Journal of Orthopaedic Case Reports最新文献

{"title":"Bilateral Patellar Tendon Avulsion in End-Stage Renal Disease with G6 PD Deficient Patient: Case Report and Review of Literature.","authors":"Shakil Ahmad, Sreenath Shankar, Mohammed Nasir Al Kindi","doi":"10.13107/jocr.2025.v15.i03.5320","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5320","url":null,"abstract":"<p><strong>Introduction: </strong>Among the cause of extensor mechanism failures, acute patellar tendon ruptures are less frequent than quadriceps tendon ruptures. Moreover, majority occur as unilateral injuries during athletic participation. B/L acute patellar tendon ruptures are extremely rare and only been documented in literature as case reports with majority having predisposing factors such as tendinopathy, steroid abuse systemic lupus erythematosus, and end-stage renal disease (ESRD).</p><p><strong>Case report: </strong>We present a case of 34-year-old male patient k/c of G6pd deficency Patient with ESRD on regular hemodialysis thrice a week since 8 years came to A/E with H/O pain and swelling in both knees due to a fall from stairs. Plain X-rays and magnetic resonance imaging confirmed the diagnosis of B/L patellar tendon avulsion from the lower end of patella. Patient was operated according to the Krackow technique Patient recovered well and we achieved excellent result in both knees.</p><p><strong>Conclusion: </strong>Since B/L tendon rupture is extremely rare therefore there is always a high chance of missing the diagnosis due to lack of other normal knee for comparison. We want to highlight the relation of comorbidities like G6pd def, ESRD with B/L patellar tendon avulsion, and to have a high degree of suspicion if ESRD Patient comes to A/E with B/L knee swelling and pain.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Atlantoaxial Joint Steroid Injections in Managing Cervicogenic Headache: A Case Series.","authors":"Rampal Singh, Lautika Sonkar","doi":"10.13107/jocr.2025.v15.i03.5390","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5390","url":null,"abstract":"<p><strong>Introduction: </strong>The International Headache Society divides headaches into primary (vascular and muscular) and secondary (inflammatory). Secondary headaches include headaches secondary to inflammation caused by injuries to the head and neck. Cervicogenic headache (CGH) is thought to be referred pain arising from irritation caused by cervical structures innervated by spinal nerves C1, C2, and C3; therefore, any structure innervated by the C1-C3 spinal nerves could be the source of a CGH. Pain from the lateral atlanto-axial joint (AAJ) is one of several causes of CGH. The pain is perceived in the upper neck and can be referred to the occiput, ear, vertex, and forehead.</p><p><strong>Case report: </strong>Patients who attended our pain clinic were presented with complaints of pain in the upper cervical, occipital, and sometimes periorbital and retro-orbital area and around the post-auricular area. On the numerical rating pain scale, patients had pain score of 8-9/10. Three patients had a history of trauma to the cervical region and 2 had a history of rheumatoid arthritis (RA). Patients suffering from RA also had pain in bilateral wrist joints along with neck pain. On examination, there was tenderness along the facet joint line on both sides, when the site of maximum tenderness was checked under the C-Arm machine, it was found at the AAJ on both sides. Patients having a history of trauma first had conservative treatment with analgesics while rheumatoid patients with analgesics and disease-modifying anti-rheumatoid drugs. When patients had no satisfactory pain relief with conservative treatment then patients were considered for fluoroscopy (C-Arm) and 0.5-1 mL Iohexol 300 guided AAJ steroid injection with dexamethasone. After steroid injection, all patients had good-to-excellent results and were followed up for 4 months. Trauma patients got complete relief whereas patients having a history of RA had only mild pain.</p><p><strong>Conclusion: </strong>AAJ steroid injection with dexamethasone is an effective pain-relieving procedure for acute pain relief in patients having severe pain due to cervical trauma or due to RA involving AAJ.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"207-214"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Shortening Osteotomy in Managing Congenital Patellar Dislocation: A Case Report and Review of Literature.","authors":"Samyabrata Das, P Gopinath Menon, C Sitsabesan","doi":"10.13107/jocr.2025.v15.i03.5336","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5336","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital patellar dislocation is a very rare knee disorder characterized by the lateral dislocation of patella from birth, which cannot be reduced. The disorder affects both knees and is a persistent condition. Bony and soft tissue anomalies are part of the pathoanatomy of this disorder. The diagnosis is clinically confirmed by the presence of a patella that is displaced posterolaterally. Neglected ailments may lead to severe functional impairment and degenerative changes in the knee joint, resulting in increasing disability over time. Usually, correction by surgery is the recommended treatment approach.