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: 3.235.40.122 | ||||||
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: 3.235.40.122 | ||||||
Open Access journal
Case: An 11-year-old Caucasian boy presented to the emergency department with a displaced, closed, Galeazzi equivalent (GE) left wrist fracture sustained after a fall. Closed reduction was deemed unsatisfactory because of persistent displacement of the distal ulna epiphysis. An open reduction of the distal ulna and percutaneous fracture pinning was performed. At 1 year, the patient reported return to his preinjury baseline. No evidence of subsequent pathologic growth was detected on follow-up imaging.Conclusion: Open anatomic reduction of the distal ulna epiphysis and percutaneous fracture pinning may improve patient outcomes and limit progressive wrist deformity when treating GE wrist injuries.
Case: A 49-year-old highly active man had a direct fall on the left shoulder, causing a chronic locked posterior shoulder dislocation. Radiographic analysis revealed a reverse Hill-Sachs lesion (RHSL) that affected 31% of the articular surface. He was successfully treated with a modified McLaughlin procedure that included a double-row suture anchor as a novel fixation approach to secure the lesser tuberosity transfer and the subscapularis tenodesis.Conclusion: The reported approach for reconstructing the RHSL provides adequate stability, pain reduction, and functional outcomes. It may be considered as an option for joint preservation in extensive humeral head defects.
Case: A 53-year-old man sustained an injury to his left index finger and underwent presumably traumatic neuroma excision from the radial digital nerve 2 years ago. He presented with a painful mass distal to the prior site of neuroma excision with distinctly different symptoms from those that led to his index surgery. Thus, he underwent excisional biopsy of the mass which was adherent to his radial digital nerve consistent with a benign glomus tumor on histologic examination.Conclusion: Digital nerve glomus tumors are rare. In most of the cases, some portion of the digital nerve requires excision but decreased pain can be expected.
Case: A 47-year-old Japanese woman with a medical history of xanthoma disseminatum (XD) presented with posterior neck pain and abnormal gait without a history of trauma. Imaging studies revealed odontoid process thinning resulting in its fracture due to XD involvement in the atlantoaxial joint and subsequent cervical myelopathy. Posterior C1-C2 fusion surgery improved the patient's symptoms. An XD lesion around the odontoid process was confirmed intraoperatively.Conclusion: We report cervical myelopathy caused by XD involvement in the C1-C2 joint, showing that early fusion surgery is critical for treating pathological fractures in patients with XD.
Case: A 14-year-old boy with proximal thoracic kyphoscoliosis associated with the bilateral absence of thoracic pedicles presented with progressive deformity, paraparesis, and difficulty in ambulation. The case was managed by preoperative halo traction, single-stage 2-level vertebral column resection, decompression, and arthrodesis of thoracic vertebrae. Two years postoperatively, the patient showed neurological improvement, leading to unassisted ambulation and fusion at the corpectomy site.Conclusion: Preoperative halo-gravity traction restores the sagittal and coronal balance, improves the functional status of the patient, and corrects the deformity to some extent. 3D printed models help in better understanding of osseous anatomy and minimizing intraoperative time.
Case: A 38-year-old man developed a nonunion of a comminuted distal phalanx fracture, which resulted in gross instability of the fingertip. To restore stability, a patient-specific 3D-printed distal phalangeal prosthesis was implanted, and the patient was able to return to his occupation with excellent 2-year outcomes.Conclusion: This case highlights the application of 3D printing technology in the development of a patient-specific solution and discusses 6 important considerations for the design and planning process: Patient, Priorities, Point of fixation, Procedure, Problems, and People.
Case: A 29-week-old gestational age neonate born by emergent cesarean delivery was found to have a circumferential upper arm amniotic constriction band. Initial removal of the amniotic band at the time of delivery uncovered a circumferential skin band with profound venous obstruction but preserved Doppler arterial flow. Emergent excision of the constricted skin band with fasciotomies of the arm and forearm was performed shortly after birth to preserve the extremity.Conclusion: This report outlines a visualized constriction band at the time of delivery causing neurovascular compromise to an extremity of a neonate. Prompt intervention ensued preserving both form and function with an excellent 2-year follow-up.
