Case Reports in Orthopedics最新文献

{"title":"Atypical Fragility Fractures due to Bony or Soft Tissue Phosphaturic Mesenchymal Tumors: A Report of Two Cases.","authors":"Stephanie M Clegg,&nbsp;Emily S Eiel,&nbsp;Sara Fine,&nbsp;Rachel I Gafni,&nbsp;Mathew J Most","doi":"10.1155/2023/5614065","DOIUrl":"https://doi.org/10.1155/2023/5614065","url":null,"abstract":"<p><strong>Introduction: </strong>Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder where patients present with hypophosphatemia, chronic diffuse bone pain, and occasionally fractures. Benign phosphaturic mesenchymal tumors (PMT) are responsible for the TIO and are largely soft tissue tumors.</p><p><strong>Cases: </strong>Two male patients with TIO secondary to PMT were reported-one in the bony scapula and the other in the plantar foot soft tissue. The first case describes a 63-year-old Caucasian male, who sustained an intertrochanteric proximal femur stress fracture and approximately two years of diffuse bone pain and hypophosphatemia. Wide excision of a left scapula boney lesion resulted in immediate resolution of his electrolyte abnormalities and bone pain. Case 2 describes a 58-year-old male with four years of multifocal bone pain and atraumatic fractures. A ⁶⁸Ga-DOTATATE-positron emission tomography/computed tomography (PET/CT) scan identified a soft tissue tumor in his plantar foot, which was ultimately excised. He also experienced near immediate resolution of his pain and no additional fractures.</p><p><strong>Conclusion: </strong>TIO is a rare condition presenting with chronic multifocal bone pain, stress fractures, and hypophosphatemia. These two cases highlight that the causative tumor may originate in soft tissue or bone. Furthermore, a high index of suspicion, along with fibroblast growth factor-23 testing and DOTATATE-PET/CT localization, can help with diagnosis and minimize treatment delays.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"5614065"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10115527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9392518","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":"Traumatic Anterior Hip Dislocation in the Elderly: Description and Review of a Rare Trauma.","authors":"Quentin Schopfer,&nbsp;Roland Strasser,&nbsp;Eric Ngassom Leumessi,&nbsp;Aurélien Traverso","doi":"10.1155/2023/3100256","DOIUrl":"https://doi.org/10.1155/2023/3100256","url":null,"abstract":"<p><strong>Background: </strong>Traumatic hip dislocation (THD) is an orthopaedic emergency that requires rapid reduction. THD is generally encountered in high-energy trauma. THD with low-energy trauma is extremely rare, even more so in the elderly. <i>Methods/Results</i>. We report the case of a 72-year-old woman who presented to the emergency department with anterior superior left hip dislocation after a low-energy trauma.</p><p><strong>Results: </strong>The patient was initially treated with closed reduction. Because of recurring dislocation, closed reduction was performed a second time. Magnetic resonance imaging showed no soft tissue interposition. At 12 week follow-up, the patient complained of intractable hip pain and was treated with total hip arthroplasty. The post-operative course was uneventful with a return to pre-injury functional mobility. We also conducted a review of the literature with regard to anterior hip dislocation in the population aged 70 years or more.</p><p><strong>Conclusion: </strong>THD can be associated with significant morbidity. Time to reduction is considered essential in improving functional outcomes. In the case of poor functional outcomes, total hip arthroplasty should be considered.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"3100256"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10208754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9531816","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":"Posteromedial Submeniscal Arthrotomy and Fixation with a Posteromedial Rim Plate in a Comminuted Medial Tibial Plateau Fracture.","authors":"Nicolás Franulic,&nbsp;Tomás Pineda,&nbsp;José Laso,&nbsp;Diego Valiente,&nbsp;Nicolás Gaggero","doi":"10.1155/2023/3635067","DOIUrl":"https://doi.org/10.1155/2023/3635067","url":null,"abstract":"<p><p>Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"3635067"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9901327","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":"MACI \"Sandwich\" Technique for a Large Osteochondritis Dissecans Lesion: A Case Report.","authors":"Bhumit Desai,&nbsp;Graylin Jacobs,&nbsp;Deryk Jones","doi":"10.1155/2023/7612206","DOIUrl":"https://doi.org/10.1155/2023/7612206","url":null,"abstract":"<p><p>There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous chondrocyte implantation procedure has shown efficacy in small- to medium-sized osteochondral lesions. This case report demonstrates use of the \"Sandwich\" technique in a large, deep osteochondritis dissecans lesion of the medial femoral condyle. Technical considerations that are key to containment of the lesion and outcomes are reported.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"7612206"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9946755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Bilateral Avulsion of Tibial Anterior Tubercle in Adolescent: Two Case Reports and Narrative Review of the Literature.","authors":"Dario Giunchi,&nbsp;Jorge Gonzalez,&nbsp;Marco Odorizzi,&nbsp;Mario Sagaon Mendoza,&nbsp;Vincenzo De Rosa","doi":"10.1155/2023/1035705","DOIUrl":"https://doi.org/10.1155/2023/1035705","url":null,"abstract":"<p><p>Fractures of the anterior tibial tuberosity are uncommon, ranging from 0.4% to 2.7% of all epiphyseal lesions reported. Bilateral sequential fractures are even rarer, with less than twenty-eight cases described to date and, as such, there is very little consensus data on their treatment as a whole. We report the first two documented cases of bilateral tibial tuberosity avulsions of the anterior tubercle in Switzerland, treated by open reduction and internal fixation. Both cases were 14-year-old healthy males with no previous medical history, who both suffered extra-articular fractures after falling from a height. The first case was treated in 2012 with a four-year long clinical follow-up and full recovery. The second, treated in 2019, was clinically followed for one year with a complete recovery and has returned to sporting activity at a pre-injury level. Due to the rarity of the condition, a lack of consensus on the optimal therapy, we believe the documentation of these two cases treated by the same team may be of clinical relevance.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"1035705"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10757709","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 Closed Pilon Fracture Resulting in Soft-Tissue Necrosis and Treated with Reverse Sural Artery Flap and Circular External Fixation.","authors":"Ryu Igaki,&nbsp;Tomohiro Yasuda,&nbsp;Yuki Samejima,&nbsp;Yuko Irie,&nbsp;Yuto Murakami,&nbsp;Taisuke Yoneya,&nbsp;Shinsuke Takagi,&nbsp;Keikichi Kawasaki,&nbsp;Koji Kanzaki","doi":"10.1155/2023/9222479","DOIUrl":"https://doi.org/10.1155/2023/9222479","url":null,"abstract":"<p><p>Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. Open reduction and internal fixation is a commonly used method of treatment. However, it has a high risk of infection and soft-tissue complications due to the extensive detachment of soft tissue. We report on a case with a tibial pilon fracture and soft-tissue necrosis that we treated using limited internal fixation combined with a circular external fixator (LIFCEF) and reverse sural artery flap (RSAF) as part of an orthoplastic approach within the orthopedic surgery department alone, which obtained good results. A 51-year-old man was injured in a motorcycle accident and transported to a nearby hospital. X-rays at the time of injury showed tibial pilon fractures (AO Foundation/Orthopedic Trauma Association 43c3.3, Ruedi-Allgower: Type III). Soft-tissue necrosis with blisters on the medial side of the lower leg (AO soft-tissue classification: IC3-MT1-NV1) was observed. In addition, the patient was referred to our hospital on day 10 of the injury. LIFCEF was chosen for treating the fracture because plate fixation was accompanied by the risk of plate exposure, soft-tissue complications, and an increased skin defect area, and RSAF was chosen to reconstruct the soft tissue defect. Four years after the surgery, the American Orthopedic Foot and Ankle Score was 92 points. X-ray alignment evaluation showed mLDTA 93° and aADTA 91°. Stage 2 arthrosis was present according to the Takakura ankle osteoarthritis classification, but the patient was able to walk without pain. Tibial pilon fractures are difficult to treat due to articular comminution and soft-tissue injuries caused by high-energy trauma. The timing and choice of treatment are crucial concerning the soft tissue.