Journal of Orthopaedic Case Reports最新文献

{"title":"Fixation in Intertrochanteric Fractures Using Short Proximal Femoral Nail Anti-Rotation-2: A Functional and Radiological Prospective Study.","authors":"Thangaraj Shenbagamoorthy Raagul, K V Prem Kumar, Karthik Seetharaman, V Bharath, Thirumal Ranganathan, Vijayashankar Murugesan","doi":"10.13107/jocr.2025.v15.i05.5628","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5628","url":null,"abstract":"<p><strong>Introduction: </strong>Intertrochanteric fractures are among the most common fractures in elderly patients, often associated with osteoporosis and high morbidity. Surgical fixation is the preferred treatment approach to enable early mobilization and reduce complications. The Short Proximal Femoral Nail Anti-Rotation-2 (PFNA-2) has emerged as an effective implant for these fractures, offering improved stability, enhanced biomechanical properties, and reduced risk of implant failure. This study aims to evaluate the functional and radiological outcomes of PFNA-2 in the management of intertrochanteric fractures.</p><p><strong>Materials and methods: </strong>This prospective study was conducted at the Department of Orthopaedics, Chettinad Health Institute, Tamil Nadu, involving 50 patients with Boyd and Griffin Type 1-4 intertrochanteric fractures. Functional outcomes were assessed using the Modified Harris Hip Score (MHHS), while radiological outcomes were evaluated based on fracture union time, neck-shaft angle, and tip-apex distance (TAD). Patients were followed for a minimum of 6 months postoperatively, with serial radiographic assessments conducted at 6, 12, and 24 weeks. Post-operative rehabilitation included early mobilization, pain management, and weight-bearing exercises to optimize recovery.</p><p><strong>Results: </strong>The mean age of the study population was 69.04 ± 10.69 years, with a slight female predominance (52%). The mean MHHS was 83.08 ± 8.005, with 44% of patients categorized as having good outcomes and 26% classified as excellent. Younger patients demonstrated significantly better functional outcomes (P = 0.000). The mean neck-shaft angle was 130.6° ± 2.1°, with no significant variation across demographic groups (P = 0.191). The mean TAD was 18.25 ± 4.89 mm, with 12% of patients having a TAD >25 mm. Post-operative complications were minimal, with screw cut-out occurring in 4% of cases and superficial wound healing delays in 2%.</p><p><strong>Conclusion: </strong>The findings suggest that PFNA-2 provides effective fixation and favorable functional outcomes in intertrochanteric fractures, particularly in elderly patients. With minimal complications and early mobilization benefits, PFNA-2 proves to be a reliable implant for optimizing recovery. Future studies with larger cohorts and longer follow-ups are recommended to validate these findings.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"261-268"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009578","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":"Occult Papillary Carcinoma Thyroid with Solitary Appendicular Bone Metastasis in Proximal Humerus - A Case Report.","authors":"Prabodh Kantiwal, Vimal Prakash, Sandeep Kumar Yadav, Abhay Elhence, Aakarsh Aggarwal, Sudeep Khera","doi":"10.13107/jocr.2025.v15.i05.5566","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5566","url":null,"abstract":"<p><strong>Introduction: </strong>An occult presentation of primary thyroid malignancy refers to a clinically silent primary tumor that initially manifests through metastasis or secondary paraneoplastic phenomena. Papillary carcinoma is a well-recognized thyroid malignancy associated with this pattern of presentation, but bone metastases are uncommon in occult papillary thyroid carcinoma (OPTC), with reported cases typically involving the axial skeleton.</p><p><strong>Case report: </strong>A woman in her 70s presented with swelling and pain in her right arm. Examination revealed an oval swelling on the proximal humerus. Radiographs and magnetic resonance images suggested a lytic lesion in the proximal humerus. Upon metastatic workup, biopsy, and immunohistochemistry, the diagnosis turned out to be metastasis from occult papillary thyroid cancer.</p><p><strong>Conclusion: </strong>Bone metastases are uncommon in OPTC, with reported cases typically involving the axial skeleton. Metastasis to the appendicular skeleton as the initial presentation is exceptionally rare.