Journal of Orthopaedic Case Reports最新文献

{"title":"Late Presentation of Cauda Equina Syndrome with Isolated Bladder Bowel Incontinence in Massive Lower Lumbar Disc Herniation: A Series of Three Cases.","authors":"Kiran Dhole, Kuber Sakhare, Nilesh Sakharkar, Pravin Agrawal, Sumedh Chaudhary, Vishal Giri","doi":"10.13107/jocr.2025.v15.i02.5242","DOIUrl":"10.13107/jocr.2025.v15.i02.5242","url":null,"abstract":"<p><strong>Introduction: </strong>Cauda equina syndrome (CES) is a constellation of symptoms that include lower limb paralysis, saddle anesthesia, bowel bladder incontinence, and sexual dysfunction. However, atypical cases of CES may present with isolated bladder-bowel involvement without motor weakness. This often leads to late patient presentation to an orthopedic surgeon and late surgical intervention. Surgical outcomes in such cases are unpredictable owing to chronic bladder incontinence. The purpose of this case series is to evaluate the effect of surgical decompression in delayed presentation of CES with isolated bladder bowel involvement.</p><p><strong>Case report: </strong>We attended three such patients at our institute with massive lumbar disc herniation. All of them had bladder and bowel dysfunction with the absence of lower limb weakness. Patients were operated with conventional laminectomy and discectomy. Bladder ultrasonography was done preoperatively and postoperatively. Bladder and bowel function improved in all three patients, but recovery duration was different in all three cases.</p><p><strong>Conclusion: </strong>Atypical presentation of CES presenting to other broad specialties, especially urology, may not detect massive lumbar disc herniation in the absence of lower limb deficit. Clinicians should be highly suspicious about the isolated presentation of CES and refer to spine surgeons. Thus, surgical decompression of massive lumbar disc prolapse can be done in the initial stages of bladder-bowel dysfunction. Surgical decompression is effective in delayed presentation of CES with good long-term prognosis.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"95-100"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433317","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":"Atlantoaxial Instability in Neurofibromatosis Type 1: A Case Report.","authors":"Sankalp Lal, Pankaj Kumar Damor, Mahendra Singh Tak, Mukesh Kumar Saini, Mahesh Bhati","doi":"10.13107/jocr.2025.v15.i02.5270","DOIUrl":"10.13107/jocr.2025.v15.i02.5270","url":null,"abstract":"<p><strong>Introduction: </strong>Neurofibromatosis (NF) is a cluster of conditions in which tumors grow in the nervous system. Even though the spine is the most common site of skeletal involvement in NF type 1 (NF-1), cervical spinal anomalies are infrequent.</p><p><strong>Case report: </strong>The atlantoaxial joint is a critical transitional zone in the cervical spine and is prone to instability. We report the case of a 49-year-old gentleman with atlantoaxial instability due to NF-1 who presented with quadriparesis and was managed by reduction with skull traction followed by C1-C2 Goel-Harms fixation.</p><p><strong>Conclusion: </strong>In the present case, there was substantial bleeding and significant vertebral dysplasia, which makes the case distinctly unique. Skull traction and C1-C2 Goel-Harms fixation with fusion should be considered for patients with NF-1 complicated by atlantoaxial instability.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"167-171"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433292","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":"Management of Kyphosis, Lumbar Spondylosis, and Mycobacterium avium Discitis in a 70-year Male with Chronic Lymphocytic Leukemia with Vascular Complication.","authors":"Vadim Dolgov, David Frolov, Ryan Tapio, Samantha Hill, Miguel Schmitz","doi":"10.13107/jocr.2025.v15.i02.5272","DOIUrl":"10.13107/jocr.2025.v15.i02.5272","url":null,"abstract":"<p><strong>Introduction: </strong>Kyphosis is characterized by excessive forward curvature of the spine often causing back pain and stiffness, and occasionally, neurological deficit. Surgical management of kyphosis can entail an anterior lumbar interbody fusion (ALIF) in addition to a posterior spinal fusion with or without a laminectomy. Chronic lymphocytic leukemia (CLL) is a slow-growing cancer that affects the bone marrow. If ALIF is considered as a treatment option for kyphosis in a patient with CLL, attention needs to be taken to minimize complications.