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"9222479"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10432129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10047813","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":"Persistent Hemarthrosis of the Knee after Arthroscopic Meniscal Repair.","authors":"Shunichiro Kambara,&nbsp;Shinichi Yoshiya,&nbsp;Shintaro Onishi,&nbsp;Ryoji Yasumizu,&nbsp;Toshiya Tachibana","doi":"10.1155/2023/8806299","DOIUrl":"https://doi.org/10.1155/2023/8806299","url":null,"abstract":"<p><strong>Introduction: </strong>In this case report, we report a patient with complicated with persistent hemarthrosis following arthroscopic meniscal repair. <i>Case Presentation</i>. A 41-year-old male patient presented with persistent swelling of the knee 6 months after arthroscopic meniscal repair and partial meniscectomy performed for lateral discoid meniscal tear. The initial surgery was performed at another hospital. Four months after the surgery, swelling of the knee was noted when he resumed running. At his initial visit to our hospital, intra-articular blood accumulation was revealed via joint aspiration. A second arthroscopic examination performed 7 months after the initial procedure showed healing of the meniscal repair site and synovial proliferation. The suture materials identified during the arthroscopy were removed. Histological examination of the resected synovial tissue showed inflammatory cell infiltration and neovascularization. In addition, a multinucleated giant cell was identified in the superficial layer. After the second arthroscopic surgery, the hemarthrosis did not recur, and the patient was able to resume running without symptom one and a half years post-surgery.</p><p><strong>Conclusion: </strong>Bleeding from the proliferated synovia at or near the periphery of the lateral meniscus was thought to be the cause of the hemarthrosis as a rare complication following arthroscopic meniscal repair.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"8806299"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10091326","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":"Spontaneous Recovery of Paraplegia in a Polytrauma Patient following Spinal Cord Ischemia due to Type B Traumatic Aortic Dissection.","authors":"Pedro Ramos Jurado,&nbsp;Fernando Hernández Aragón,&nbsp;Víctor Aaron Miranda González,&nbsp;Jesús Antonio Loya Silva,&nbsp;Edgar Azael Pérez Gutiérrez,&nbsp;Nadia Karina Portillo Ortiz,&nbsp;Adriana Cristina Quintana Vázquez,&nbsp;Luisa Fernanda Trujillo Venzor,&nbsp;Eduardo Enrique Gámez Aponte,&nbsp;Arturo Aguirre Madrid,&nbsp;Edmundo Berumen Nafarrate","doi":"10.1155/2023/8918724","DOIUrl":"https://doi.org/10.1155/2023/8918724","url":null,"abstract":"<p><p>Aortic dissection is a life-threatening acute condition characterized by the separation of the aortic wall's layers. It is caused by a tear in the internal vascular wall (intimal layer and middle layer), which results in bleeding between the layers and causes abrupt and excruciating pain. The appropriate consideration must be given to the condition's dynamic nature, and variations in clinical presentation, without neglecting the urgency for intervention. In this case study, a 65-year-old male engaged in a car accident is admitted to urgent care with a traumatic aortic dissection diagnosis that included the aortic arch, a segmental exposed fracture of 1/3 distal of the right femur AO 32C3k, and an intertrochanteric fracture AO 31A1.3. The patient developed transient paraplegia as the initial manifestation of acute aortic dissection, which represents a high mortality and morbidity entity without adequate and prompt treatment, and prompt diagnosis and management were critical. A patient with severe thoracic and abdominal trauma caused by high-energy injury should be properly evaluated for the possibility of traumatic aortic dissection. The endovascular aortic repair was performed, resulting in a positive clinical evolution due to the important participation of the multidisciplinary trauma team involved in patient management and prompted decision-making.