Journal of Orthopaedic Case Reports最新文献

{"title":"Early Recognition of Glomus Tumor of Hand Using Clinical Tests: Experience from an Indian Tertiary Center.","authors":"Abhishek Sharma, Akshay Kumar, Kuldeep Singh, Iti Jain, Preksha Sharma, Eashnoor Singh","doi":"10.13107/jocr.2026.v16.i10.8284","DOIUrl":"10.13107/jocr.2026.v16.i10.8284","url":null,"abstract":"<p><strong>Introduction: </strong>Glomus tumors are rare, benign neoplasms of the glomus body, most often occurring in the subungual region of the digits. Their small size and nonspecific symptoms frequently lead to delayed diagnosis and patient suffering.</p><p><strong>Materials and methods: </strong>A retrospective review of seven histopathologically confirmed cases of glomus tumors treated at a tertiary center was performed. Clinical features, diagnostic tools, surgical approaches, and outcomes were analyzed. Pain severity was assessed using the Visual Analog Scale (VAS) before and after surgical excision.</p><p><strong>Results: </strong>The cohort included five females and two males, mean age 42 years (range 32-51). Tumors were right sided in five patients and located in the subungual region (n = 3), lateral nail fold (n = 2), pulp (n = 1), and arm (n = 1). Pain was universal; Love's test was positive in all patients, cold sensitivity in 71.4%, and Hildreth's test in 57.1%. The mean duration of symptoms before diagnosis was 17.5 months. Magnetic resonance imaging (MRI) revealed characteristic hyperintense T2 lesions in all imaged cases. All patients underwent surgical excision (transungual or direct approaches). Pre-operative mean VAS pain score was 8.7, improving to 2.0 postoperatively. No recurrences were observed during a mean 7-month follow-up. One patient developed minor nail deformity.</p><p><strong>Conclusion: </strong>Digital glomus tumors, though rare, should be strongly suspected in patients with focal fingertip pain and positive Love's test. MRI supports localization, but simple clinical tests remain highly effective, particularly in resource-constrained settings. Surgical excision remains the treatment of choice, providing excellent pain relief with minimal complications and no recurrence in this series.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"339-344"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137226","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":"Dynamic Computed Tomography Evaluation of Patellar Tracking Following Unrestricted Kinematic Versus Mechanical Alignment in Primary Total Knee Arthroplasty: A Prospective Comparative Study.","authors":"Elvis Benjamin, R P Dinesh, Gagandeep Singh, Dilip Charan, Hijas Ismayil, Tej Kulkarni","doi":"10.13107/jocr.2026.v16.i10.8340","DOIUrl":"10.13107/jocr.2026.v16.i10.8340","url":null,"abstract":"<p><strong>Introduction: </strong>Restoration of physiological knee kinematics has become an important objective in total knee arthroplasty (TKA). Unrestricted kinematic alignment (KA) has been proposed as an alternative to conventional mechanical alignment (MA) to better reproduce native knee anatomy and improve patellofemoral biomechanics. This study compared post-operative patellar tracking and clinical outcomes between unrestricted KA and standard MA using dynamic computed tomography (CT).</p><p><strong>Materials and methods: </strong>A prospective comparative study was conducted among 50 patients with primary end-stage knee osteoarthritis undergoing primary TKA at a tertiary care teaching hospital. Patients were equally allocated into unrestricted KA (n = 25) and MA (n = 25) groups. Dynamic CT was performed postoperatively to assess patellar tracking, patellar tilt, and patellar translation. Functional outcomes were evaluated using Knee Society Score (KSS), functional KSS, post-operative range of motion (ROM), anterior knee pain, and complications. Statistical analysis was performed using the Statistical Package for the Social Sciences version 26.0, with P < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Baseline demographic and clinical characteristics were comparable between the groups (P > 0.05). Normal patellar tracking was significantly more frequent in the KA group than the MA group (92.0% vs. 72.0%; P = 0.043). Mean patellar tilt (5.1 ± 2.0° vs. 8.4 ± 2.8°; P < 0.001) and patellar translation (2.8 ± 1.1 mm vs. 4.5 ± 1.6 mm; P < 0.001) were significantly lower following KA. Patients undergoing KA achieved significantly higher post-operative KSS (90.6 ± 5.4 vs. 84.8 ± 6.3; P = 0.001), functional KSS (88.7 ± 6.1 vs. 82.9 ± 6.8; P = 0.002), and ROM (122.6 ± 8.5° vs. 115.3 ± 9.6°; P = 0.007). Anterior knee pain was significantly less frequent in the KA group (24.0% vs. 52.0%; P = 0.038), whereas post-operative complications were comparable between groups (P = 0.293).