</p><p><strong>Case report: </strong>A 70-year-old male with a history of kyphosis and CLL presented with refractory lower back pain attributed to his kyphosis. The patient required multiple procedures to correct his kyphosis including an ALIF between L3 and S1. During the ALIF, significant scar tissue and phlegmon were noted at the surgical site, and disc cultures revealed Mycobacterium avium. The accumulation of phlegmon and scar tissue required significant manipulation of the vessels to perform the procedure. Before closure of the anterior incision, the patient presented with absent pulses of the left leg. A thrombosis in the left iliac artery was noted and treated with stent placement during the surgery.</p><p><strong>Discussion: </strong>CLL leads to an immune compromised state which may lead to undiagnosed infections, specifically M. avium in our patient. Imaging showed the infection likely played a role in the disc degeneration of the lumbar spine, exacerbating the formation of the phlegmon and scar tissue. This required extensive manipulation of the vessels that resulted in the formation of thrombosis of the left iliac artery.</p><p><strong>Conclusion: </strong>Care must be taken during ALIF procedures on patients with CLL during manipulation of the vessels. If kyphosis is rapidly worsening in a patient with CLL, infection of the vertebra should be ruled out.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"172-176"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433322","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":"Delayed Mycotic Prosthetic Joint Infection: A Rare Case Report.","authors":"Nikhil Cs, Sharafuddeen Mammu, Vishnu Unnikrishnan, Saad Sulaiman","doi":"10.13107/jocr.2025.v15.i02.5266","DOIUrl":"10.13107/jocr.2025.v15.i02.5266","url":null,"abstract":"<p><strong>Introduction: </strong>Fungal infections following total knee replacement surgeries are rare but present significant challenges in management due to their delayed diagnosis and resistance to standard antimicrobial therapies.</p><p><strong>Case report: </strong>This case report describes the management of a delayed prosthetic joint infection in a 65-year-old female, diagnosed as a fungal infection 4 years after total knee replacement. Initially presented with persistent knee pain, swelling, and restricted range of motion despite standard antimicrobial therapy, further investigation revealed fungal elements in synovial fluid analysis, confirming the diagnosis. The patient underwent a staged procedure involving debridement, application of antifungal and antibiotic cement spacer, followed by delayed revision surgery. A 12-week course of antifungal fluconazole therapy was administered postoperatively. Subsequent 1-year follow-ups revealed symptomatic improvement and the absence of infection recurrence.</p><p><strong>Conclusion: </strong>This case highlights the efficacy of staged surgical interventions and targeted antifungal therapy in achieving favorable outcomes for fungal prosthetic joint infections. It underscores the importance of long-term follow-up for monitoring and surveillance in such cases.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"155-160"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433312","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":"Non-union of a Tibial Plafond Fracture in a COVID-Positive Patient: A Case Report.","authors":"Amy Singleton, Anthony J Mancuso Ii, Samuel G Eaddy, Seth Phillips","doi":"10.13107/jocr.2025.v15.i02.5210","DOIUrl":"10.13107/jocr.2025.v15.i02.5210","url":null,"abstract":"<p><strong>Introduction: </strong>Several studies have proposed a relationship between the coronavirus disease 2019 (COVID-19)-induced cytokine storm and prohibitive effects on the musculoskeletal system, including increased risk of fracture, osteoporosis, and impaired bone healing. To our knowledge, this is the first known case report involving a fracture non-union concomitant with COVID-19 infection and apparent cytokine storm.</p><p><strong>Case report: </strong>A 47-year-old male presented with an open pilon fracture of the left ankle after falling off a 6-foot ladder. At his 4-month post-operative follow-up, the patient attempted to ambulate without his cam boot for the 1st time, causing acute displacement of his poorly healed tibia fracture. A non-union laboratory workup demonstrated elevated inflammatory markers indicative of septic non-union; however, the patient also tested positive for severe acute respiratory syndrome coronavirus 2 at this time. Because of this, antibiotic treatment was not initiated due to suspicion of a cytokine storm. One month later, the patient's inflammatory markers had decreased and he underwent revision surgery.</p><p><strong>Conclusion: </strong>This case underscores the potential impact of COVID-19 on fracture healing and the importance of vigilant monitoring and differential diagnosis in managing non-union in COVID-19-positive patients.