Case: A 43-year-old woman with dermatomyositis presented with Mycobacterium avium complex (MAC) knee septic arthritis with superimposed polymicrobial infection. After poor infection control with antibiotic therapy, she underwent debridement and antibiotic cement spacer placement, followed by knee arthrodesis 6 months later. At 2-year follow-up, she had no pain and was ambulating without assistive devices.Conclusion: As far as we know, this is the first reported case of MAC native-knee septic arthritis successfully treated with antibiotic cement spacer followed by knee arthrodesis. This case sheds insight on treatment strategies for a rare native-knee infection.
Case: Soft-tissue amyloidomas are exceedingly rare, with only a few cases reported in the literature. There are no reports of sciatic nerve compression secondary to a soft-tissue amyloidoma. We report a unique case of a 71-year-old man with an incidentally found amyloidoma who was initially believed to have deep gluteal syndrome. He had a favorable outcome after surgical decompression.Conclusion: For patients who do not have classic examination and electromyography/nerve conduction findings of piriformis syndrome, providers should explore other etiologies of peripheral nerve compression including soft-tissue amyloidoma.
Case: A 54-year-old immunocompetent man presented to the office with severe right knee pain and swelling 27 days after knee arthroscopy. Additional diagnostics identified a monomicrobial infection of the right knee joint by the bacterium Leclercia adecarboxylata, which was later confirmed by repeated aspiration of the joint and culture of the aspirated fluid.Conclusion: This case report details a postoperative monomicrobial infection with L. adecarboxylata after a knee arthroscopy in an immunocompetent host. Although infection by this bacterium is rare, this case demonstrates the possibility of L. adecarboxylata infection in the knee joint after orthopaedic surgery.
Case: A 27-year-old woman with increasing bilateral thigh pain and underlying diagnosis of dysosteosclerosis was diagnosed with bilateral impending pathological femur fractures. Both femurs exhibited abnormal morphology with bowing, thickened cortices, and narrow intramedullary canals. We planned minimally invasive prophylactic plate osteosynthesis. Computed tomography scans of both femora were obtained and used to generate 3-dimensional (3D) printed models. Osteosynthesis plates were precontoured to fit the 3D models and sterilized, and prophylactic fixation was performed using a minimally invasive submuscular technique.Conclusion: 3D printed models aided in precontouring fixation plates in a case with challenging bony anatomy, enabling minimally invasive surgery.
Case: A 40-year-old man presented with spontaneous, atraumatic right groin pain and inability to bear weight secondary to an isolated avulsion of the right lesser trochanter. Magnetic resonance imaging of the affected hip was suggestive of an infection, and a computed tomography–guided biopsy was remarkable for Mycobacterium tuberculosis, which was successfully managed with antitubercular therapy and activity modification.Conclusion: Although an isolated spontaneous avulsion of the lesser trochanter is typically pathognomonic for malignancy, an infectious etiology, such as tuberculosis, should also be considered in the differential diagnosis.
Case: Herein is presented a case of rupture of the A2/A3 annular pulleys of the left second toe in a 33-year-old male patient after a snowboarding injury. The injury was detected on magnetic resonance imaging (MRI) 7 weeks after the initial trauma. The patient was treated conservatively, including toe splinting, with the patient returning to his asymptomatic preinjury baseline after 6 months.Conclusion: Annular pulley rupture of the toes is a novel cause of prolonged forefoot pain. Clinician awareness of this unique injury and its often subtle MRI findings may help avoid delays in appropriate diagnosis and treatment.
Case: A 73-year-old woman presented with degenerative kyphoscoliosis. Radiographs revealed sagittal and coronal imbalance with lumbar spinal stenosis. Extreme lateral interbody fusion (XLIF) was performed in the first stage of 2-stage surgery, and a closed-suction drainage tube was placed in the retroperitoneal cavity. Postoperatively, there was massive bleeding through the tube. Contrast-enhanced computed tomography revealed lumbar artery injury, which required emergency arterial embolization.Conclusion: Placing a drainage tube in the retroperitoneal cavity during XLIF surgery can help detect complications such as intestinal and ureteral injuries, the lumbar artery within the lumbar muscle can be injured during drain placement.