</p><p><strong>Conclusion: </strong>Unrestricted KA provides superior patellofemoral biomechanics, improved functional outcomes, and reduced anterior knee pain compared with standard MA without increasing post-operative complications. Dynamic CT is a valuable modality for objectively assessing post-operative patellar kinematics following TKA.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"555-562"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137118","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":"Evaluation of Changes in Spinal Posture Following Fluoroscopy-Guided Transforaminal Epidural Steroid Injection in Chronic Low Back Pain using the DIERS Formetric 4D Spine Posture Analysis System: A Prospective Observational Study.","authors":"Purushotham Lingaiah, Banoth Kiran Kumar, K Venkata Ramana, A R Nataraj, Raunak Kumar, Shoibam Jenifa","doi":"10.13107/jocr.2026.v16.i10.8336","DOIUrl":"10.13107/jocr.2026.v16.i10.8336","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic low back pain (CLBP) is a common cause of pain, disability, and impaired quality of life. Persistent pain often leads to compensatory postural changes, including pelvic asymmetry, coronal imbalance, and vertebral rotation. Although fluoroscopy-guided transforaminal epidural steroid injection (TFESI) is an established treatment for patients who fail conservative therapy, its effects on spinal posture have not been well studied. This study aimed to evaluate changes in spinal posture following TFESI using the radiation-free DIERS formetric 4D spine posture analysis system, along with changes in pain, disability, quality of life, and neural mobility.</p><p><strong>Materials and methods: </strong>This prospective observational study included 43 patients aged 18-60 years with magnetic resonance imaging-confirmed CLBP refractory to at least 6 weeks of conservative management. All patients who were planned for fluoroscopy-guided TFESI were included. Clinical outcomes assessed at baseline and 8 weeks included the visual analog scale, modified Oswestry disability index, short form-12, and straight leg raise test (SLRT). Spinal posture was evaluated using the DIERS formetric 4D system, measuring sagittal alignment, spinal curvature, pelvic parameters, coronal imbalance, and vertebral rotation. Statistical analysis was performed using the Wilcoxon signed-rank test and McNemar test.</p><p><strong>Results: </strong>Significant improvements were observed in pain, disability, quality of life, and SLRT angle (all P < 0.0001). Objective posture analysis demonstrated significant improvements in pelvic obliquity (P = 0.011), coronal imbalance (P < 0.0001), and vertebral rotation (P ≤ 0.001). However, no significant changes were noted in sagittal imbalance, thoracic kyphosis, lumbar lordosis, cervical or lumbar sagittal arrows, or pelvic torsion.</p><p><strong>Conclusion: </strong>Fluoroscopy-guided TFESI provides significant short-term improvements in pain, function, quality of life, and selected spinal posture parameters in patients with CLBP. The DIERS formetric 4D system is a reliable, radiation-free tool for objectively monitoring postural changes following interventional treatment.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"542-549"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136781","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":"Functional Outcome of Lucerne Cast in Patients with Metacarpal Fracture with or without Proximal Phalanx Fracture: An Observational Prospective Study.","authors":"Prateek Sahu, Manmohan Shakya, Syed Tariq Mahamood, Mohit Dashore, Nilesh Gupta, Gautam Chatterji","doi":"10.13107/jocr.2026.v16.i10.8300","DOIUrl":"10.13107/jocr.2026.v16.i10.8300","url":null,"abstract":"<p><strong>Introduction: </strong>Metacarpal fractures are among the most common hand injuries encountered in clinical practice, predominantly affecting young, active adults. The Lucerne cast (LuCa) is a semi-rigid functional metacarpal cast that immobilizes the metacarpophalangeal joints in flexion while preserving wrist and interphalangeal joint motion. Evidence regarding its outcomes across varying fracture complexity remains limited.