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008045","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 Chronic Achilles Tendon Rupture with Tibialis Anterior Allograft: A 2-Year Follow-up Study.","authors":"Prasad Bhagunde, Nihar Modi, Siddharth Gunay, Damini Shah","doi":"10.13107/jocr.2025.v15.i05.5576","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5576","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic Achilles tendon ruptures are challenging to manage, particularly in older patients. This report describes the surgical repair of a chronic rupture using a tibialis anterior allograft in a 61-year-old male, emphasizing the technique and outcomes of this approach.</p><p><strong>Case report: </strong>A 60-year-old male with a 3-month-old Achilles tendon rupture presented with difficulty in walking, pain, and functional impairment. Imaging revealed a 2 cm gap. Surgical management included debridement and reconstruction using a tibialis anterior allograft anchored transversally through the calcaneus. At 2 years postoperatively, the patient had a full ankle range of motion, pain-free ambulation, and restored functionality.</p><p><strong>Conclusion: </strong>Tibialis anterior allograft is a viable option for reconstructing chronic Achilles tendon ruptures with smaller gaps in older patients. It offers reliable functional recovery while minimizing the morbidity associated with autografts.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"114-118"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997591","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 Rare Case of Shoulder Tuberculosis Managed with Anti-tuberculosis Treatment and Antibiotic Coated Cement Spacer.","authors":"Ishan Shevate, Sarthak Walia, Kishankumar Mahida, Rahul Salunkhe, Rishabh Aggarwal","doi":"10.13107/jocr.2025.v15.i05.5544","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5544","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) remains a significant health issue in India, with approximately 30-40% incidence. While only 18% of TB cases are extrapulmonary, shoulder TB, particularly Caries sicca, is extremely rare. Caries sicca is characterized by severe pain, restricted shoulder movements, and significant muscle wasting, often resulting in avascular necrosis (AVN) of the humeral head.</p><p><strong>Case report: </strong>This case report describes the management and rehabilitation of a 38-year-old woman with shoulder TB and AVN. The patient presented with a 5-year history of persistent shoulder pain and restricted motion. Radiological and histopathological examinations confirmed osteonecrosis and TB. The treatment involved arthroscopic debridement, antitubercular therapy, and staged surgical intervention including the placement of an iliac crest bone graft and antibiotic cement spacer, followed by reverse shoulder replacement.</p><p><strong>Conclusion: </strong>Tubercular shoulder is challenging to diagnose and manage. Anti-tuberculosis treatment (ATT) combined with the use of an antibiotic-coated cement spacer provides an effective strategy to eradicate infection and prepare the joint for future replacement. Early diagnosis and a staged approach are essential to address joint destruction and restore functionality, ensuring better outcomes for patients.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"29-32"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988367","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":"Eosinophilic Synovitis Masquerading as Septic Arthritis in a Pediatric Patient: A Case Report and Diagnostic Insights.","authors":"Nikhil Cs, Sharafuddeen Mammu, Jayesh Neerngat, Afeefa Moidu, Siddharth M Pawaskar, Jamshad Op","doi":"10.13107/jocr.2025.v15.i05.5574","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5574","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic synovitis, though rare, can closely mimic septic arthritis in children, often complicating diagnosis. This inflammatory condition is typically linked to allergic reactions or parasitic infections, though idiopathic cases have been documented.</p><p><strong>Case report: </strong>We describe a 4-year-old boy initially diagnosed with septic arthritis of the knee. The patient underwent arthrotomy, and synovial fluid analysis surprisingly revealed significant eosinophilia. Histopathology confirmed eosinophilic synovitis. Following a 3-week course of diethylcarbamazine (DEC), the patient achieved full recovery with no recurrence.</p><p><strong>Conclusion: </strong>This case emphasizes the importance of synovial fluid analysis in pediatric monoarticular joint swelling, as eosinophilic synovitis should be considered in differential diagnoses to avoid misdiagnosis and unnecessary interventions.