Although several conditions present as soft tissue masses, reports of loose fibrotic nodular lesions within the glenohumeral joint are lacking. Herein, we report a case of a mass pathologically identified as a loose fibrotic nodular lesion within the glenohumeral joint and treated successfully with arthroscopic resection.
Case presentation
A 72-year-old woman presented with a mass in the deep layer of the subscapularis muscle, accompanied by shoulder pain and restricted range of motion, and underwent arthroscopic resection. Pathology revealed a loose fibrotic nodular lesion, and the surgery successfully relieved her symptoms with no recurrence.
Conclusions
This is the first reported case of a loose fibrotic nodular lesion in the shoulder joint. Arthroscopic resection is a viable option for masses within the glenohumeral joint that can potentially cause pain and limited shoulder motion.
{"title":"Loose fibrotic nodular lesion in the glenohumeral joint: A case report","authors":"Hiroki Kita, Noboru Matsumura, Akiko Torii, Yasuhiro Kiyota, Taku Suzuki, Takuji Iwamoto, Masaya Nakamura","doi":"10.1016/j.joscr.2026.05.001","DOIUrl":"10.1016/j.joscr.2026.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Although several conditions present as soft tissue masses, reports of loose fibrotic nodular lesions within the glenohumeral joint are lacking. Herein, we report a case of a mass pathologically identified as a loose fibrotic nodular lesion within the glenohumeral joint and treated successfully with arthroscopic resection.</div></div><div><h3>Case presentation</h3><div>A 72-year-old woman presented with a mass in the deep layer of the subscapularis muscle, accompanied by shoulder pain and restricted range of motion, and underwent arthroscopic resection. Pathology revealed a loose fibrotic nodular lesion, and the surgery successfully relieved her symptoms with no recurrence.</div></div><div><h3>Conclusions</h3><div>This is the first reported case of a loose fibrotic nodular lesion in the shoulder joint. Arthroscopic resection is a viable option for masses within the glenohumeral joint that can potentially cause pain and limited shoulder motion.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 83-86"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856187","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}
Heterotopic ossification (HO) is an uncommon but potentially disabling complication in pediatric patients with neurologic injury, often leading to severe joint stiffness and functional impairment.
Case presentation
A 10-year-old boy developed severe bilateral hip ankylosis after idiopathic thoracic myelitis with resultant paraplegia. Progressive hip stiffness compromised sitting balance and self-catheterization. Radiographs and computed tomography demonstrated extensive bilateral HO involving the tensor fascia latae and piriformis muscles. Staged surgical excision of the heterotopic bone followed by rehabilitation improved hip mobility. However, a persistent internal rotation deformity of the right femur, attributed to prolonged immobilization after a prior femoral fracture, continued to impair self-catheterization and required subtrochanteric derotational osteotomy. Postoperatively, stable sitting balance and independent catheterization were achieved.
Conclusions
This case underscores the importance of accurate imaging, appropriate surgical timing, and multidisciplinary management in severe pediatric HO.
{"title":"Severe bilateral hip heterotopic ossification in a pediatric patient with paraplegia following idiopathic myelitis: A case report","authors":"Tsukagoshi Yuta, Nozawa Daisuke, Kamada Hiroshi, Tomaru Yohei, Homma Yasuhiro","doi":"10.1016/j.joscr.2026.03.001","DOIUrl":"10.1016/j.joscr.2026.03.001","url":null,"abstract":"<div><h3>Background</h3><div>Heterotopic ossification (HO) is an uncommon but potentially disabling complication in pediatric patients with neurologic injury, often leading to severe joint stiffness and functional impairment.</div></div><div><h3>Case presentation</h3><div>A 10-year-old boy developed severe bilateral hip ankylosis after idiopathic thoracic myelitis with resultant paraplegia. Progressive hip stiffness compromised sitting balance and self-catheterization. Radiographs and computed tomography demonstrated extensive bilateral HO involving the tensor fascia latae and piriformis muscles. Staged surgical excision of the heterotopic bone followed by rehabilitation improved hip mobility. However, a persistent internal rotation deformity of the right femur, attributed to prolonged immobilization after a prior femoral fracture, continued to impair self-catheterization and required subtrochanteric derotational osteotomy. Postoperatively, stable sitting balance and independent catheterization were achieved.</div></div><div><h3>Conclusions</h3><div>This case underscores the importance of accurate imaging, appropriate surgical timing, and multidisciplinary management in severe pediatric HO.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 59-63"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856581","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}
Lumbar stress fractures involving the pars interarticularis, inferior articular process, and lamina are rare. This report describes such a “triple stress fracture” in an elite athlete that was managed with a comprehensive strategy.