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2023 ","pages":"8918724"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10438978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10105511","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":"Complementary Effects of Surgery and Pexidartinib in the Management of Patients with Complex Diffuse-Tenosynovial Giant Cell Tumor.","authors":"Nicholas M Bernthal, R Lor Randall, Lauren N Zeitlinger, Erik J Geiger, John H Healey","doi":"10.1155/2022/7768764","DOIUrl":"10.1155/2022/7768764","url":null,"abstract":"<p><p>Tenosynovial giant cell tumor (TGCT) is a rare neoplasm of the joint synovium that has a wide clinical spectrum including pain and stiffness in the affected joint, joint swelling, periarticular erosions, and cartilage loss, which can severely impact quality of life. The mainstay treatment for TGCT has been surgery involving partial or total synovectomy using arthroscopic or open techniques. However, surgical resection alone is associated with high recurrence rates, particularly in diffuse-TGCT (D-TGCT) cases. The 3 cases presented here summarize a combination approach (surgery+pexidartinib [tyrosine kinase inhibitor]) in patients with previously unresectable or inoperable D-TGCT. <i>Case 1-Hip.</i> A 29-year-old male was treated with pexidartinib prior to surgery, resulting in tumor reduction. A left total hip arthroplasty (THA) was then performed with a lack of recurrence in 12 months postoperative, and the patient currently on pexidartinib treatment. <i>Case 2-Foot.</i> A 35-year-old female, nearly a decade following a left foot mass resection, was treated with pexidartinib following disease recurrence. A decrease in soft tissue lesions at the midfoot and decreased marrow enhancement at the first metatarsal head were seen within 4-5 months of pexidartinib treatment; the patient is currently on pexidartinib (400 mg/day) with improved symptom control. <i>Case 3-Knee.</i> A 55-year-old male patient received pexidartinib pre- and postoperatively. A reduction in swelling and the size of the popliteal cyst was significant and maintained, with the synovial disease growing when pexidartinib was discontinued. Surgery and adjuvant therapy eliminated the disease as of the last follow-up visit (11 months postoperative). These cases provide a unique perspective based on tumor location, type/timing of treatment strategy, and patient outcomes. Optimal treatment strategies for this debilitating disease may entail utilizing a combination approach (surgery+systemic treatment) to reduce surgical morbidity and the risk of postoperative disease recurrence.</p>","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"2022 ","pages":"7768764"},"PeriodicalIF":0.0,"publicationDate":"2022-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10704935","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 Change in the Classical Order of Setting of Porous Metal Augments with Locked Cups in Hip Revision Surgery: Technical Note and Case Report","authors":"A. Murcia-Asensio, F. Ferrero-Manzanal, P. Sanz-Ruíz, Hermenegildo Cañada-Oya, R. Lax-Pérez, C. Goetze","doi":"10.1155/2022/4062172","DOIUrl":"https://doi.org/10.1155/2022/4062172","url":null,"abstract":"Introduction Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup. Methods We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion. Results The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation in the midterm follow-up did not show mobilization of implants. Discussion. The use of metal porous augments is widely used for severe acetabular defects, being a versatile system to adapt to the different size defects. Nevertheless, its use may be technically demanding and time consuming. It is not infrequent that the setting of the augments conditions the final position of the cup with a possible interference with initial stability and eventually bone ingrowth of the cup. The interlocking mechanism offers an additional biomechanical stability and thus may allow us to place the cup first in the desired position with a less demanding technique. Conclusion With the use of locked-screw porous metal cups, the order of setting of implants may be changed in order to obtain a better restoration of the center of rotation and increased host-bone implant contact with a simplified surgical technique.","PeriodicalId":30287,"journal":{"name":"Case Reports in Orthopedics","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81184566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}