Journal of Orthopaedic Case Reports最新文献

{"title":"Four-Time Failed Subtrochanter Femur Fracture Fixation in Elderly: What's Next - A Case Report.","authors":"Bushu Harna, Anil Kapoor, Dinesh Sandal, Shivali Arya","doi":"10.13107/jocr.2025.v15.i02.5208","DOIUrl":"10.13107/jocr.2025.v15.i02.5208","url":null,"abstract":"<p><strong>Introduction: </strong>Subtrochanteric fractures are difficult fractures to manage, and a failed fixation in these fractures is a complex and challenging entities. Re-osteosynthesis and prosthesis replacement are two viable options. We present a case of four failed subtrochanter fracture fixations, managed with cementless long stem total hip replacement and augmented plate.</p><p><strong>Case report: </strong>A 68-year-old lady presented with pain and difficulty in walking for 12 years with four failed surgeries. The initial diagnosis was a subtrochanteric fracture managed with a proximal femur nail. The construct failed and was revised with a proximal femur plate. After a few years, the plate was broken and revised with the proximal femur nail again. Subsequently, the nail also failed after 3 years for which re-osteosynthesis with proximal femur nail was performed. The fixation again failed after 3 years leading to the inability to bear weight on the limb and pain. Cementless long stem total hip replacement with augmented plate along with bone grafting was performed as a one-time solution to the complexities in the management of 4 time-failed subtrochanter femur fractures. At 1 year of follow-up, the patient was walking pain-free and independently without any aid.</p><p><strong>Conclusion: </strong>Failed subtrochanter femur fracture fixation is a complex situation to manage. Re-osteosynthesis is the favored modality of treatment but prosthesis replacement is a feasible option in elderly patients. Total hip replacement provides a single solution to all the intricate problems in the management of failed subtrochanter femur fractures in the elderly.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433170","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":"Medial Epicondyle Fracture Dislocation, Multiple Failed Reductions, and a Median Nerve Entrapment: A Case Report.","authors":"Neal Chase Farmer, Joseph Boesel, David Yatsonsky, Scott Riley, Chase Kluemper","doi":"10.13107/jocr.2025.v15.i02.5244","DOIUrl":"10.13107/jocr.2025.v15.i02.5244","url":null,"abstract":"<p><strong>Introduction: </strong>Medial epicondyle fracture dislocations are common in the pediatric population; however, they often lead to favorable patient outcomes. Rarely, the median nerve (MN) can be trapped within the joint space or fracture upon reduction. If the nerve is trapped within the fracture, the MN slowly gets compressed as the fracture heals, leading to progressive deficits in motor function and sensation. These symptoms present as a mixture of pain, numbness, weakness, and paresthesia in the distribution of the MN. Therefore, careful monitoring of the patient post-reduction is crucial in making an early diagnosis.</p><p><strong>Case report: </strong>A 9-year-old girl presented with an incarcerated MN following closed reduction of a left elbow medial epicondyle fracture after multiple reduction attempts. She presented 2 years post-injury with a healed medial epicondyle, median sensory deficits, and anterior interosseous palsy. Nerve studies showed deficits in median-innervated muscles. Operative exploration revealed the MN incarcerated within the healed fracture. Tendon transfer allowed for opposition and flexion of the thumb, index finger flexion, and composite fist formation.</p><p><strong>Conclusion: </strong>MN entrapment following medial epicondyle reduction may present as ongoing sensory changes and median innervated weakness. Electromyography and advanced imaging should be obtained expeditiously.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"101-105"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433337","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":"Novel Use of Tricortical Iliac Crest Bone Allograft to Reconstruct the Lateral Tibia Plateau Articular Surface: A Case Series.","authors":"Luke Benjamin Schwartz, Matthew Kingery, Abhishek Ganta, Kenneth Egol, Sanjit Konda","doi":"10.13107/jocr.2025.v15.i02.5214","DOIUrl":"10.13107/jocr.2025.v15.i02.5214","url":null,"abstract":"<p><strong>Introduction: </strong>A tricortical iliac crest graft can be used to reconstruct the lateral proximal tibial articular surface.</p><p><strong>Methods/surgical technique: </strong>Anterior tricortical iliac crest autograft from the ipsilateral pelvis is harvested to approximate the contour of the native tibial plateau. A lateral proximal tibial locking plate is used to fix the bony construct to the surrounding native bone.</p><p><strong>Case report: </strong>Functionally, patients have been able to return to ambulation with and without an assistive device.</p><p><strong>Conclusion: </strong>Reconstruction of the joint surface with a tricortical iliac crest graft represents a novel surgical technique that may delay the need for arthroplasty and preserve bone stock for eventual knee replacement.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"22-27"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433414","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":"Limb Salvage and Reconstruction of a Complex Upper Extremity Injury: A Case Report.","authors":"Christos Koukos, Mikail Chatzivasiliadis, Stylianos Kapetanakis, David Latz, S Samundeeswari, Fredy Montoya","doi":"10.13107/jocr.2025.v15.i02.5224","DOIUrl":"10.13107/jocr.2025.v15.i02.5224","url":null,"abstract":"<p><strong>Introduction: </strong>Complex upper extremity trauma poses us with significant challenges in orthopedic and reconstructive surgery due to the complex anatomy and functional importance of the extremities. These injuries are often the result of high-energy mechanisms like motor vehicle collisions, which makes their management particularly demanding. Making the decision between limb salvage and amputation in such cases requires careful consideration of multiple factors such as functionality, risk of complications, and recovery.