatic nerve injury.Conclusion: A favorable outcome may be achieved in young patients who sustain this unusual compilation of ipsilateral anterior acetabulum fracture, posterior hip dislocation, femoral head fracture, and sciatic nerve injury with meticulous preoperative surgical planning and tailored patient management.
Case: A 6-year-old boy with a Renshaw type 4 sacral agenesis presented paraplegia and rigid, “Buddha-like” lower-limb contractures, including severe knee pterygia, which made crawling and sitting difficult. Staged surgical treatment involved bilateral knee disarticulation, soft tissue surgery, and bifocal femoral osteotomies for lower-limb reorientation. At 18 months postoperatively and after prosthetic fitting, the patient can stand and take steps with assistance.Conclusion: This effective surgical strategy achieves standing in a troublesome orthopaedic congenital condition. The intervention should be tailored to specific orthopaedic disorders and the wishes of patients and families, aiming to improve function.
Case: A 6-year-old girl who had midshaft forearm fractures treated conservatively had volar distal radioulnar joint (DRUJ) instability caused by radial malunion at the 1-year follow-up. Corrective osteotomy was planned using computer-aided design (CAD) software based on computed tomography images. According to the analysis, the radial bone had an 8° apex volar deformation in the sagittal plane. Corrective osteotomy was performed based on preoperative planning. After surgery, the patient regained full function of her right forearm without volar DRUJ instability.Conclusion: This case report shows that corrective osteotomy with 3D CAD analysis can help surgeons plan and accurately correct malunion.
Case: A 66-year-old woman presented with shoulder pain and weakness 4 months after augmentation of a rotator cuff repair with a Stryker InSpace subacromial balloon spacer. A magnetic resonance imaging (MRI) demonstrated a failed rotator cuff repair, large effusion with rice bodies, synovitis, axillary lymphadenopathy, loose anchors, and erosive changes to the greater tuberosity. Arthroscopy revealed balloon fragmentation surrounded by diffusely hyperemic synovium without repairable cuff tissue. Final cultures proved negative for infection. Histologic evaluation revealed ulcerated synovium with diffuse chronic and focal acute inflammation.Conclusion: Despite promising early results, augmentation of a rotator cuff repair with a subacromial balloon spacer introduces a risk of inflammatory reaction that may mimic a deep infection and compromise rotator cuff healing.
Case: A 60-year-old woman sustained a type IV capitellum fracture from falling on an outstretched arm. Open reduction internal fixation (ORIF) was performed using an anconeus approach, and a transolecranon tunnel was created to place a trochlear screw. The patient showed good clinical outcomes with almost full range of motion at 6 months.Conclusion: With type IV capitellum fractures, the olecranon often obstructs the screw trajectory necessary for anterior-to-posterior fixation of trochlear fragments. Drilling a transolecranon tunnel through the proximal olecranon with the elbow flexed creates a viable pathway for screw placement from a more medial starting point than what is possible with traditional techniques.
Case: A 33-year-old woman with back pain and radiculopathy had presented with bilateral ankle weakness. MRI showed an intramedullary conus lesion suggestive of neoplasm, but posterior midline durotomy revealed only pus. Pus samples showed Staphylococcus aureus, which was treated with 6 weeks of antibiotics. Two-year follow-up showed complete neurological recovery with no clinicoradiological signs of recurrence.Conclusion: Usually, intramedullary spinal cord abscess (ISCA) has an acute presentation and warrants an emergent line of treatment with a risk of mortality. Very rarely chronic ISCA can mimic intramedullary spinal cord tumor. It is the first case reported in the literature of chronic ISCA mimicking conus IMST.
Case: A 65-year-old man with severe left talar avascular necrosis, arthritis, and chronic lateral ankle instability underwent total ankle total talus replacement (TATTR) with lateral ligament reconstruction. Tibial component placement was performed using preoperative computed tomography navigation and patient-specific guides. A custom, total talus replacement to mate with the fixed-bearing tibial component was implanted. Last, a modified Brostrom procedure was performed to restore lateral ankle stability. The patient has performed well through 1 year with improved pain-free function.Conclusion: This case report details a novel technique for performing a modified Brostrom procedure in conjunction with TATTR to restore lateral ankle stability.
