Journal of Orthopaedic Case Reports最新文献

{"title":"Tuberculous Osteomyelitis of the Coracoid Process Presenting as Shoulder Pain: A Case Report.","authors":"Rahul Shah, Aditya Rao, Siddharth Gunay, Shradha Kulkarni","doi":"10.13107/jocr.2025.v15.i02.5278","DOIUrl":"10.13107/jocr.2025.v15.i02.5278","url":null,"abstract":"<p><strong>Introduction: </strong>India accounts for more than 25% of the global cases of tuberculosis (TB). Skeletal TB accounts for approximately 15% of extra-pulmonary TB cases and up to 5% of all TB cases. Spine is the most common site for osteoarticular TB accounting for half of the total osteoarticular TB cases. TB osteomyelitis of flat bones such as the scapula is uncommon. The risk of TB among healthcare workers is significantly higher as compared to the general population. This is of particular concern, especially in endemic countries.</p><p><strong>Case report: </strong>A 26-year-old doctor presented with a 1-month history of dull-aching right shoulder pain without constitutional symptoms. The patient had tenderness over coracoid process on deep palpation with no other positive findings. Plain radiographs were unremarkable but magnetic resonance imaging revealed osteomyelitic changes in the coracoid process which was confirmed as TB on histopathology. The patient had excellent outcome after 18 months of anti-tuberculous therapy.</p><p><strong>Conclusion: </strong>A high index of suspicion of TB is imperative in endemic countries, especially in healthcare workers, irrespective of the immunity, vaccination status, and radiographic appearance. Early diagnosis and timely treatment give excellent functional outcomes.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"188-192"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433478","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 Evolution Of Surgical Hands Anti-Sepsis: From Scrub To Rub.","authors":"Faaiz Ali Shah, Ashok Shyam","doi":"10.13107/jocr.2025.v15.i02.5204","DOIUrl":"10.13107/jocr.2025.v15.i02.5204","url":null,"abstract":"","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433459","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 Case of \"Subtle\" Missed Complex Elbow Dislocation - Learning from Mistakes Made on Plain Radiography.","authors":"Asad Khan, Yasir Salam Siddiqui, Mohd Baqar Abbas, Mohd Arshad Rahman, Pranjal Agrawal, Nikhil Sharma","doi":"10.13107/jocr.2025.v15.i02.5264","DOIUrl":"10.13107/jocr.2025.v15.i02.5264","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic elbow dislocation is a profoundly debilitating condition characterized by severe instability, limited elbow function, and significant pain. The term \"neglected dislocation of the elbow\" refers to a traumatic elbow dislocation that has gone untreated for three weeks or longer. Successfully treating this condition presents a challenge, as it involves restoring elbow stability and achieving a decent range of motion, which can be particularly complex.</p><p><strong>Case report: </strong>We present a case involving a 34-year-old male patient who experienced a complex dislocation of his right elbow joint. Initial diagnosis at our emergency department missed the elbow dislocation, but a follow-up visit three weeks later revealed the true extent of the injury. Fortunately, successful closed reduction resulted in the patient regaining full range of motion, with a Mayo Elbow Performance Score of 90.</p><p><strong>Conclusion: </strong>This case report serves to underscore the essential nature of accurate diagnosis and treatment of elbow dislocations, both clinically and radiologically, to prevent future complications.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"150-154"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433270","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":"Cervicomedullary Spinal Cord Injury.","authors":"Noah King, Andrew Waack, Ethan Kosco, Aastha Bhavsar, Jason Schroeder, Alastair Hoyt","doi":"10.13107/jocr.2025.v15.i02.5238","DOIUrl":"10.13107/jocr.2025.v15.i02.5238","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord injury (SCI) is most common following trauma, typically involving motor vehicle incidents. The clinical prognosis depends on many factors, most importantly the initial grade of injury.