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025110","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 Rare Case of Anterior Osteochondroma of Distal Femur with Quadriceps Rupture: A Case Report.","authors":"Aman Hooda, Harsh Mander, Amit Lakhani, Nirali Mehta, Mandeep Dhillon","doi":"10.13107/jocr.2025.v15.i05.5592","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5592","url":null,"abstract":"<p><strong>Introduction: </strong>Despite osteochondromas being fairly common around the knee, cases causing mechanical disruption and being associated with fractures or tears of the Quadriceps are rare.</p><p><strong>Case report: </strong>A 27-year-old male presented after a fall under the influence of alcohol, along with pain in the knee and inability to bend it. Radiographs revealed an undisplaced vertical split type of Patellar fracture with an osteochondroma of the distal femur located anteriorly, and growing towards the knee joint. Patient had a previous history of mechanical symptoms, occasional knee pain, limited range of motion and repeated falls. Computed tomography and magnetic resonance imaging showed an associated incomplete, non-insertional quadriceps rupture. The patella fracture eventually healed conservatively in the cylindrical cast before the patient underwent surgery for mechanical problems around his knee. Patient consented to undergo surgical intervention after a period 1 month since injury in the form of exostosis excission en bloc, extra-periosteally, followed by repair of the quadriceps tendon, with an uneventful post-surgery rehabilitation phase.</p><p><strong>Conclusion: </strong>The unusual location of the osteochondroma along with the fact that it was directly impinging on the upper part of the Patella and the distal quadriceps tendon makes this an interesting case. The long history of \"pseudo locking\" and instability in this cases should have prompted earlier diagnostic interventions, which were delayed due to his alcohol dependence. The anterior location of the osteochondroma at the knee may have relevance in causing patellar degeneration and instability and lead to associated tears of the quadriceps even with lesser trauma.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"151-155"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022647","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":"Atypical Triplane Ankle Fracture - Antero-Medial Epiphyseal Separation and the Unfused Growth Plate: A Case Report.","authors":"Ethan Toner, David White, David Kealey","doi":"10.13107/jocr.2025.v15.i05.5604","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5604","url":null,"abstract":"<p><strong>Introduction: </strong>Triplane fractures represent a complex injury that occur at the distal tibia in the pediatric population and follow a characteristic pattern in keeping with the progressive closure of the physis typically from age 12 to 17. We present a case of a triplane variant where the medial growth plate was unfused leading to an additional mobile antero-medial fracture fragment. The rarity of our case makes this a very interesting one.</p><p><strong>Case report: </strong>A 16-year-old Caucasian boy presented to the emergency department after slipping on wet grass and injuring his left ankle. He was unable to weight bear. He sustained an isolated and closed injury. He had no significant medical comorbidities and was otherwise a fit and active teenager. Following initial investigations, a triplane ankle fracture was diagnosed, and he was placed into a short leg cast and referred directly to the orthopedic trauma team for admission.</p><p><strong>Conclusion: </strong>Atypical triplane variants are rare. The presence of an additional anteromedial epiphyseal fragment separated from the metaphysis and remaining portion of the epiphysis is even rarer. We present the surgical management of such a case in our unit, with a good patient outcome.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"180-183"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014923","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":"Isolated Compound Dislocation of the Pisiform Bone with Associated Neurovascular Injury Following an Assault: A Rare Injury Pattern.","authors":"Mohammed Sadiq, Anudeep Manne, Mangalapuri Rajesh, Madhi Devender Reddy, Sangem Srichandra Kumar, B Devandra Naik","doi":"10.13107/jocr.2025.v15.i05.5584","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5584","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated pisiform dislocation is a rare form of carpal bone dislocations. It is usually associated with a violent pull of the flexor carpi ulnaris tendon or a sudden dorsiflexion of the wrist. The management varies from conservative treatment to complete excision of the bone. However, a consensus has not yet been established about the management.