Case: Ten days after L3-L5 instrumented posterior lumbar spinal fusion, an 85-year-old woman developed Grade 4 spondylolisthesis at L5-S1 after a minor fall. She underwent posterior open reduction and internal fixation with extension of fusion from L2 to the pelvis. The preexisting hardware at L5 caused partial laceration of the right L5 nerve root. One year after surgery, computed tomography demonstrated maintenance of correction and fusion at L5-S1.Conclusion: High-grade lumbosacral spondylolisthesis can occur with minor trauma after short-segment lumbar fusion. Maintenance of correction and fusion is achievable with posterior open reduction and internal fixation to the pelvis alone. Preexisting hardware can damage nerve roots causing permanent neurological deficits.
Case: This report details the cases of 2 older male patients with ankylosing spondylitis (AS) who presented with lumbar spinal stenosis at a single residual mobile segment and were treated with decompression without fusion. Both patients presented with severe symptoms in their lower limbs and opted to proceed with surgery.Conclusion: With autofusion above and below their single, stable mobile segment, decompression without fusion was a safe and effective procedure. A Coflex device was implanted in 1 patient. After successful surgery, both patients experienced significantly decreased symptoms.
Case: A right hand dominant 10-year-old girl presenting with an open right distal humerus fracture dislocation involving complete medial column bone loss and a>50% trochlea defect was reconstructed with a size-matched, fresh distal humerus osteochondral allograft. Successful bony integration and functional elbow range of motion were achieved.Conclusion: A paucity of literature exists to guide the treatment of pediatric distal humerus fractures with significant bone loss. Despite complications associated with osteochondral allografts, they provide a reasonable treatment option to preserve elbow motion in children with unreconstructible intra-articular distal humerus fractures to avoid arthrodesis.
Case: A 48-year-old man presented with neck pain and torticollis without any neurodeficit. He was diagnosed with C1-C2 tuberculosis with left C1-C2 joint destruction and was immobilized with a halo vest and started on antitubercular treatment (ATT). At the 3-month follow-up, he presented with left hypoglossal nerve palsy (HNP). He responded to ATT with complete healing of C1-C2 lesion and good correction of deformity but persistent left-sided tongue deviation at the 2-year follow-up.Conclusion: HNP may occur as a complication of conservative management of craniovertebral junction tuberculosis (CVJ TB). Careful neurological assessment and monitoring must be performed while correcting deformities in CVJ TB using halo-vest immobilization.
Case: We report a patient with permanent tracheostomy in the context of muscular dystrophy presented for pneumonia. On bronchoscopy, a pedicle screw was seen penetrating the trachea. Computed tomography revealed significant anterior erosion of the T1-T3 vertebrae due to chronic pressure injury from the tracheostomy cuff, exposing pedicle screws implanted>10 years earlier. The patient was fitted for a custom low-pressure cuff. No further sequelae developed for 4 months.Conclusion: To the best of our knowledge, this is the first case of exposed spinal fusion instrumentation due to chronic vertebral erosion. Early sagittal imaging and the use of low-pressure cuffs may help prevent this complication.
Case: A 21-year-old man presented with knee pain secondary to tibial plateau malunion and an osteochondral defect 1 year after open reduction and initial fixation. Two-stage reconstruction with transplantation of a bulk heat-treated osteochondral allograft and an autologous chondrocyte implantation was performed.Conclusion: This technique may be a good choice for large defects in the articular cartilage in cases of tibial plateau malunion. It may be a viable alternative for defect reconstruction, resulting in favorable early clinical, functional, and radiological outcomes.
Cases: Two patients with periprosthetic femur fracture proximal to a femoral osseointegration had surgical stabilization. These cases produced operative challenges because commonly used intraoperative traction methods cannot be used for patients with transfemoral osseointegration.Conclusion: We describe a novel technique to apply traction and rotation to the osseointegrated extremity: using the implant's antirotation propeller handle. This allows for an otherwise familiar technique to be used for fracture fixation: open reduction with internal fixation using a proximal femur hook plate and eccentric peri-implant screws.
Case: Pseudoaneurysms of the peroneal artery around the ankle joint have rarely been reported. We present the case of a 64-year-old man with a pseudoaneurysm of the anterior perforating branch of the peroneal artery associated with a screw inserted from the anterolateral distal tibia during ankle arthrodesis. Endovascular treatment with selective catheterization and coil embolization was successfully performed. The ankle joint achieved bone union without delay, and the pseudoaneurysm did not recur at the 18-month follow-up.Conclusion: This is the first report describing a pseudoaneurysm of the peroneal artery after ankle arthrodesis. Successful outcomes can be achieved by endovascular treatment.