Case: A 4-year-old girl sustained a traumatic atlantoaxial rotatory subluxation. She presented at the treating facility 8 months after injury with cervical deformity, neck pain, gait instability, and decreased cervical motion. Her delay in presentation was partially because of international Corona Virus of 2019 (COVID-19) travel restrictions. The case was successfully treated with halo traction, followed by halo vest immobilization.Conclusion: Chronic atlantoaxial rotatory fixation can be treated nonsurgically with closed reduction and halo traction, but is associated with operative risks. Optimal pin placement is challenging in the pediatric skull and may be improved with a preoperative or intraoperative computed tomography (CT) scan.
Case: A 15-year-old adolescent boy had severe groin pain because of extensive osteonecrosis of the femoral head with collapse, joint space narrowing, and nonunion after a failed internal fixation for femoral neck fracture. We performed a 60° valgus osteotomy that moved the posteromedial small viable portion of the femoral head to the weight-bearing acetabular area. The femoral neck nonunion and the necrosis healed completely, and the spherical contour of the femoral head was regained after postoperative hip joint remodeling.Conclusions: Good remodeling and congruency were achieved by performing high-degree valgus osteotomy to obtain sufficient viable area below the acetabular roof.
Case: Rod fracture (RF) occurred at L5-S level in a 79-year-old woman 7 months after spinal corrective surgery for adult spinal deformity (ASD). Four years after the surgery, pyogenic spondylitis occurred at the same level as RF. After the reinforcement of broken rods posteriorly, a transperitoneal approach was used for debridement and bone graft. However, prolonged infection, adhesive ileus, and small bowel perforation led to a total of 3 reoperations, resulting a colostomy. Three years after the reoperation, she was ambulatory with assistance.Conclusion: We need to follow-up postoperative ASD patients carefully because a single complication can lead to serious consequences.
Case: A 68-year-old woman presented with a paraspinal mass of indeterminate imaging characteristics. Workup and computed tomography-guided Fine Needle Aspiration (FNA) aspiration revealed extramedullary hematopoiesis (EMH) adjacent to a prior compression fracture in the setting of pernicious anemia.Conclusion: The combination of findings suggests a possible relationship of the compression fracture and the EMH because of traumatic extravasation of marrow contents, with the patient's underlying anemia possibly providing an underlying predisposition to EMH.
Cases: Three patients presented with bilateral knee pain, effusion, decreased range of motion, and difficulty ambulating. Synovial analysis demonstrated leukocytosis in bilateral knees with positive serum enzyme-linked immunosorbent assay. All cases were managed with antibiotics and anti-inflammatories. One patient developed chronic Lyme arthritis and underwent arthroscopic synovectomy.Conclusion: Bilateral knee arthritis is a possible presentation of Lyme disease in children. Accurate diagnosis and treatment with antibiotics and anti-inflammatories can lead to satisfactory outcomes. Arthroscopic synovectomy may be indicated if conservative treatment fails.
Case: A 63-year-old farmer who is a known diabetic and chronic alcoholic presented with lower back pain and neurological weakness of lower limbs present for the past 3 months. His acute phase reactants were very high, and magnetic resonance imaging displayed L4-L5 vertebral involvement with epidural, paravertebral, and bilateral psoas abscesses. Cultures of an ultrasound-guided aspiration from the psoas were positive for Burkholderia pseudomallei, and a nucleic acid amplification test also detected Mycobacterium tuberculosis. He underwent posterior decompression and fixation, and intraoperative biopsy confirmed a granulomatous reaction. He received appropriate antibiotics for both diseases. At 1 year, he showed healing on radiographic imaging, with independent ambulation status.Conclusion: The coexistence of melioidosis and tuberculosis is rare, and as far as we know, a case of infective spondylodiscitis has not been reported. In patients with infective spondylodiscitis, every attempt should be made to confirm the diagnosis before starting empirical antitubercular treatment (ATT).