</p><p><strong>Case report: </strong>We present a case of isolated fracture dislocation of the pisiform bone following an assault with a sharp object. Injury to the ulnar neurovascular bundle in the Guyon's canal was noted. The bone was fixed with K wire followed by repair of the neurovascular structures. There was good functional recovery after the repair. The mode of injury and the associated neurovascular injury make this report unique.</p><p><strong>Conclusion: </strong>Fixation of certain fracture dislocation plays a major role in the improvement of functional outcomes when compared to conservative management.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"132-135"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012450","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":"Brachial Plexus Neuropraxia Post Open Reduction and Internal Fixation of Left Acetabulum Fracture.","authors":"Turki Alshehri, Mohammed Abdulhadi Alhassan, Ali Ahmed Muharraq, Abdulrahman Adil Pasha","doi":"10.13107/jocr.2025.v15.i05.5550","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5550","url":null,"abstract":"<p><strong>Introduction: </strong>Acetabular fractures are often sustained injuries linked to high-energy trauma, such as falls from a considerable height or road traffic incidents. The modified Stoppa technique is currently used approach to treat acetabular fractures. The brachial plexus injury following open reduction and internal fixation (ORIF) of the left acetabulum fracture wasn't reported before.</p><p><strong>Case report: </strong>Herein we presented a case of a 16-years-old male with a history of road traffic accident sustained an isolated close left acetabulum fracture. X-ray shows associated both column acetabulum fracture with central subluxation. He was managed with open reduction and internal fixation through a modified Stoppa approach with a lateral window. The patient underwent ORIF on the 6th day of the trauma. Fixation was done with plates and screws. At recovery room he could not move whole left upper limb and no sensation while the operated limb DNV was intact. After 15 min of recovery, sensation returned, but motor deficit persisted, indicating brachial plexus neuropraxia. The brain CT scan of was performed and unremarkable finding. After 6 months, the patient restores his sensation on his own, and improved power 5/5 of the left upper limb.</p><p><strong>Conclusion: </strong>Long stays under general anesthesia and patient position are considerable causes of BPI. Early diagnosis (clinical/imaging) and management typically involve conservative measures, with most patients achieving full recovery. Prevention procedures are essential, including monitoring the patient and proper intraoperative positioning to avoid such nerve injury.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970685","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":"Phrenic Nerve Palsy in Anterior Cervical Discectomy and Fusion: Rare as Hen's Teeth.","authors":"Aditya Gupta, Ira Dhawan, Aakashdeep Singh, Vishal Kumar, Sarvdeep Singh Dhatt","doi":"10.13107/jocr.2025.v15.i05.5564","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i05.5564","url":null,"abstract":"<p><strong>Introduction: </strong>Phrenic nerve palsy is a rare but potentially serious complication. The clinical presentation can vary from being asymptomatic to severe respiratory distress requiring mechanical complication. In the Anglophone literature, there is only a single case report of bilateral phrenic nerve injury as a complication following anterior cervical discectomy and fusion (ACDF).</p><p><strong>Case report: </strong>This case report describes a 52-year-old female who developed right-sided phrenic nerve palsy after undergoing ACDF for cervical spine trauma. The patient had respiratory distress immediately after surgery and Ultrasonography and X-rays revealed Rt phrenic nerve palsy. To the best of our knowledge, this is the first case of unilateral phrenic nerve palsy after ACDF at the C5-C6 level.</p><p><strong>Conclusion: </strong>Unilateral phrenic nerve palsy probably occurred as a complication of ACDF for cervical spine trauma. Phrenic nerve palsy should be kept in mind as a serious complication of spinal surgery.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 5","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12064271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029956","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}