Case: A 16-year-old boy with a history of Down syndrome presented with right knee pain and swelling. He was diagnosed with isolated septic arthritis of the knee due to Fusobacterium necrophorum in the absence of current or recent oropharyngeal infection. He was successfully treated with arthroscopic irrigation and debridement and 12 weeks of oral antibiotics.Conclusion: Fusobacterium necrophorum is a part of the normal oral flora and a rare cause of septic arthritis, typically associated with recent oropharyngeal infection. However, patients with immune dysregulation such as those with Down syndrome may develop isolated septic arthritis due to transient hematogenous seeding.
Case: Three cases of atypical metatarsalgia are presented, all diagnosed with foot synovial sarcomas (SSs) at different stages of evolution, after a year of medical consultations. One case was treated with marginal excision without requiring bone excision; the second patient required amputation of the first ray; and the third patient, with advanced disease, required amputation through Chopart's joint.Conclusion: Metatarsalgia is a recurrent reason for consultation in orthopaedics. Even so, patients with persistent symptoms should be studied further in depth. Computed tomography or magnetic resonance imaging can detect tumor pathology, such as SS, of insidious development.
Case: A 56-year-old woman underwent a left total hip arthroplasty (THA) after developing avascular necrosis after chemotherapeutic treatment of breast cancer. She presented approximately 2 years after index THA with left groin pain and complaints of instability. Imaging revealed pseudodislocation of the ceramic femoral head with erosion through the acetabular component. Intraoperative evaluation revealed a dissociated polyethylene liner, damaged acetabular locking mechanism, metallosis, and well-fixed and aligned components. Treatment consisted of component retention, bone grafting, and dual-mobility liner cementation into the acetabular component.Conclusions: The two-year follow-up demonstrated a pain-free, well-functioning hip, bone graft incorporation, and no evidence of loosening.
Case: A 28-year-old woman developed gait disturbance due to lower limb weakness 3 years before presentation. Conventional magnetic resonance imaging (MRI) findings were inconclusive; therefore, we performed cine MRI, which confirmed the presence of a pulsatile cyst on the posterior thoracic spinal cord. The cyst compressed the spinal cord, and its pulsations synchronized with the patient's heartbeats. We resected the intradural arachnoid cyst and thickened arachnoid membrane. The gait disturbance improved after surgery.Conclusions: Cine MRI can be used to identify a pulsating arachnoid cyst that cannot be visualized with a conventional MRI. Cine MRI is useful in patients with unexplained spinal symptoms.
Case: Fractures of the femoral head are infrequent injuries with potentially devastating complications. Pipkin type II fractures often require surgical fixation. It involves intraarticular approaches that may increase the inherent morbidity of these fractures. Hip arthroscopy minimizes surgical aggression and allows for direct control of fracture reduction. We present a case report of an arthroscopic-assisted percutaneous fixation of a Pipkin-II femoral head fracture. A hip arthroscopy without traction and percutaneous screw fixation was conducted under arthroscopic and fluoroscopic guidance.Conclusion: Arthroscopic-assisted percutaneous fixation is a useful technique for optimal femoral head fracture treatment and may also minimize surgical morbidity and optimize early recovery.
Case: A 17-year-old male patient suffered a radial lateral meniscus tear and underwent an arthroscopic all-inside suture repair. After 7 months, the patient experienced catching. Magnetic resonance imaging and computed tomography revealed an intra-articular loose body without calcification, which was removed surgically. The excised specimen was histopathologically confirmed to be a necrotic meniscus fragment with a suture knot. In addition, cartilage damage because of suspected impingement by a residual suture knot was observed. After removing the loose body and knot, the patient's symptoms were relieved, and he returned to sports.Conclusion: Suture knot-related complications should be considered while performing meniscal repairs.