</p><p><strong>Materials and methods: </strong>This prospective observational study enrolled 30 adult patients with closed 2nd-5th metacarpal fractures, with or without proximal phalanx involvement, managed with the LuCa at a tertiary care center. Functional outcomes were assessed using the Michigan Hand Outcomes Questionnaire (MHQ) at 1, 4, 8, and 12 weeks. Radiological union and immobilization duration were recorded as secondary outcomes.</p><p><strong>Results: </strong>The cohort was predominantly male (80%) with a mean age of 35.27 ± 9.95 years. Isolated metacarpal fractures constituted 83.3% of cases. Mean total MHQ scores improved significantly within both fracture groups from week 1 to week 12 (P < 0.001). No statistically significant between-group differences were observed in MHQ scores at the assessed follow-up points, immobilization duration, or timing of radiological union.</p><p><strong>Conclusion: </strong>In this prospective observational study, LuCa immobilization was associated with progressive improvement in patient-reported hand function and satisfactory radiological healing over 12 weeks in appropriately selected closed metacarpal fractures, with or without associated proximal phalanx fractures.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"400-407"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136791","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":"Open Traumatic Achilles tendon Rupture in a Pediatric Patient Managed by Modified Kessler Technique: A Case Report.","authors":"Mubasshir Farooqui, Nikhil Game","doi":"10.13107/jocr.2026.v16.i10.8178","DOIUrl":"10.13107/jocr.2026.v16.i10.8178","url":null,"abstract":"<p><strong>Introduction: </strong>Open traumatic Achilles tendon rupture is uncommon, particularly in the pediatric population. Unlike closed spontaneous ruptures - which predominantly affect middle-aged adults - sharp lacerating injuries in children pose challenges due to contamination risk and the close relation of neurovascular structures in the posterior ankle.We report a case of complete open Achilles tendon rupture in a 9-year-old boy following a sharp metallic object injury, treated with primary tendon repair using the Modified Kessler technique. This case adds to the limited pediatric literature and may guide clinicians in management of this injury.</p><p><strong>Case report: </strong>A 9-year-old male child presented with a 3 × 1 × 1 cm contaminated laceration wound over the right posterior ankle following injury by a sharp metallic object. Clinical examination revealed a positive Thompson test and a palpable gap at the Achilles tendon. Primary surgical repair was performed using the modified Kessler technique with epitendinous augmentation under general anesthesia.</p><p><strong>Conclusion: </strong>This case highlights that open Achilles tendon injury can occur in children and prompt surgical repair using the modified Kessler technique yields excellent functional outcomes with an AOFAS ankle-hindfoot score of 95. Pediatric surgeons and orthopedic residents should be aware of this rare but serious injury pattern.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137195","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":"The Constant Fragment: A Unifying Principle in Fracture Reduction and Fixation.","authors":"John Mukhopadhaya, Janki Sharan Bhadani, Ashok Shyam","doi":"10.13107/jocr.2026.v16.i10.8168","DOIUrl":"10.13107/jocr.2026.v16.i10.8168","url":null,"abstract":"","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"11-13"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137167","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":"Development of a Non-ossifying Fibroma in the Same Femur 6 Years after Limb-Salvage Surgery for Osteosarcoma: A Case Report.","authors":"Dheeraj Yadav, Dilip Kumar Sankhwar, Dyuti Deepta Rano, Asit Ranjan Mridha, Sandeep Sehrawat, Venkatesan Sampath Kumar","doi":"10.13107/jocr.2026.v16.i10.8250","DOIUrl":"10.13107/jocr.2026.v16.i10.8250","url":null,"abstract":"<p><strong>Introduction: </strong>A new osteolytic lesion detected during surveillance after osteosarcoma treatment usually raises concern for local recurrence, a skip lesion, metastasis, or a treatment-related secondary process. Non-ossifying fibroma (NOF) is a common benign fibrous lesion in children and adolescents, but its delayed appearance in the same surgically reconstructed femur is unusual and may create a major diagnostic dilemma.