</p><p><strong>Case report: </strong>We present a 26-year-old male who presents to the emergency department after a motor vehicle accident. He sustained significant injuries with an initial Glasgow Coma Scale of 3 and signs of complete SCI. A computed tomography scan demonstrated cervicomedullary transection caused by C6-C7 facet distraction with C6 retrolisthesis on C7. The patient recovered the ability to track with eyes, utilize facial expression, and unilateral trapezius function to command. Neurological recovery was not made despite aggressive treatment.</p><p><strong>Conclusion: </strong>Patients with complete SCI typically have poor outcomes despite aggressive treatment. We present a unique mechanism, treatment, and outcome of a cervicomedullary SCI through C6 retrolisthesis on C7.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"86-89"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433293","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":"Combined Arthroscopic Anterior Cruciate Ligament Reconstruction and Distal Femoral Osteotomy in a Patient of Bilateral Genu Valgum - A Rare Case Report.","authors":"Parthasarathi Das, Soumitesh Sibananda Das","doi":"10.13107/jocr.2025.v15.i02.5222","DOIUrl":"10.13107/jocr.2025.v15.i02.5222","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament (ACL) injury sometimes is associated with genu valgum. Valgus malalignment poses concerns due to its potential to increase strain on the ACL, thereby elevating the risk of osteoarthritis in the lateral compartment of the knee. However, lacune still exists regarding the concomitant reconstruction of ACL and distal femoral osteotomy in ACL-deficit knee with genu valgum. The present case report aims to fill this gap by presenting a rare case of a young patient with a symptomatic ACL deficit knee and femur-originated genu valgum.</p><p><strong>Case report: </strong>A young male presented with bilateral genu valgum at our clinic with pain and instability of the right knee following a sports injury for 1 year. The anterior drawer, Lachman, pivot shift, and McMurray test were positive in physical examination. The surgical intervention comprised lateral open wedge osteotomy of the distal femur, all-inside reconstruction of the ACL, and partial meniscectomy for the meniscal tear.</p><p><strong>Conclusion: </strong>Simultaneous ACL reconstruction with femur osteotomy offers favorable outcomes in patients presenting with genu valgum. This integrated approach minimizes hospitalization and rehabilitation periods. Meticulous planning and surgical techniques, including careful femoral tunnel placement, can mitigate potential complications like plate interference.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433296","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":"Comparative Efficacy and Safety of Fluoroscopy-guided Caudal Epidural Steroid Injection and Transforaminal Epidural Steroid Injection for Unilateral L5-S1 Paracentral Discogenic Radicular Pain.","authors":"Sathish Muthu, Praveen Thangavel, Sivaraman Duraisamy, Arun Anand Palaniappan","doi":"10.13107/jocr.2025.v15.i02.5296","DOIUrl":"10.13107/jocr.2025.v15.i02.5296","url":null,"abstract":"<p><strong>Introduction: </strong>Epidural steroid injection (ESI) is one of the key management strategies in the management of discogenic radicular pain. This study aims to compare the efficacy and safety of fluoroscopy-guided ESI through caudal (cESI) and transforaminal (tfESI) routes for unilateral paracentral L5-S1 discogenic radicular pain.</p><p><strong>Materials and methods: </strong>This prospective non-randomized comparative study conducted between January 2023 and January 2024 in a tertiary care hospital included patients presenting with unilateral paracentral L5-S1 discogenic radicular pain who failed 6 weeks of conservative care. The pain and functional outcome was analyzed using numerical pain rating scale (NPRS) and Oswestry disability index, respectively, at baseline, 3-week, 6-week, and 6-month post-intervention. Procedure failure is defined as NPRS score improvement <50% or ODI improvement <40% of baseline. Other outcomes analyzed were the duration of the procedure, and fluoroscopy shots used during the procedure.