Case: We present the case of a patient who developed scaphoid avascular necrosis in the setting of scaphoid hypoplasia, 37 years after an index finger repositioning for thumb agenesis, due to Holt-Oram syndrome.Conclusion: To the best of our knowledge, this is a unique case of scaphoid avascular necrosis in a patient with Holt-Oram syndrome with scaphoid hypoplasia who underwent index finger repositioning 37 years earlier. Her wrist pain was successfully treated with scaphoid excision and intercarpal fusion.
Case: A 29-year-old man presented 2 years after anterior cruciate ligament (ACL) reconstruction by autologous semitendinosus graft and suspensory fixation on both tibial and femoral sides for chronic drainage of clear fluid from an anteromedial wound at the site of the tibial tunnel with a visible sinus tract. Magnetic resonance imaging showed a transtibial articulocutaneous fistula. The patient was treated by tunnel debridement, impaction bone grafting, bioresorbable interference screw, and cement to fully seal the tunnel. The surgery was successful with good clinical outcomes for recurrence and knee stability.Conclusion: Communicating transtibial articulocutaneous fistulas are rare complications after ACL reconstruction. Tunnel debridement and filling with graft material affected by an interference screw seem to be an effective method for dealing with such a clinical scenario.
Case: A 22-year-old man presented with long-standing, progressive neck pain of unknown etiology. Investigation revealed a cervical spine osteoid osteoma affecting the right C4-5 facet joint. He underwent minimally invasive en bloc resection with O-arm–assisted 3-dimensional navigation without introducing iatrogenic spinal instability. Symptoms resolved after surgery, without recurrence or instability at the 2-year follow-up.Conclusion: Cervical spine osteoid osteoma is a tumor that presents diagnostic and therapeutic challenges. Achieving precise, complete resection of the tumor with a minimally invasive approach while avoiding spinal instrumentation and arthrodesis is paramount to excellent surgical outcomes.
Case: A case of Francisella tularensis finger proximal interphalangeal joint septic arthritis secondary to feral cat bite is presented. The patient underwent operative debridement on presentation. On postoperative day 5, a gram-negative rod resembling F. tularensis was identified. The patient received 4 weeks of gentamicin for culture-confirmed ulceroglandular tularemia. At the final follow-up, the infection had resolved, and full function of the digit had been regained.Conclusion: Francisella tularensis septic arthritis secondary to a feral cat bite is exceedingly rare but should be considered in the appropriate clinical context. Proper identification and treatment with antibiotics is essential for a positive outcome.
Case: Distal radius reconstruction after giant cell tumor (GCT) resection is typically performed with free fibular flaps when a vascularized bone is needed. However, vascularized fibular flaps are contraindicated in patients with peroneal artery variants. We present 2 patients with GCTs of the radius and bilateral peronea arteria magna who underwent resection with wrist fusion using an allograft bone and vascularized free medial femoral condyle periosteal flaps. Both patients had excellent outcomes with minimal postoperative morbidity.Conclusion: Allograft bone with vascularized medial femoral condyle periosteal flaps is an effective option for reconstructing distal radius defects after GCT resection when conventional methods fail.
Case: A 57-year-old man presented with pain and paresthesia in both hands and was diagnosed with pronator teres syndrome. Surgical decompression of the left elbow and forearm revealed the median nerve in an unusual anatomic location, specifically running within the pronator teres muscle.Conclusion: Anatomic anomalies of the pronator teres muscle and the path of the median nerve have been described. However, there are no reports of the median nerve entering and traveling within the pronator teres. Surgeons should be aware of this anomaly to avoid potential iatrogenic injury when performing an anterior surgical approach to the elbow and proximal forearm.
Case: A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone–patellar tendon–bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union.Conclusion: Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome.
Case: Appendicular fecaliths have been reported to migrate to nearby organs before or during surgical treatment and become a late source of infection. We report an extremely rare case of recurrent iliopsoas abscesses caused by appendicular fecaliths that have migrated to the psoas muscle before or during the previous appendicectomy for acute appendicitis. In this case, surgical removal of fecaliths cured the iliopsoas abscess.Conclusion: Orthopaedic surgeons and gastroenterologists should remember that appendicular fecaliths that migrated into the iliopsoas muscle may cause late-onset iliopsoas abscesses.