Case presentation
A 20-year-old professional volleyball player presented with fractures of the right pars and inferior articular process and the left lamina at L5. In the absence of stable anchorage points for standard fixation, we performed direct repair using the smiley face rod method. Rehabilitation focused on correcting restricted thoracic extension to eliminate compensatory stress. Bony union was achieved, and the patient returned to full competitive play 10 months after surgery.
Conclusions
The smiley face rod method can stabilize complex posterior element fractures when standard techniques cannot be used. Correction of the underlying biomechanical dysfunction may be important for reducing the risk of recurrence of these fractures in elite athletes.
{"title":"Surgical repair and functional rehabilitation of a rare L5 triple stress fracture in an elite athlete: A case report","authors":"Takafumi Ohshima, Junzo Fujitani, Ken Tomonari, Takayuki Kitahara, Seiya Watanabe, Saori Soeda, Daiki Nakajima, Hiroshi Kageyama, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka, Koichi Sairyo","doi":"10.1016/j.joscr.2026.05.002","DOIUrl":"10.1016/j.joscr.2026.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar stress fractures involving the pars interarticularis, inferior articular process, and lamina are rare. This report describes such a “triple stress fracture” in an elite athlete that was managed with a comprehensive strategy.</div></div><div><h3>Case presentation</h3><div>A 20-year-old professional volleyball player presented with fractures of the right pars and inferior articular process and the left lamina at L5. In the absence of stable anchorage points for standard fixation, we performed direct repair using the smiley face rod method. Rehabilitation focused on correcting restricted thoracic extension to eliminate compensatory stress. Bony union was achieved, and the patient returned to full competitive play 10 months after surgery.</div></div><div><h3>Conclusions</h3><div>The smiley face rod method can stabilize complex posterior element fractures when standard techniques cannot be used. Correction of the underlying biomechanical dysfunction may be important for reducing the risk of recurrence of these fractures in elite athletes.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 87-91"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856582","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}
Wire or screw fixation is commonly used to treat proximal toe phalangeal fractures. However, these methods are sometimes insufficient for stabilizing nonunion with bone defects. Here, we report two cases of hallux proximal phalanx nonunion repair using a mesh plate.
Case reports
Case 1 describes a 23-year-old male patient with a fracture of the proximal phalanx of the hallux who was initially treated with pinning, leading to nonunion; thus, they were referred to our department for treatment. Autologous bone grafting and fixation with a mesh plate were performed, and bone union was achieved after three months. Case 2 describes a 35-year-old male patient with an injury to the proximal phalanx of the hallux. Nonunion occurred despite plate fixation; thus, the patient was referred to our department. Plate removal, autologous bone grafting, and fixation with a mesh plate resulted in bone union after six months.
Conclusion
The mesh plate is a useful implant for nonunion of the hallux proximal phalanx with bone defects.
{"title":"Nonunion of proximal phalanx of hallux treated using mesh plate: Report of two cases","authors":"Yuya Ohno, Tomoaki Fukui, Yohei Kumabe, Takahiro Niikura, Ryosuke Kuroda, Keisuke Oe","doi":"10.1016/j.joscr.2026.03.002","DOIUrl":"10.1016/j.joscr.2026.03.002","url":null,"abstract":"<div><h3>Background</h3><div>Wire or screw fixation is commonly used to treat proximal toe phalangeal fractures. However, these methods are sometimes insufficient for stabilizing nonunion with bone defects. Here, we report two cases of hallux proximal phalanx nonunion repair using a mesh plate.</div></div><div><h3>Case reports</h3><div>Case 1 describes a 23-year-old male patient with a fracture of the proximal phalanx of the hallux who was initially treated with pinning, leading to nonunion; thus, they were referred to our department for treatment. Autologous bone grafting and fixation with a mesh plate were performed, and bone union was achieved after three months. Case 2 describes a 35-year-old male patient with an injury to the proximal phalanx of the hallux. Nonunion occurred despite plate fixation; thus, the patient was referred to our department. Plate removal, autologous bone grafting, and fixation with a mesh plate resulted in bone union after six months.</div></div><div><h3>Conclusion</h3><div>The mesh plate is a useful implant for nonunion of the hallux proximal phalanx with bone defects.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 64-68"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856583","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}
Total elbow arthroplasty is a viable option for metastatic tumors of the distal humerus, but accurate implant placement —particularly proper rotational alignment—is challenging after wide bone resection due to the loss of anatomical landmarks. This case report aims to demonstrate the utility of augmented reality (AR) technology in ensuring the intraoperative reproducibility of a three-dimensional (3D) preoperative plan in a complex oncologic reconstruction.