</p><p><strong>Results: </strong>We enrolled 60 patients in the study, 54 patients were available till the final follow-up with 26 patients in the cESI group and 28 patients in the tfESI group. The mean age of the cESI group (M: F 12:14) and tfESI group (M:F 10:18) was 36.1 (±4.1) years and 38.9 (±3.9) years, respectively. The pain and functional scores were significantly reduced compared to the baseline scores in both the groups (P < 0.001) and the reduction between the two groups was comparable at every follow-up. The tfESI group experienced significantly more failures (n = 8) at 6 months compared to the cESI group (n = 2) (P = 0.048). The tfESI group had significantly longer mean procedure time (18.8 min) and more fluoroscopy usage (16 shots) compared to cESI group with mean procedure time of 13 min (P = 0.014) and fluoroscopy usage of 10 shots (P = 0.023), respectively. No major adverse events were reported for either of the groups.</p><p><strong>Conclusion: </strong>cESI is a simple, safe, and efficacious technique comparable to tfESI in the management of unilateral L5-S1 paracentral discogenic radicular pain with significantly less procedural time and fluoroscopy usage. Further, large-scale studies are needed to validate the study results.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433297","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":"Revision Reverse Total Shoulder Arthroplasty Combined With Secondary Pectoralis Major Transfer for Tray-Taper Breakage and Internal Rotational Dysfunction: A Case Report.","authors":"Chang Hee Baek, Bo Taek Kim, Jung Gon Kim","doi":"10.13107/jocr.2025.v15.i02.5218","DOIUrl":"10.13107/jocr.2025.v15.i02.5218","url":null,"abstract":"<p><strong>Introduction: </strong>Reverse total shoulder arthroplasty (RTSA) has become a pivotal intervention for managing rotator cuff arthropathy in the elderly, showing consistent improvements in pain relief and shoulder function. However, the broad spectrum of indications for RTSA is accompanied by a notable incidence of complications, prompting continuous advancements in technology and surgical techniques.</p><p><strong>Case report: </strong>This case report presents an uncommon complication rarely discussed in the existing literature - humeral tray-taper breakage after RTSA. The patient, a 68-year-old with a history of rotator cuff repair surgery, underwent RTSA with concurrent subscapularis repair due to rotator cuff arthropathy. Postoperatively, the patient gradually reported weakness in internal rotation (IR), leading to a subsequent secondary pectoralis major (PM) transfer. However, following an incident where the patient experienced acute pain due to a slip, a tray-taper breakage in the implant was revealed. To address the broken implant and the weakness in IR, the patient underwent revision RTSA combined with the PM transfer. With a post-operative rehabilitation program, at 1 year and 6 months postoperatively, the patient demonstrated significant pain relief and improved functional outcomes.</p><p><strong>Conclusion: </strong>The case report underscores the importance of recognizing and addressing rare complications associated with RTSA, providing insights into the management of humeral tray-taper breakage. Furthermore, combined PM transfer to RTSA could be a solution to weakness in IR. This case report emphasizes the need for careful consideration of potential complications and innovative solutions for optimal patient outcomes.</p><p><strong>Level of evidence iv: </strong>Case report.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"32-36"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433404","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 Role of Computed Tomography in Achieving True External Rotation in Robotic Knee Replacement: A Retrospective Analysis of 300 Knees.","authors":"Pramod Bhor, Sawankumar Pawar, Syed Ali, Arvind Vatkar, Sachin Kale, Dnyanada Kutumbe","doi":"10.13107/jocr.2025.v15.i02.5304","DOIUrl":"10.13107/jocr.2025.v15.i02.5304","url":null,"abstract":"<p><strong>Introduction: </strong>Midflexion gap (MFG) malalignment remains a challenge in total knee arthroplasty (TKA), often attributed to inaccurate femoral component positioning. Precise determination of true external rotation (TER) is crucial for optimal implant orientation and MFG reduction. This study aimed to evaluate the utility of computed tomography (CT)-based TER measurement in robotic knee replacements.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on data from 300 patients who underwent robotic TKA using a system that incorporates CT-derived bone models. TER was measured preoperatively on CT scans.