Case: A 17-year-old adolescent boy complained of plantar pain at the first metatarsal 2 months after a catfish spine injury. Imaging was consistent with a retained foreign body, and surrounding osteolysis was concerning for osteomyelitis. He underwent surgical debridement and was found to have inflammation and necrosis, apparently caused by catfish spine venom.Conclusion: Although osteolytic lesions are commonly attributed to infection or tumor, in the situation of venomous injuries, osteolysis can be a sequela of the severe local inflammatory reaction due to the toxins. Debridement is vital to remove the offending agent and the local toxins from the venom.
Case: A 34-year-old man had an injury which resulted in pilon fracture and acute compartment syndrome of his forefoot. The case report describes the use of a novel minimally invasive dorsal approach for decompression of the lateral, central, medial, and interosseous compartments. The release was performed through multiple small incisions on the dorsal foot. The patient had complete relief with normal function of all muscle groups at 6 weeks and is now 18 months after surgery. He has returned to full activity.Conclusion: The successful decompression of the forefoot compartments through a percutaneous approach avoided known complications of muscle death, toe clawing, and secondary surgeries.
Case: An 8-year-old boy with left lateral ankle pain was diagnosed with acute osteomyelitis after methicillin-susceptible Staphylococcus aureus was identified in a subperiosteal abscess in the distal fibula that had been aspirated using an ultrasound-guided needle. Symptoms improved after 2 weeks of intravenous and 4 weeks of oral antimicrobial therapy; no additional treatment was required. No growth retardation or sequelae were observed at the 6-year follow-up.Conclusions: In acute osteomyelitis, the identification of subperiosteal abscess is key for early diagnosis. Ultrasound evaluation of the distal fibula should also be considered in the diagnosis of lateral ankle pain in children.
Case: This report describes a histoplasma capsulatum total knee prosthetic joint infection (PJI) in an immunosuppressed patient treated with a 2-stage revision. The diagnosis of PJI was made based on minor criteria, and the causative organism was identified from cultures obtained at the time of explantation. The patient underwent induction with amphotericin B, followed by oral antifungal therapy and a successful 2-stage revision with a hinged prosthesis with an interval of ∼7 months between stage 1 and stage 2. At the most recent follow-up (18 months), she remained clear from infection with planned lifetime antifungal suppressionConclusion: This case report highlights the importance of consideration of atypical organisms when treating immunocompromised patients. Furthermore, this case report documents one of the few cases of histoplasma PJI and provides a successful treatment algorithm to potentially be applied to future cases.
Case: A 69-year-old male patient, 5 years after a well-functioning total hip arthroplasty for severe osteoarthritis, presented with a 3-month history of progressive, unrelenting, “burning” pain in his right hip with accompanying fullness of the right thigh. Inflammatory markers were elevated, and imaging revealed a large unilocular fluid collection with communication to the hip joint. Aspiration was positive for Mycobacterium senegalense. A combination of surgical and antibiotic therapy successfully treated this patient.Conclusion: Mycobacterium senegalense is a rare cause of prosthetic joint infection. A combination of surgical and antimicrobial management is required for effective treatment.
Case: A 45-year-old woman had a grade II chondrosarcoma (T2N0M0G2) located at the spinous processes and laminas of T3-6 with the tumor extension into the spinal canal at T3-4. To perform en bloc tumor resection, we released or disarticulated bilateral costovertebral ligaments from T3-6 and cut the bilateral pedicles at T3-5 all from posteriorly. Then, we completed en bloc resection without violating the tumor capsule.Conclusion: Our novel procedure, bilateral osteotomy of pedicles for en bloc resection successfully allowed for en bloc tumor resection involving the posterior elements with wide surgical margins.
Case: We present 2 cases of pathologic periprosthetic radius fractures in the setting of osteolysis after radial head arthroplasty (RHA) with a porous-coated, press-fit implant. Both patients were managed with implant removal without subsequent instability. Although radiographic lucencies are common after RHA, progressive bone resorption can result in subsequent periprosthetic fractures.Conclusion: Although osteolysis after RHA is not always clinically significant, these cases demonstrate that this radiographic finding may indicate adverse clinical consequences. Surgeons who perform implant excision should be ready to address further instability as needed.Level of Evidence: Level V, case reports.