Case: A 40-year-old man presented with progressive shoulder pain, associated with static posterior subluxation and mild eccentric glenohumeral osteoarthritis. Compared with a mean statistical shape model of a normal shoulder, the patient's acromion was abnormally high and horizontal, and the glenoid abnormally inclined inferiorly and minimally retroverted. Restoration of normal scapular anatomy using 3-dimensional planned acromial and glenoid osteotomies led to recentering of the joint and full shoulder function up to 24 months postoperatively.Conclusion: The correction of associated acromial and glenoid malformation can revert early static posterior subluxation of the shoulder. Whether successful recentering prevents progression of osteoarthritis remains to be established.
Case: A 54-year-old woman with rheumatoid arthritis presented with a flexor pollicis longus (FPL) rupture at the level of the metacarpophalangeal joint secondary to attritional damage from metacarpophalangeal (MCP) degenerative changes and exostoses from the radial sesamoid. She underwent direct tendon repair with debridement of the MCP joint and radial sesamoidectomy.Conclusion: Rheumatoid arthritis can potentially lead to rupture of the FPL tendon in locations distal to the carpus, namely at the level of the MCP joint. Contrary to other reports, a quality outcome may be obtained with direct repair and may not necessarily require tendon transfer, fusion, or grafting.
Case: An 18-year-old male polytrauma patient sustained a high-energy posterior fracture dislocation of his left elbow associated with a comminuted and irreparable O'Driscoll type 2 subtype 3 anteromedial facet coronoid fracture. He underwent early coronoid reconstruction using ipsilateral olecranon osteoarticular autograft with incorporation of the sublime tubercle attachment of the medial collateral ligament and repair of the lateral ulnar collateral ligament. A 3-year follow-up revealed a functional, painless, congruent, and stable elbow.Conclusion: Early reconstruction of a highly comminuted coronoid fracture may be a useful salvage option for the polytrauma patient, thereby avoiding complications associated with late reconstruction of posttraumatic elbow instability.
Case: We present a case of traumatic anterior obturator hip dislocation in a pediatric patient with a focus on acute management of this injury. The orthopaedic team successfully performed closed reduction of this injury on an emergent basis, and the patient had minimal issues with ambulation and pain at subsequent follow-up.Conclusion: Pediatric traumatic hip dislocations are rare injuries with potentially devastating sequelae, particularly if diagnosis and treatment are delayed. Proper technique during closed reduction is essential. Be prepared for potential emergent open reduction. Two years of postinjury follow-up is recommended to monitor for signs of femoral head osteonecrosis.
Case: A 74-year-old male patient presenting with chronic radiating shoulder pain, paresthesias, and weakness had previously undergone reverse shoulder arthroplasty and anterior cervical discectomy and fusion for an irreparable cuff tear and cervical radiculopathy, respectively. After being diagnosed with neurogenic thoracic outlet syndrome and undergoing physiotherapy, the patient's recalcitrant condition was surgically managed with arthroscopic pectoralis minor tenotomy, suprascapular nerve release, and brachial plexus neurolysis.Conclusion: This ultimately led to complete pain relief and improved function. By sharing this case, we aim to shed light on this overlooked pathology and help prevent unnecessary procedures for others suffering from similar conditions.
Case: A 26-year-old man with a minimally displaced tibial shaft fracture after an all-terrain vehicle crush injury rapidly developed fat embolism syndrome (FES), leading to diffuse alveolar hemorrhage (DAH) preoperatively. He was treated with an intramedullary rod 10 days after injury after a complicated clinical course and went on to full union with no long-term mental or systemic sequelae.Conclusions: FES is a known complication of long bone fractures, frequently presenting with hypoxemia. DAH is a rare complication of the condition. This case demonstrates the need for a high index of suspicion both for FES and DAH as complications of orthopaedic trauma.