</p><p><strong>Case report: </strong>A 6-year-old female child was diagnosed with congenital patella dislocation in both knees. The child was unable to walk due to this disorder. The range of movement was 70°-130° in both knees. Subsequently, the child had to undergo surgery to repair the knee defect in bilateral lower limbs. The patient's condition at the time of presentation, the surgical procedure, and clinical outcomes at the end of 1 year has been described.</p><p><strong>Conclusion: </strong>Congenital dislocation of the patella is an uncommon disease that typically develops from birth. Although repeated casting and braces are effective for treating the flexion contracture of the affected knee in case of congenital patella dislocation, repositioning the displaced patella requires surgical intervention. To prevent any possible problems and long-term consequences of the disease, it is essential to identify it and perform a surgical intervention to repair the deformity as soon as possible. Usually, surgical correction is the recommended treatment approach for this congenital disorder.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"63-69"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melorheostosis: Two Case Reports and Review of Current Literature.","authors":"Lou Mervyn Tec, Keiichi Muramatsu, Yasuhiro Tani, Masato Kobayashi, Hideaki Sugimoto, Ian Jason Magtoto","doi":"10.13107/jocr.2025.v15.i03.5348","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5348","url":null,"abstract":"<p><strong>Introduction: </strong>Melorheostosis was first described in 1922 with a pattern of linear hyperostosis described as a \"dripping candle-wax\" appearance. It is a rare benign disease with an estimated incidence of 1: 1,000,000. The classic appearance exists only in less than half of the patients, making the atypical presentations confounding and can lead to delayed presentations and misdiagnosis. We here describe two distinct cases of melorheostosis, which represent the classic and atypical melorheostosis presentation.</p><p><strong>Case report: </strong>The first case presents as pain and limitation of hand motion, while the other case presents as an insidious pain of the foot. Both are managed surgically and with excellent outcomes.</p><p><strong>Conclusions: </strong>Although melorheostosis is benign, other atypical types exist, with significant overlap with other conditions, especially malignancy. In some cases, the disease can result in debilitating chronic pain, deformity, and joint contractures leading to severe disability. Holistic and individualized management, including adequate pain control, physiotherapy, and surgical interventions, are required to address specific complaints and improve functional capacity.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"100-106"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More Evidence that Surgical Intervention for Unstable Distal Radius Fracture in Elderly Does not Offer a Superior Patient Perceived Functional Advantage over Time Honored Conservative Treatment in Long Term Follow-Up: A Critical Appraisal at 10 Years (Range 10-13 Years) Follow-up Study.","authors":"Raghavendra S Kulkarni, Sriram R Kulkarni","doi":"10.13107/jocr.2025.v15.i03.5396","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5396","url":null,"abstract":"<p><strong>Introduction: </strong>In this study, elderly distal radius fracture treatment by both conservatively and surgical intervention was examined at 1 and 2 years post-injury and then reevaluated after a median of 10 (range 10-13) years.</p><p><strong>Materials and methods: </strong>Sindhudurg residents who were treated by the author for distal radius fracture between January 01st, 2008, to December 31st, 2011, at Government District Hospital Sindhudurg are enrolled in this prospective study. The follow-up clinic was conducted in the orthopedic department from January 01st, 2022, to May 31st, 2022, with a long-term follow of 10-14 years after this original study period of 2008-2011. The patients in the study period of 2008-2011 were treated by five different treatment methods, both operative and conservative.</p><p><strong>Results: </strong>The mean patient-rated wrist evaluation score was 12 (standard deviation [SD] = 17, range 0-96). The mean EuroQol Visual Analog Scale was 81.2 (range 25-100, 95% confidence interval 76-84). The scores were lower in patients treated conservatively compared to three subgroups of surgical intervention (P = 0.03). The patient self-rated outcomes at long-term follow-up with mean ± SD values were for the surgical intervention group, pins and plaster 13.5 ± 29.6, external fixator 14.6 ± 32.1, open reduction, and internal fixation 6.3 ± 22.3. Similar values for conservatively treated patients were for below elbow cast 7.3 ± 12.5 and for above elbow cast with forearm in supination 7.2 ± 13.3, respectively. The conservatively treated patient group (mean ± SD, 11.5 ± 28.0 vs. 7.3 ± 12.9: P = 0.5) with better functional outcomes and greater satisfaction (P = 0.5) for the difference. Overall 36 (43.9%) elderly patients treated by the conservative method were very much satisfied with the eventual long-term outcome of their distal radius fracture as against 27 (35.5%) treated by surgical intervention. Similarly, 4 (4.8%) were very much dissatisfied in the conservatively treated group as against 10 (15.7%) from the surgical intervention group (P > 0.001).