Case: We present a 58-year-old left hand–dominant woman with right glenohumeral osteoarthritis and anterior instability in the setting of a congenital residual limb at the level of the mid-humerus. She had persistent pain and dysfunction despite trying conservative treatments and elected for a stemless or “canal-sparing” hemiarthroplasty with anterior capsular reconstruction. At the 2-year follow-up, there was significant improvement in her pain, motion, and function without signs of radiographic loosening.Conclusion: A stemless humeral implant is a versatile component that can be used in the face of humeral dysplasia, such as this patient with a congenital residual limb.
Case: We present a case of a patient who suffered from wrist swelling and had symptoms of carpal tunnel syndrome. The patient underwent ultrasound and magnetic resonance imaging, in which signs of joint effusion and a fatty synovial lesion were presented. The treatment included open excision of the tumor. In addition, the palmaris longus muscle had an anatomic variation with proximal and distal tendon portions. The histopathological examination disclosed lipoma arborescens of the synovial membranes of the joints.Conclusion: The recognition of this entity and its characteristics are important not only for correct diagnosis but also for the appropriate treatment.
Case: A 76-year-old fisherman with a history of diabetes mellitus, coronary artery bypass grafting, and a previous ipsilateral elbow wound presented with a 1-year history of hand pain and swelling. Anti-inflammatories and antibiotics were administered without improvement. Magnetic resonance imaging and ultrasound demonstrated flexor tenosynovitis. Intraoperative cultures revealed Mycobacterium chimaera. The treatment course included 2 tenosynovectomies and a 1-year course of triple antimycobacterial therapy.Conclusion: Nontuberculous mycobacteria infections should be considered in cases of indolent tenosynovitis. M. chimaera should be considered in patients with a history of cardiopulmonary bypass given its association with cardiopulmonary heater-cooler units.
Cases: Two women presented with newly growing callosities beneath the first and second metatarsal heads, initially believed to reflect gastrocnemius tightness and plantar plate pathology. In another man, swelling at the posterolateral aspect of the heel was mistaken for a Haglund deformity. Subsequent imaging of each patient led to delayed diagnosis of extraskeletal osteochondroma (ESO). Surgical excision resolved symptoms in all 3 with no recurrence over 12 months later.Conclusions: Whenever bony prominences newly develop in soft tissues of the foot, ESO should be suspected and appropriate imaging obtained. We describe physical features to help differentiate ESO from other common causes of foot overload.
Case: A 66-year-old man presented with new left hip pain after total hip arthroplasty 21 years earlier. Computed tomography imaging revealed massive osteolysis involving the ileum behind the well-fixed acetabular component. The patient was indicated for head and liner exchange with grafting of the osteolytic lesion. Surgery was complicated by cardiopulmonary arrest after injection of a bone graft substitute into the lesion. Despite resuscitation attempts, the patient died.Conclusion: Embolism is a rare complication of bone graft substitute injection for pelvic osteolysis. This material can extravasate from bone and deposit in the pulmonary and cerebral microcirculation.
Case: A 13-year-old girl presenting with scoliosis accompanied by type I neurofibromatosis (NF1) underwent deformity correction surgery. On the second postoperative day, she had sudden-onset acute cerebral infarctions and was diagnosed with moyamoya syndrome. After neurological conservative treatment, at the sixth month after surgery, her symptoms and signs were significantly improved and the daily life was not affected by herself.Conclusion: NF1 scoliosis with moyamoya syndrome is an uncommon inherited disorder. Intracranial vasculopathy is hardly detected from routine preoperative examinations. The specific intracranial vascular examination should be performed for patients with NF1 scoliosis, especially those who have a positive history of cerebral ischemic or hemorrhagic symptoms.
Case: We report a case of flexor pollicis longus (FPL) tendon rupture and carpal tunnel syndrome due to scaphoid nonunion advanced collapse deformity. Intraoperative findings showed disruption of the palmar joint capsule and a sharp proximal bone fragment protruding into the carpal tunnel. Removal of this proximal fragment and tendon grafting were performed. At the postoperative 2-year follow-up, the patient had no wrist pain, finger numbness, or restriction of thumb motion.Conclusion: Our results suggest that minimally invasive surgical procedures, such as proximal pole or osteophyte resection, might be optimal choices for early rehabilitation after tendon repair in cases of FPL tendon rupture due to asymptomatic scaphoid nonunion.