Case: Iatrogenic heterotopic calcification and calcinosis cutis secondary to extravasations of intravenous calcium is very rare. We report a case of a neonate treated with intravenous calcium resulting in extravasations causing heterotrophic calcification and calcinosis cutis with subcutaneous mass causing perinatal peripheral brachial palsy.Conclusion: We highlight these rare potential complications of calcium extravasations and recommend conservative treatment and the avoidance of the temptation of surgical excision of any bony lumps as they resolve spontaneously in time. These complications should not be confused as a fracture with callus formation and periosteal reaction.
Case: This case demonstrates the attempted utilization of an osteochondral allograft for the prevention of bony overgrowth in a patient with fibular hemimelia and previous transtibial amputation with failure of Teflon capping. Additionally, we describe a novel technique to provide additional padding and increase the width of the residual limb using a dermal allograft.Conclusions: Bony overgrowth after pediatric amputations is common and often necessitates revision procedures secondary to infection, ulceration, pain, and discomfort with prosthesis use. Our use of an osteochondral allograft cap to prevent bony overgrowth ultimately failed 13 months following the procedure, and further research on various graft options and other treatment modalities is warranted, especially if the proximal fibula is unavailable or there is concern for donor site morbidity associated with harvesting autologous grafts.
Case: A judo athlete presented with an open inferior shoulder dislocation that occurred during competition. Examination revealed a transection of the axillary artery and neuropraxia of the posterior cord. Neuropraxia was resolved within 2 weeks. The axillary artery was repaired with a femoral vein graft. He regained full strength, range of motion, and function at 8 months.Conclusion: Inferior glenohumeral dislocations are rare, and their management can be complicated by vascular and neurological injuries. We emphasize the importance of examination, diagnosis, and treatment of neurovascular pathologies to avoid catastrophic outcomes.
Case: A 19-year-old woman developed spontaneous onset of right midfoot pain in the absence of trauma. Conservative management including orthotics and steroid injection reduced, but did not resolve, pain. Weight-bearing x-ray and CT confirmed naviculo-medial cuneiform coalition. After failure of conservative treatment, the patient elected to undergo right naviculo-medial cuneiform arthrodesis and returned to normal activity without pain postoperatively and at 4-year follow-up.Conclusion: Naviculo-medial cuneiform coalition is a rare source of midfoot pain, but should be considered as a differential diagnosis. This case suggests that naviculo-medial cuneiform arthrodesis can successfully resolve symptoms if conservative measures fail.
Case: Although implanted tuberculosis (TB) is rare, a single lot of cellular bone matrix was found to be infected with TB, leading to devastating outcomes. We present 2 cases referred to our institution because of instrumentation failure caused by TB inoculation of cellular bone matrix.Conclusion: Irrespective of spinal region of implanted TB infection, excision of infected bone, extensive irrigation and debridement, and instrumented stabilization are of primary importance to ensure TB eradication and adequate stabilization.
Case: We report a 40-year-old woman with undiagnosed patellofemoral instability that worsened 8 months after intramedullary nailing of a distal left tibia fracture in the semiextended position through a partial medial parapatellar approach. Patella stability and asymptomatic knee function were restored after IM nail removal, medial patellofemoral ligament repair, and left tibial tubercle transposition.Conclusion: The optimal surgical approach for tibial IM nailing in patients with chronic patellar instability has not been described. Clinicians should be cognizant of the potential for worsening patellofemoral instability in these patients when using the medial parapatellar approach in the semiextended position.
Case: Two cases of revision total hip arthroplasty (THA) for pseudotumor and infection with persistent postoperative bleeding because of angiosarcoma are presented. After surgery, both patients' health deteriorated because of hypovolemic shock despite transfusion, pressors, embolization, and prothrombotics. Diagnosis was obscure and delayed despite extensive imaging. Standard and computed tomography angiogram were nondiagnostic and did not localize the tumors or bleeding. Repeat surgeries and biopsies requiring special staining ultimately revealed epithelioid angiosarcoma.Conclusion: A diagnosis of angiosarcoma was etiologic for persistent postoperative bleeding after revision THA and should be considered in such cases.