</p><p><strong>Case report: </strong>We describe the case of a 39-year-old male who had sustained an open fracture of the elbow, avascular necrosis of the olecranon, a displaced ulna fracture, and transections of the triceps tendon and ulnar nerve. We tried to salvage the limb through planned reconstructive surgeries despite the complexity of the injuries and recommendations for amputation.</p><p><strong>Conclusion: </strong>Managing complex upper extremity trauma requires a structured approach that balances innovative techniques with effective infection control and soft-tissue reconstruction.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433318","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 Vital Role of Materiovigilance in Orthopedic Practice.","authors":"Sachin Kale, Deepak Langade, Vaishali Thakare, Ashok Shyam","doi":"10.13107/jocr.2025.v15.i02.5206","DOIUrl":"https://doi.org/10.13107/jocr.2025.v15.i02.5206","url":null,"abstract":"","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"4-5"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433468","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 in Ochronotic Arthropathy with quadriceps tear. A Case Report with a Review of the Literature.","authors":"Alok Chandra Agrawal, Anuj Baghel, Ankit Kumar Garg, Alok Rai, Harshal Sakale","doi":"10.13107/jocr.2025.v15.i02.5236","DOIUrl":"10.13107/jocr.2025.v15.i02.5236","url":null,"abstract":"<p><strong>Introduction: </strong>Alkaptonuria is a rare genetic disorder characterized by the absence of the enzyme homogentisate 1,2 dioxygenase, which leads to the accumulation of homogentisic acid in connective tissues and blood, resulting in Ochronosis and osteoarthropathy.</p><p><strong>Case report: </strong>We present a case report of a 56-year-old male with ochronotic arthropathy and quadriceps tendon rupture who underwent a total hip replacement. The patient exhibited right hip pain, difficulty walking, and restricted movement at the hip and spine. Radiographic and magnetic resonance imaging findings confirmed significant arthritic changes in the right hip joint and a mid-substance tear in the quadriceps tendon. Intraoperatively, dark pigmentation was observed in the affected tissues, consistent with the diagnosis of Ochronosis. The literature review indicates that joint replacement surgery is the treatment of choice for ochronotic arthropathy, with patients experiencing good functional recovery. The prosthesis's long-term survival rate is comparable to primary arthroplasty, and the optimal surgical approach regarding capsule preservation remains a topic of debate.</p><p><strong>Conclusion: </strong>Joint replacement is a feasible treatment option for patients with ochronotic arthropathy. Understanding the spine-pelvic relations and other potential complications can help surgeons plan for better recovery and functional outcomes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433470","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":"Chronic Midfoot Pain Due to Idiopathic Osteonecrosis of Tarsal Navicular Bone in Adult - Mueller-Weiss Syndrome: A Case Report.","authors":"N Adithya, P Sunil Kumar, B S Narendra, V Varun","doi":"10.13107/jocr.2025.v15.i02.5228","DOIUrl":"10.13107/jocr.2025.v15.i02.5228","url":null,"abstract":"<p><strong>Introduction: </strong>Mueller-Weiss syndrome is a rare condition seen in adults due to spontaneous osteonecrosis of tarsal navicular bone unlike Koehler's disease which is quite common in paediatric population.</p><p><strong>Case report: </strong>We report a single case of Mueller-Weiss syndrome in an adult female. After a trail of conservative treatment, operative management was done with excision of necrotic fragment and arthrodesis of mid-foot joints augmented with tricortical iliac crest graft. Good fusion and significant reduction of pain on weight-bearing was observed after a duration of 6 weeks.</p><p><strong>Conclusion: </strong>Mueller-Weiss syndrome is relatively rare differential for mid-foot pain in adult population. Early recognition and management of the condition prevents arthritic changes and disability.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"60-64"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433294","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":"Mucinous ACL Degeneration is Rarely Thought About, a Missing Diagnosis: Case Report.","authors":"Chadalavada Aravindbabu, Syed Kareemulla, Aditya Chadalavada, Naveen Kumar, Pranavi Nutalapati, Taslim Fathima","doi":"10.13107/jocr.2025.v15.i02.5250","DOIUrl":"10.13107/jocr.2025.v15.i02.5250","url":null,"abstract":"<p><strong>Introduction: </strong>Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a rare entity affecting the middle-aged people with equal gender predisposition. The enigmatic pathological etiology of MD of ACL has been the subject of numerous ideas, including synovial, traumatic, degenerative, ectopic, changed joint mechanics, etc. correlating magnetic resonance imaging (MRI) with clinical diagnosis helps in concluding the diagnosis. Arthroscopic debulking of the ACL helps in relieving the pain.</p><p><strong>Case report: </strong>We describe here a woman in her 40s who has been experiencing right knee pain for the past 2 years. Although there are no additional clinical symptoms visible upon examination, there is pain with deep knee flexion. MRI's knee has been taken, and celery stalk appearance has been noticed, as described by Akin. The patient was treated with arthroscopic debulking using conventional arthroscopic portals, and the pain was relieved.</p><p><strong>Conclusion: </strong>The diagnosis of MD is assisted by clinical examination and correlating the clinical findings with MRI, as it is typically overlooked. The pain is reduced with arthroscopic debulking.