</p><p><strong>Discussion: </strong>Conservative treatment has always been a dilemma for surgeons. Indeed, the quality of anatomic reduction assessed on radiographs is often recognized as a predictive factor for a good functional result; however, several studies proved that this dogma was disputable. Despite wrist arthritis, the functional result is not different. A systematic review of the literature and meta-analysis comparing conservative treatment and surgical intervention found similar results.</p><p><strong>Conclusion: </strong>Elderly patients treated conservatively had overall long-term better functional outcomes and patient satisfaction with improved patient-reported daily living activities than patients treated by surgical intervention.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"227-232"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Hip Dislocation Following Total Hip Arthroplasty, Caused by Broken Trial Femoral Head Particles: A Case Report.","authors":"Tanguy Segers, Mathias van den Broek","doi":"10.13107/jocr.2025.v15.i03.5340","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5340","url":null,"abstract":"<p><strong>Introduction: </strong>Dislocation is one of the most common causes of patient and surgeon dissatisfaction following total hip arthroplasty (THA). In this case, we describe the presence of broken plastic particles, originating from the plastic trial femoral head (TFH) which caused total hip dislocation.</p><p><strong>Case report: </strong>A 67-year-old man with avascular necrosis of his left hip, who underwent a hybrid THA, dislocated his hip twice in the first 2 months after the initial surgery. A computed tomography scan revealed a well-oriented cup and stem and the presence of two dense intra-articular particles, later identified as the possible cause of dislocation. The particles were removed during revision surgery and were retrospectively determined to be broken TFH particles, made of hard plastic.</p><p><strong>Conclusion: </strong>We believe that the brittle design of certain TFH components is vulnerable to damage during perioperative trialing and testing; therefore, care must be taken to check the integrity of these devices during hip surgery. It is important to recognize the existence of such a rare complication.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Study of Functional and Radiological Outcome after Operative Management of Supracondylar Fracture Humerus in Children.","authors":"Sanavvar Ali, Sanjay Kumar, Rohit Nath, Ayush Prakash","doi":"10.13107/jocr.2025.v15.i03.5406","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5406","url":null,"abstract":"<p><strong>Introduction: </strong>Supracondylar fractures of the humerus are the most frequently encountered injuries around the elbow with predominantly occurring in age group 5-7 years, with a higher incidence among male. Research has indicated that for displaced humeral supracondylar fractures, both closed and open reduction with internal fixation using K-wires results in more stable outcomes.</p><p><strong>Objectives: </strong>The purpose of this study was to determine the functional and radiological outcome of operative management of supracondylar fracture humerus in children.</p><p><strong>Materials and methods: </strong>It was a prospective study from 2022 to 2024. The study included 53 patients with close supracondylar fractures humerus who were surgically managed by either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF) by K-wire fixation, cross pinning, or lateral pinning fixation. The functional and radiological outcomes were assessed by Flynn's criteria.</p><p><strong>Results: </strong>Out of 53, according to Flynn criteria out of 53 patients, 14 (26.4%) of the patients had excellent outcomes, 28 (52.83%) had good outcomes, 7 (13.2%) had fair outcomes, and 4 (7.5%) had poor outcomes. Satisfactory results in 49 patients (93.33%) and unsatisfactory results in 4 (7.54%) patients.</p><p><strong>Conclusion: </strong>CRPP is a preferred method for treating displaced supracondylar humeral fractures in children due to its minimally invasive nature, ability to maintain fracture alignment, and generally favorable outcomes with complete functional range of motion and good pain relief along with fracture union. CRPP and ORIF groups had no significant difference with respect to functional outcome. Neurovascular complications most frequently occur with Gartland type 3 and type 4 extension supracondylar fractures.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"257-264"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Femoral Nail as a Cost-Effective Alternative to Tibiotalocalcaneal Nail for Ankle Fracture Non-Union in an Elderly Patient: A Case Report.","authors":"Pawan Kumar, Abhishek Kumar Das, Sudarsan Behera, Manish Raj, Janki Sharan Bhadani, Baibhav Mishra","doi":"10.13107/jocr.2025.v15.i03.5374","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5374","url":null,"abstract":"<p><strong>Introduction: </strong>Ankle fracture non-union in elderly patients is challenging due to osteoporotic bone, comorbidities, and risks associated with open reduction and internal fixation (ORIF). Tibiotalocalcaneal (TTC) nail fixation enables early weight-bearing but is costly and not widely available in resource-limited settings.