Case: A 9-month-old infant girl with Down syndrome presented with an atrophic nonunion of the right humerus diaphysis secondary to birth trauma. Surgical intervention included open reduction and external fixation plus cadaveric cancellous bone allograft and platelet-rich plasma and then was changed to an external fixator in axial compression. At 16 months after surgery, bone healing was achieved.Conclusion: Nonunions in infants are rare, and their treatment is a challenge; an adequate vascular supply with good stabilization and reduction are keys to management. We believe that the improvement in reduction and stability under axial compression were the keys to achieve consolidation.
Case: We present a delayed failure of an M6-C cervical disc arthroplasty after conversion of a subjacent failed cervical disc arthroplasty to fusion. The annular component had failed, and the core had been ejected. Histology demonstrated a giant cell reaction to polyethylene debris, and tissue cultures were positive for Cutibacterium acnes.Conclusion: This is the first report of M6-C failure after conversion of an adjacent arthroplasty to fusion. A growing number of reports surrounding the M6-C failure rate and mechanisms raise concern about the device's durability and underscore the importance of routine clinical and radiographic surveillance for these patients.
Case: Unstable pelvic ring fractures in pregnancy are an uncommon injury. Successful treatment of these patients with an INFIX device is even less common, with sparse literature to document the patient outcomes. We found no literature documenting the acute management of a pregnant patient with an INFIX device with (1) dynamic changes recorded, such as increasing pubic symphysis diastasis, and (2) restoration of normal symphyseal anatomy after birth and INFIX removal.Conclusion: Use of a pelvic INFIX during pregnancy allowed functional independence. The construct offered sufficient stability while also allowing for pubic symphysis diastasis. After parturition, she returned to normal function with no injury sequela.
Case: A 65-year-old man with osteoarthritis of the hip developed a soft-tissue mass of the inferior gluteal region 3 years after metal-on-metal resurfacing hip arthroplasty. Clinical and imaging findings suggested an adverse local tissue reaction. Intraoperatively, nearly 1 liter of intra-articular fibrinous loose bodies (rice bodies) was removed, and histology showed features of an adaptive immune response. The patient had no evidence of an autoimmune disease or mycobacterial infection.Conclusion: To our knowledge, this is the first reported case of florid rice bodies associated with a metal-on-metal hip arthroplasty and adverse local tissue reaction.
Case: A 13-year-old adolescent boy visited our hospital with a growing mass on his left leg. Investigations and examinations were performed to obtain a final diagnosis of Ewing sarcoma in the head of the left fibula with lung metastasis. Neoadjuvant chemotherapy was extended to 11 courses with radiation before wide tumor resection could be performed. The final 3 adjuvant chemotherapy courses were administered to complete the original protocol while surgical resection complications were also treated. The pathological report revealed free margin resection with nonviable tumor cells.Conclusion: An extended neoadjuvant chemotherapy regimen with additional radiation therapy for Ewing sarcoma provided extra local control and allowed limb salvage.
Case: A 31-year-old right-hand–dominant man sustained an open left distal humerus fracture resulting in a complete loss of the lateral column involving 30% of the articular surface and the lateral collateral ligament complex. Reconstructive surgery was conducted in 2 stages, beginning with articulated external elbow fixation followed by reconstruction with a fresh osteochondral allograft. Outcomes were satisfactory with no elbow pain or instability, and osseointegration was demonstrated in radiographs.Conclusion: The technique described in this report can be a viable option for treating young patients with a severe distal humerus fracture complicated and can provide favorable clinical and radiological outcomes.