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"11-15"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433394","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":"Hip Fusion Takedown with Dislocation and Cup Dislodgement Requiring Revision Arthroplasty: A Case Report.","authors":"Justin T Butler, Samuel D Stegelmann, Amy Singleton, Chris J Leibold, Samuel G Eaddy, Richard M Miller","doi":"10.13107/jocr.2025.v15.i02.5268","DOIUrl":"10.13107/jocr.2025.v15.i02.5268","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous hip fusion is a multifactorial condition that can cause drastic functional limitations. Total hip arthroplasty (THA) can provide symptomatic improvement but leads to high rates of instability, dislocation, and revision.</p><p><strong>Case report: </strong>A 66-year-old woman with a long-standing history of dysplastic and spontaneously fused left hip received a fusion takedown to primary THA. She subsequently dislocated with catastrophic acetabular cup failure necessitating revision THA. She reports no pain or dislocations at 12 months post-revision.</p><p><strong>Conclusion: </strong>Deciding to perform THA for spontaneous hip fusion should consider clinical benefit alongside increased risks of dislocation and revision. Patients with acetabular dysplasia and longer durations of fusion are at an increased risk, due to skewed anatomic landmarks, weak abductors, and altered spinopelvic parameters. However, in the case of primary THA failure, revision surgery can provide satisfactory benefits.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"161-166"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433314","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":"Internal Plate Fixation of Comminuted Fracture of the Distal End of the Tibia and Fibula Using a Single-Incision Technique: A Novel Approach and a Series of Nine Cases.","authors":"Tej Pratap Gupta, Narender Singh, S K Rai, Vivek Mathew Philip, Ritesh Sharma","doi":"10.13107/jocr.2025.v15.i02.5288","DOIUrl":"10.13107/jocr.2025.v15.i02.5288","url":null,"abstract":"<p><strong>Introduction: </strong>Comminuted fractures of the distal end of the tibia and fibula usually occur due to high-velocity trauma, and the tibia, being subcutaneous in this area, is prone to wound healing risks and complications. Fixation typically involves two separate incisions, medial and lateral, which pose risks of wound healing complications and devascularization of the distal tibia. This study aims to present a novel single anterolateral incision approach for the internal fixation of distal tibia and fibula fractures to minimize soft-tissue complications.</p><p><strong>Case report: </strong>Nine patients were treated with internal plate fixation for their comminuted fractures of the distal end of the tibia and fibula using a single-incision technique. The cohort included six male and three female patients, with a mean age of 31.8 years (range 17-59).</p><p><strong>Conclusion: </strong>We present nine cases of comminuted fractures of the distal end of the tibia and fibula treated with a single-incision technique for internal plate fixation, resulting in satisfactory outcomes without any wound healing complications.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"215-220"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433315","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 Total Knee Replacement for Autofusion Secondary to Juvenile Idiopathic Arthritis: A Case Report.","authors":"Morgan K Villa, Rafael Robles, Maya Johnson, Wesley Lemons, Geoffrey Marano, Gregory J Golladay","doi":"10.13107/jocr.2025.v15.i02.5252","DOIUrl":"10.13107/jocr.2025.v15.i02.5252","url":null,"abstract":"<p><strong>Introduction: </strong>Juvenile idiopathic arthritis (JIA) poses lifelong challenges due to chronic inflammation that can lead to permanent deformities like autofusion, severely affecting quality of life.</p><p><strong>Case report: </strong>In this case, a 31-year-old female with a 21-year history of bilateral knee pain secondary to JIA faced a unique challenge: bilateral knee autofusion. Radiographs revealed severe bilateral contractures, erosive changes, and autofusion, prompting the decision for simultaneous total knee arthroplasties (TKAs). Evaluation at 1-year postoperatively showed significant improvements in function, pain, and activities of daily living.</p><p><strong>Conclusion: </strong>This case provides insight into outcomes of simultaneous TKAs in the context of autofusion, highlighting the procedure's viability in resolving debilitating knee conditions, even in the presence of complex factors such as JIA.