</p><p><strong>Case report: </strong>A 12-year-old child presented with a 4-month history of pain and swelling in the right thigh. Imaging and core needle biopsy confirmed osteosarcoma of the femur. The patient received three cycles of doxorubicin- and cisplatin-based neoadjuvant chemotherapy, followed by wide resection, extracorporeal radiotherapy of the resected segment, reimplantation, and plate fixation. The patient remained symptom-free with good limb function for 6 years. Routine surveillance then identified a new, well-defined cortically based osteolytic lesion in the distal femoral metaphysis. Computed tomography (CT) demonstrated sclerotic margins without cortical breach or a soft-tissue component, while positron emission tomography-CT showed only low-grade metabolic activity. Serial imaging and the absence of symptoms supported a radiological diagnosis of NOF, and observation was continued. At 8 years of follow-up, the patient remained asymptomatic with satisfactory knee motion and no evidence of osteosarcoma recurrence.</p><p><strong>Conclusion: </strong>Benign lesions should remain in the differential diagnosis when a new lytic lesion is detected during long-term osteosarcoma surveillance. Correlation of lesion morphology, metabolic activity, clinical findings, and interval behavior is essential to avoid misdiagnosis and overtreatment.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137056","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":"Multimodal Biological Augmentation with Umbilical Cord Mesenchymal Stem Cell Secretome, Recombinant Human Bone Morphogenetic Protein-2, and Allogeneic Umbilical Cord Mesenchymal Stem Cells in Neurofibromatosis Type 1-Confirmed Congenital Pseudarthrosis of the Distal Tibia and Fibula: A Case Report with Mechanistic Scoping Review.","authors":"Luh Gede Djatu Anggitadewi, Oen Sindrawati, Komang Agung Irianto, Tri Wahyu Martanto","doi":"10.13107/jocr.2026.v16.i10.8268","DOIUrl":"10.13107/jocr.2026.v16.i10.8268","url":null,"abstract":"<p><strong>Introduction: </strong>Congenital pseudarthrosis of the tibia (CPT) associated with neurofibromatosis type 1 (NF1) is characterized by convergent dysregulation of three molecular pathways - transforming growth factor-beta/Smad-driven fibrogenesis, RAS-MEK-ERK hyperactivation, and Wnt/β-catenin blockade - none of which is addressed by conventional surgical fixation alone. This case explores the clinical feasibility of a multimodal biological protocol targeting all three pathways simultaneously.</p><p><strong>Case report: </strong>A 6-year-old male with histopathologically confirmed NF1-associated Crawford type IV CPT of the distal tibia and concurrent distal fibular pseudarthrosis underwent radical hamartoma excision combined with quadruple biological augmentation: Allogeneic umbilical cord mesenchymal stem cells (UC-MSC) (20 million cells), UC-MSC conditioned medium (secretome; first injection intraoperatively post-graft), recombinant human bone morphogenetic protein-2 (rhBMP-2) (Novosys), and synthetic hydroxyapatite scaffold (Bongros), stabilized with an Ilizarov trans-ankle external fixator. A second secretome injection (1.4 mL, fluoroscopy-guided) was administered percutaneously at 8 months, targeting the distal tibial union site during frame removal.</p><p><strong>Conclusion: </strong>Tibial callus measured 9.88 mm at 6 months (equalling diaphyseal width) with no graft resorption. At 8 months, tibial bridging callus was sufficient to permit Ilizarov frame removal without refracture. The distal tibial pseudarthrosis was stabilized with retained K-wires; the fibula received no internal fixation and showed no ongoing healing. No infection or hardware complication occurred. This case is, to our knowledge, the first to describe this quadruple augmentation protocol and a two-stage secretome delivery strategy in CPT, providing a hypothesis-generating proof of concept for future translational investigation.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"286-291"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137204","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":"Single-Stage Fixation of Bilateral Open Medial Hoffa Fractures Associated with Bilateral Patella Fracture and Bilateral Distal Radius Fractures: A Case Report.","authors":"Sunil D Magadum, Ram Prasad Jasti, Prithvi Mohandas, Surya Balaji Ravichandran","doi":"10.13107/jocr.2026.v16.i10.8220","DOIUrl":"10.13107/jocr.2026.v16.i10.8220","url":null,"abstract":"<p><strong>Introduction: </strong>Hoffa fractures are uncommon coronal-plane fractures of the femoral condyle. Bilateral open medial Hoffa fractures associated with patellar fractures, knee dislocation, vascular compromise, and bilateral distal radius fractures are exceptionally rare and present major diagnostic, surgical, and rehabilitation challenges.