Case: We report a six-year-old child with SCARF syndrome (skeletal anomaly, cutis laxa, ambiguous genitalia, mental retardation and distinct facial features) who presented with unilateral teratologic hip dislocation. She underwent an open reduction of her hip with femoral and pelvis osteotomies. At six years follow-up, she was asymptomatic with a mild lurch, a leg length discrepancy of 1.5cms and a good range of motion at the hip. A mild shortening of the femoral neck was noted but the joint was congruous and concentrically reduced at 6 years.Conclusion: The management principles must follow an aggressive approach which includes open reduction of the hip, femoral and pelvic osteotomies with a good capsular repair. We may expect good hip development after surgical intervention even in a child with increased elasticity due to this genetic condition.
A 79-year-old right-handed woman presented with an indirect trauma to her left shoulder after a fall down the stairs. X-rays and computed tomography showed a four-part glenohumeral fracture-dislocation with a subcutaneous ectopic location of the humeral head in the retroclavicular space. A reverse total shoulder arthroplasty was performed using a deltopectoral approach with direct superior extraction of the humeral head. The result at 2 years was a subjective shoulder value of 80%, an absolute Constant score of 59, and a relative Constant score of 92/100. To the best of our knowledge, this is the first description in the literature of such a lesion of superior glenohumeral fracture-dislocation and its treatment.
Case: A 16-year-old female competitive gymnast presented to our orthopaedic clinic with an acute Achilles tendon rupture at the myotendinous junction. Direct end-to-end repair was performed and augmented with a bioinductive collagen patch. The patient had increased tendon thickness at 6 months postoperatively, as well as significant improvements in strength and range of motion at 12 months.Conclusion: Bioinductive collagen patch augmentation of Achilles tendon repair may be a useful adjunct for myotendinous junction Achilles ruptures, particularly in high-demand patients including competitive gymnasts.
Case: A 76-year-old woman with multiple myeloma and osteoporosis presented with right hip pain and an impending atypical femoral fracture in the setting of chronic bisphosphonate use. After preoperative medical optimization, she was scheduled for prophylactic intramedullary nail fixation. Intraoperatively, the patient experienced episodes of severe bradycardia and asystole associated with intramedullary reaming, which ceased after distal venting of the femur. No additional intraoperative or postoperative complications were encountered, and the patient recovered uneventfully.Conclusion: Femoral canal venting may be an appropriate intervention for similar transient dysrhythmias caused by intramedullary reaming.
Case: A 50-year-old healthy man with normal kidney function underwent surgery for fracture-related infection. Unfortunately, the patient received 2.5 times the intended dose of tobramycin pellets in the medullary cavity and developed acute kidney failure. Given the intraosseous administration of tobramycin, the drug displayed an absorption-dependent pharmacokinetics and multiple treatments with hemodialysis were needed. However, the patient had a complete recovery, and the kidney function remained normal at the 2-year follow-up.Conclusion: Tobramycin pellets are nephrotoxic in supratherapeutic doses; however, it was reversible in this case. Owing to the intraosseous administration, multiple treatments with hemodialysis were required.
Case: A 71-year-old woman with Ehlers-Danlos syndrome suffered an atraumatic obturator dislocation status post direct anterior total hip arthroplasty. A closed reduction under conscious sedation was attempted, but was unsuccessful. Repeat closed reduction under full general anesthesia with paralysis and fluoroscopic guidance was successful at reducing the femoral prosthesis out of the pelvis and back into an appropriate position.Conclusion: Atraumatic obturator dislocations after total hip arthroplasty are exceedingly rare. General anesthesia with full paralysis is helpful for a successful closed reduction, and open reduction may be necessary to remove the femoral prosthesis from the pelvis.
Case: A 29-year-old woman presented with bilateral tarsal tunnel syndrome caused by bilateral flexor digitorum accessorius longus, experiencing immediate relief of symptoms after surgical intervention through 1 year.Conclusion: Accessory muscles can cause compressive neuropathies in multiple areas of the body. In patients who have FDAL as the cause of their tarsal tunnel syndrome, surgeons should have a high index of suspicion of bilateral FDAL if the same patient develops similar contralateral symptoms.