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"120-125"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433408","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 Neuropathy Secondary to Compression by Spontaneous Iliac Hematoma.","authors":"Rui Sousa, Ana Flávia Resende, Luís Barbosa Pinto, Marta Lages, Luísa Negrão, Nuno Simões","doi":"10.13107/jocr.2025.v15.i02.5258","DOIUrl":"10.13107/jocr.2025.v15.i02.5258","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral neuropathy is a rare condition typically resulting from compression of the femoral nerve. While it is commonly associated with anticoagulated patients due to psoas hematomas, spontaneous iliacus muscle hematomas without any evident trauma or coagulation disorders are exceedingly uncommon. This case report details the occurrence and management of a spontaneous iliacus muscle hematoma in an adolescent patient. Such cases have been scarcely reported, making this documentation critical for enhancing clinical understanding and management strategies.</p><p><strong>Case report: </strong>A 16-year-old male of Caucasian ethnicity, with no significant medical history, presented with thigh muscle atrophy, decreased strength in the left lower limb, and progressive loss of weight-bearing capacity over a month. The patient reported no history of trauma. Clinical examination revealed hypoesthesia in the femoral nerve territory and significantly reduced quadriceps muscle strength. Imaging studies, including magnetic resonance imaging, identified a fusiform mass deep to the left iliac muscle, consistent with an encapsulated hematoma. The patient was treated conservatively with rest and analgesics, followed by physical rehabilitation. Follow-up assessments showed progressive improvement in muscle trophism and weight-bearing capacity, with complete recovery of femoral nerve conduction at 1 year.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering spontaneous iliacus muscle hematomas in the differential diagnosis of femoral neuropathy, even in the absence of trauma or anticoagulation therapy. The report highlights the necessity for thorough clinical evaluation and imaging to ensure accurate diagnosis. It adds valuable information to the orthopedic literature, particularly in managing rare presentations of femoral neuropathy, emphasizing the need for vigilance in monitoring and follow-up to prevent long-term complications. By detailing this unusual presentation, the report aims to enhance the understanding and treatment strategies for similar cases.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"136-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432834","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":"A prospective randomized placebo-controlled study evaluating the safety and benefits of tranexamic acid injections for primary unilateral total knee replacement.","authors":"Prashant Bhavani, Suhas Aradhya Bhikshavarthi Math, Mainak Roy, Mulagondla Harshavardhan Reddy, Deepanjan Das, Priyanshu","doi":"10.13107/jocr.2025.v15.i02.5308","DOIUrl":"10.13107/jocr.2025.v15.i02.5308","url":null,"abstract":"<p><strong>Background: </strong>One of the primary issues following total knee arthroplasty (TKA) is blood loss. According to the research, tourniquet time which works by inducing fibrinolysis activity is one of the primary factors contributing to blood loss. This element gives the surgeon the chance to reduce blood loss, which subsequently avoids allogenic blood transfusion and any associated risks. Both oral and intravenous administrations of tranexamic acid (TXA) are acceptable. There is disagreement over the ideal administrative mode. Because TXA is delivered locally, it has a higher chance of being both safe and effective at the target site due to the drug's low systemic absorption.</p><p><strong>Materials and methods: </strong>We conducted a prospective trial involving 50 unilateral TKA procedures. In 25 TKR following closure, intra-articular TXA was administered, and in 25 TKR, 0.9% normal saline of equivalent volume was provided. Hemoglobin, hematocrit, and the number of patients needing blood transfusions and blood collection in the drain after surgery were used to gauge the effectiveness. Complications were assessed using lower leg Doppler ultrasonography to detect deep vein thrombosis (DVT).</p><p><strong>Results: </strong>Despite the control group receiving more blood transfusions, we observed a substantial decrease in hemoglobin in the TXA group (P < 0.002) and a significant decrease in drain collection (95% CI: 203.8-406.2, P < 0.001). There were no DVT patients in.</p><p><strong>Conclusion: </strong>TXA injected intra-articularly appears to be a safe and effective way to lessen post-TKA blood loss and the need for blood transfusions.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"283-288"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433274","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}