</p><p><strong>Case report: </strong>A 23-year-old man sustained polytrauma in a two-wheeler road traffic accident. He had bilateral open medial femoral condyle fractures, bilateral patellar fractures, a posterior dislocation of the right knee with compression of the popliteal artery, and bilateral distal radius fractures. Emergency closed reduction of the right knee restored distal perfusion. After resuscitation from hypovolemic shock and achievement of haemodynamic stability, single-stage definitive fixation was performed. The Hoffa and patellar fractures were stabilised with fracture-specific fixation and extensor-mechanism reconstruction. The right distal radius was fixed with a volar plate, whereas the open left distal radius fracture was managed with Kirschner wires and a wrist-spanning external fixator.</p><p><strong>Results: </strong>At 1-year follow-up, all fractures had united without infection or neurovascular deficits. Both knees had a range of motion from 0° to 120°, with Lysholm scores of 91 on the right and 90 on the left. Both wrists had near-full motion and Modified Mayo Wrist Scores of 85. The patient was independently ambulant and had returned to his pre-injury occupation.</p><p><strong>Conclusion: </strong>In selected polytrauma patients who respond adequately to resuscitation, single-stage definitive fixation can be considered after urgent vascular compromise has been addressed. Individualized fixation, meticulous soft-tissue management, and coordinated rehabilitation are essential for a favorable outcome.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"154-160"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137169","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 Hip Arthroplasty for Neglected Pathological Femoral Neck Fracture in a Young Patient with Autoimmune Polyglandular Syndrome.","authors":"Plaban Nath Chowdhury, Mridushman Medhi, Prateek Kaithoriya, Rajesh Malhotra","doi":"10.13107/jocr.2026.v16.i10.8288","DOIUrl":"10.13107/jocr.2026.v16.i10.8288","url":null,"abstract":"<p><strong>Introduction: </strong>Neglected pathological femoral neck fractures in young patients are rare and present significant surgical challenges, particularly in the presence of systemic metabolic disorders such as autoimmune polyglandular syndrome (APS). Poor bone quality, impaired healing potential, and endocrine instability complicate management, often limiting the success of head-preserving procedures.</p><p><strong>Purpose: </strong>The purpose of the study was to describe the surgical decision-making, technical considerations, and early outcomes of total hip arthroplasty (THA) in a young patient with a neglected pathological femoral neck fracture associated with APS.</p><p><strong>Materials and methods: </strong>A 34-year-old male with a history of Type 1 diabetes mellitus, hypoparathyroidism, and hypocalcemia presented 4 months after a trivial trauma with a displaced transcervical left femoral neck fracture. Imaging revealed non-union, mild femoral head resorption, and severe osteoporosis. After multidisciplinary endocrine optimization, THA was performed through a posterior approach. A cementless multihole acetabular cup with screw fixation, a cemented congenital dislocation of the hip femoral stem, and a dual mobility articulation system were utilised to address poor bone quality, narrow canal morphology, and instability risk.</p><p><strong>Results: </strong>The patient remained hemodynamically stable postoperatively, with transient hyperglycemia managed with insulin infusion. Radiographs demonstrated well-positioned and stable components with restoration of limb length and offset. Pain relief was achieved early. Due to compromised bone quality, weight-bearing was progressed gradually, with full weight-bearing initiated at 4 weeks. Preoperatively, the patient had severe pain and functional limitation, with a Harris Hip score (HHS) of 25/100. At 3 months, the HHS was 78/100, improving to 90/100 at 6 months.</p><p><strong>Conclusion: </strong>This case highlights the feasibility of an individualized THA approach for the management of a neglected pathological femoral neck fracture in a young patient with APS and severe osteoporosis. Satisfactory early clinical, radiographic, and functional outcomes were observed; however, longer follow-up and further studies are required to determine the durability and generalizability of this treatment strategy.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"16 10","pages":"353-360"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137198","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}