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"116-119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433342","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":"Analysis of Series of Cases of Fibrous Dysplasia of Proximal Femur in Pediatric Population.","authors":"Sumit Gupta, Ankur Agarwal, Lokesh Raghav, Shray Jain, Amit Kumar Gupta","doi":"10.13107/jocr.2025.v15.i02.5298","DOIUrl":"10.13107/jocr.2025.v15.i02.5298","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrous dysplasia (FD) accounts for 5-7% of all benign bone tumors. It presents in two main forms - monostotic, which is more common affecting a single bone and presenting usually in 3rd decade of life; polyostotic, affecting several bones, is less common, and is seen mainly in the 1st decade of life. These usually present as bone pain or pathological fracture. It may also be part of McCune-Albright syndrome. Since the femur is an important weight-bearing bone in the human body, most cases of FD affecting the femur present as pathological fracture more early than other sites. The mainstay of management includes treatment of pathological fracture and prevention of bony deformity until skeletal maturity. The aim of this study was to analyze a series of cases of FD of femur affecting the pediatric population.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted at two tertiary-level centers of urban India, wherein all case records of FD under follow-up between January 2015 and December 2023 were analyzed. In all, there were 13 cases. Definitive management was decided on a case-by-case basis. We grouped the cases into 2 categories based on recurrence.</p><p><strong>Observations: </strong>Out of 13 cases, 11 were males while 2 patients were females. The mean age at presentation was 10.5 years (range 4-12 years). Two cases were of polyostotic FD, while 11 cases were of monostotic FD. In 11 cases, the intertrochanteric region of the femur was affected, while in 2 cases the affection extended into the proximal shaft of the femur as well. The mean follow-up period was 48 months (Range 15-84 months). In category one (no recurrence) there were 10 patients, while in category two (recurrence of FD) there were 3 patients. The recurrence rate in our series was 23%.</p><p><strong>Results: </strong>Although FD is also seen in the adult population, its implications are more pronounced in a growing skeleton. The series of cases where surgical intervention has been done with a long follow-up in the pediatric population are limited. In literature, clinical classification of FD, anatomical location in the proximal femur, variation in neck-shaft angle and osteocalcin levels have been found to be significant in predicting causes of fractures and their recurrences.</p><p><strong>Conclusion: </strong>Internal fixation is preferable to prevent deformities where there are high chances of a pathological fracture as is evident by the natural history of FD. Long-term follow-up is important as there are chances of recurrence in childhood until puberty.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"249-255"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433278","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":"Complex Revisions in Total Hip Arthroplasty Amidst COVID-19 Delays: A Case Report.","authors":"Jatin Talwar, Navdeep Singh Keer, Loveneesh G Krishna, Ashish Rustagi, Ishaan Siwach","doi":"10.13107/jocr.2025.v15.i02.5260","DOIUrl":"10.13107/jocr.2025.v15.i02.5260","url":null,"abstract":"<p><strong>Introduction: </strong>Avascular necrosis (AVN) of the femoral head and its subsequent management through total hip arthroplasty (THA) remains a significant challenge in orthopedic surgery, especially in cases with long-term complications. This case report is crucial as it documents the unprecedented journey of a 69-year-old female patient who underwent multiple revision surgeries over three decades, culminating in a complex surgical intervention during the COVID-19 pandemic. To the best of our knowledge, only a handful of cases have been reported in the literature that explores the compounded effects of delayed surgical intervention due to a global pandemic on a patient with a history of multiple hip arthroplasty revisions.</p><p><strong>Case report: </strong>The patient, a 69-year-old female, initially presented with AVN of the left femoral head in 1994, for which she underwent an isoelastic cemented total hip replacement. Over the years, she required two revision surgeries due to implant loosening. In 2021, she presented with a dislocated femoral head and loosening of the cemented acetabular cup. The COVID-19 pandemic delayed operative intervention, leading to worsening complications, including proximal migration of the dislocated components. In 2022, a complex surgical procedure was performed, involving acetabular defect reconstruction and femoral shortening osteotomy, with the implantation of a new prosthetic body and a bipolar head. The surgery successfully restored hip stability, allowing the patient to walk with reduced risk of further complications.</p><p><strong>Conclusion: </strong>This case underscores the complexities of managing long-term complications in patients with a history of multiple revision hip arthroplasties, particularly when external factors like the COVID-19 pandemic delay necessary interventions. The successful outcome of the case highlights the importance of personalized treatment strategies and adaptive surgical approaches in addressing severe complications. This case provides valuable insights for orthopedic surgeons and may have broader implications for managing similar cases in the future, especially in scenarios where timely surgical intervention is compromised by external challenges.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433299","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}