</p><p><strong>Case report: </strong>We present an 83-year-old male with a painful, deformed left ankle and non-union of a bimalleolar fracture treated conservatively. Comorbidities included diabetes mellitus and hypertension. Due to fragile skin and high ORIF-associated risks, a distal femoral nail (DFN) was used as a substitute for a TTC nail. A minimally invasive technique was performed, including joint preparation and medial malleolar bone grafting. Weight-bearing was initiated postoperatively.</p><p><strong>Conclusion: </strong>DFN offered comparable fixation with reduced cost and acceptable complications. This case highlights DFN's utility as a TTC nail substitute in elderly patients, ensuring stability, early mobilization, and functional recovery in low-resource settings.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"165-168"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Bilateral Knee Extensor Mechanism Injury in a Young Male: A Clinical Diagnosis and Literature Review.","authors":"Bulelwa Andiswa Klaas, Collen Sandile Nkosi","doi":"10.13107/jocr.2025.v15.i03.5370","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5370","url":null,"abstract":"<p><strong>Introduction: </strong>Simultaneous quadriceps tendons with contralateral patellar tendon ruptures are extremely uncommon. We present a rare case of a male with bilateral simultaneous knee extensor mechanism injuries following a fall who is known to have a systemic end-stage medical disease.</p><p><strong>Case report: </strong>A 36-year-old African male is known to have end-stage renal disease following bilateral congenital kidney disease. He receives hemodialysis 3 times a week at our academic hospital renal unit. He presented at our casualty with bilateral knee pains, knee swelling, and an inability to mobilize both legs. He had an inability to extend his knee, a palpable gap along the patella tendon on the left, and a palpable gap in the right quadriceps tendon. We performed plain radiographs to confirm the clinical diagnosis.</p><p><strong>Conclusion: </strong>We experienced a simultaneous rupture of the quadriceps tendon with the contralateral patellar tendon in a 36-year-old with chronic renal failure on hemodialysis. Surgical repair was performed earlier, and he achieved good functional outcomes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"156-159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Knee Replacement for Varus Deformity in Osteoarthritis of Knee with Multiple Hereditary Exostoses - A Rare Case Report.","authors":"Chaitanya Vyawahare, Rohan Bhargava, Shivaram Muthiah, U N Rakesh, Peeyush Belsare","doi":"10.13107/jocr.2025.v15.i03.5318","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i03.5318","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple hereditary exostosis (MHE) is a genetic condition inherited in an autosomal dominant manner, resulting from point mutations in exostosin genes. Knee deformities, such as genu valgus, are common in individuals with MHE, often localized to the proximal tibial metaphysis, and occasionally involving the femur. Osteochondromas at the knee can lead to an oblique joint line orientation, contributing to earlier onset arthritis. Increased angulation may also lead to lateral patella subluxation and patellofemoral complaints, necessitating earlier interventions compared to the general population. While total knee arthroplasty (TKA) for osteoarthritis in MHE with varus deformity is rarely reported in the literature, we present a case of a high body mass index (BMI) female with MHE and varus knee deformity successfully treated with TKA using a standard posterior stabilized implant, without additional constraints or extensive releases.</p><p><strong>Case report: </strong>A 54-year-old Indian woman, homemaker presented to the clinic due to progressive left knee pain and varus deformity. Her BMI was 40. With no significant family history . The surgery was performed using a tourniquet. Using standard instrumentation for conventional TKA . The angle of bone resection was determined preoperatively through manual radiographic templating. The sizing of femoral component was done precariously since the anatomy of distal femur was altered with no prominent anterolateral ridge and an anterior referencing system was done to avoid notching. Tibial rotational alignment was based on anatomic landmarks. Patellofemoral tracking was excellent and did not require lateral retinacular release.</p><p><strong>Conclusion: </strong>Careful attention to technical aspects, selection of implants and the unique anatomy involved, is crucial in planning this procedure. Ensuring proper balance of the ligaments tented by the osteochondromas and meticulous sizing of the femur are essential for favorable functional outcomes in such cases.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 3","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}