</p><p><strong>Results: </strong>The mean posterior condylar angle (PCA) (n = 300) between the transepicondylar axis (TEA) and the posterior condylar axis was 2.87 ± 0.73° (95% confidence interval [CI]) with a range of 2.14-3.6°. The external rotation between the anatomical and surgical TEA is 1.19 ± 0.94° (95% CI) with a range of 0.25-2.13°. Intraclass correlation coefficient for the angle is 1 (TEA) and 0.98 (PCA). This highlights potential discrepancies between traditional radiographic measurements and actual TER. Femoral component positioning aligned closer to the CT-based TER compared to standard methods. In addition, a significant reduction in MFG was observed in knees with TER-guided implant placement.</p><p><strong>Conclusion: </strong>CT-based TER measurement provides a more accurate assessment of femoral rotation compared to conventional radiographs. This improved precision translates into optimal implant positioning and significantly reduces MFG malalignment in robotic knee replacements. Our findings suggest that incorporating CT-based TER into the workflow can enhance the accuracy and outcomes of robotic TKA.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"269-274"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433463","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 Complication of Hook Plate Fixation for Lateral Clavicle Fractures: Salvage Management with K-Wire Fixation.","authors":"Sunit Kumar Pani, Subrat Mohapatra, Spandan Mishra, Ramanuj Acharya, Chaitanya Khandelwal","doi":"10.13107/jocr.2025.v15.i02.5234","DOIUrl":"10.13107/jocr.2025.v15.i02.5234","url":null,"abstract":"<p><strong>Introduction: </strong>Hook plate fixation is a widely used technique for managing lateral clavicle fractures, particularly when the coracoclavicular ligaments are disrupted. However, improper placement of the hook plate can result in rare and challenging complications that require innovative management strategies. This report presents a unique case involving such a complication and describes a minimally invasive, single-stage salvage approach using K-wire fixation to effectively address the issue.</p><p><strong>Case report: </strong>A 45-year-old female presented with pain and restricted shoulder function due to a hook plate positioned incorrectly at the fracture site rather than in the acromioclavicular joint. The mispositioned plate was carefully removed, and the fracture was stabilized using K-wire fixation.</p><p><strong>Results: </strong>At the 6-month follow-up, the patient had excellent functional recovery with a Constant-Murley score of 89 and complete radiographic union at the fracture site.</p><p><strong>Conclusion: </strong>This case highlights a rare issue that can occur when a hook plate is not placed correctly. It shows how important it is to position hardware accurately. The case also illustrates how a minimally invasive technique, using K-wire stabilization, can effectively manage these types of complications.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433277","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":"Arthroscopic Management of Snapping Scapular Syndrome due to Recalcitrant Scapulothoracic Bursitis - A Case Series.","authors":"Raghavendra Kembhavi, Jojin Jose Chitten, Nagesh M Inginshetty","doi":"10.13107/jocr.2025.v15.i02.5290","DOIUrl":"10.13107/jocr.2025.v15.i02.5290","url":null,"abstract":"<p><strong>Introduction: </strong>Snapping scapula syndrome (SSS) is a rare pathological condition characterized by palpable and/or audible crackling sensation during scapulothoracic movements. Scapulothoracic bursitis with or without osseous lesions is commonly associated with this syndrome. The initial management is always non-operative methods with anti-inflammatory medications and physiotherapy modalities. However, if the symptoms persist beyond 3-6 months of non-surgical treatment, it should be categorized as refractory or recalcitrant bursitis and necessitate either open or arthroscopic surgical excision of the lesion.</p><p><strong>Case report: </strong>We successfully managed five patients with SSS with arthroscopic scapulothoracic bursectomy.</p><p><strong>Conclusion: </strong>Arthroscopic scapulothoracic bursectomy is a successful surgical intervention for patients with scapulothoracic bursitis who do not respond to the conservative mode of management.</p>","PeriodicalId":16647,"journal":{"name":"Journal of Orthopaedic Case Reports","volume":"15 2","pages":"221-226"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433291","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}