Case presentation
A 63-year-old woman sustained a pathological distal humeral fracture from metastatic renal cell carcinoma. She underwent tumor resection and total elbow arthroplasty. As the extensive resection removed anatomical landmarks, obtaining correct rotational alignment was difficult. We employed AR technology to visualize the native bone morphology and the planned implant position intraoperatively on a smartphone screen. Postoperative computed tomography confirmed that the implant was placed accurately, with a rotational error of less than 3° relative to the preoperative plan. Although long-term follow-up was limited to four weeks due to the patient's transfer for systemic treatment, she achieved early functional recovery with a range of motion from -45° to 100°.
Conclusions
AR guidance, combined with three-dimensional planning, enabled high surgical precision and excellent reproducibility of implant positioning following wide resection. This technology offers an effective solution for maintaining surgical accuracy in complex oncologic elbow reconstructions where anatomical references are compromised.
{"title":"Augmented reality-assisted total elbow arthroplasty following tumor resection of the distal humerus: A case report","authors":"Minori Sato, Takuji Iwamoto, Atsushi Tanji, Yasuhiro Kiyota, Akiko Torii, Tomoaki Mori, Satoshi Oki, Taku Suzuki, Noboru Matsumura, Masaya Nakamura","doi":"10.1016/j.joscr.2026.03.003","DOIUrl":"10.1016/j.joscr.2026.03.003","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty is a viable option for metastatic tumors of the distal humerus, but accurate implant placement —particularly proper rotational alignment—is challenging after wide bone resection due to the loss of anatomical landmarks. This case report aims to demonstrate the utility of augmented reality (AR) technology in ensuring the intraoperative reproducibility of a three-dimensional (3D) preoperative plan in a complex oncologic reconstruction.</div></div><div><h3>Case presentation</h3><div>A 63-year-old woman sustained a pathological distal humeral fracture from metastatic renal cell carcinoma. She underwent tumor resection and total elbow arthroplasty. As the extensive resection removed anatomical landmarks, obtaining correct rotational alignment was difficult. We employed AR technology to visualize the native bone morphology and the planned implant position intraoperatively on a smartphone screen. Postoperative computed tomography confirmed that the implant was placed accurately, with a rotational error of less than 3° relative to the preoperative plan. Although long-term follow-up was limited to four weeks due to the patient's transfer for systemic treatment, she achieved early functional recovery with a range of motion from -45° to 100°.</div></div><div><h3>Conclusions</h3><div>AR guidance, combined with three-dimensional planning, enabled high surgical precision and excellent reproducibility of implant positioning following wide resection. This technology offers an effective solution for maintaining surgical accuracy in complex oncologic elbow reconstructions where anatomical references are compromised.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 69-72"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856184","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}
Conservative treatment is a safe and effective treatment option for spinal osteoid osteoma, though surgical treatment is a gold standard. This report presents two cases of spinal osteoid osteoma treated conservatively and highlights changes in clinical features, including the radiological findings by computed tomography (CT).
Case presentation
Two male patients presented with low back pain. Histological diagnosis confirmed osteoid osteoma in the lumbar pedicles. Both patients were treated conservatively, resulting in complete pain relief without any complications 4.5 and 2.5 years after the onset of symptoms, respectively. The CT scans taken one year after the initial presentation demonstrated shrinkage of the nidus.
Conclusions
For spinal osteoid osteoma cases where the nidus is close to neural structures, conservative treatment is a safe and effective option. One year after the initial presentation, CT findings are useful to determine whether conservative treatment is effective.
{"title":"More than three-year radiological follow-up by computed tomography for spinal osteoid osteoma: report of two cases","authors":"Tomonori Kawaharada, Takahiro Onoki, Ko Hashimoto, Kohei Takahashi, Kenichiro Yahata, Junya Kusakabe, Toshimi Aizawa","doi":"10.1016/j.joscr.2026.04.001","DOIUrl":"10.1016/j.joscr.2026.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Conservative treatment is a safe and effective treatment option for spinal osteoid osteoma, though surgical treatment is a gold standard. This report presents two cases of spinal osteoid osteoma treated conservatively and highlights changes in clinical features, including the radiological findings by computed tomography (CT).</div></div><div><h3>Case presentation</h3><div>Two male patients presented with low back pain. Histological diagnosis confirmed osteoid osteoma in the lumbar pedicles. Both patients were treated conservatively, resulting in complete pain relief without any complications 4.5 and 2.5 years after the onset of symptoms, respectively. The CT scans taken one year after the initial presentation demonstrated shrinkage of the nidus.</div></div><div><h3>Conclusions</h3><div>For spinal osteoid osteoma cases where the nidus is close to neural structures, conservative treatment is a safe and effective option. One year after the initial presentation, CT findings are useful to determine whether conservative treatment is effective.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 78-82"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856186","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}
Pub Date : 2026-09-01Epub Date: 2026-04-22DOI: 10.1016/j.joscr.2026.03.004
Taiga Furukawa, Tasuku Arifuku, Takeshi Kokubu
Background
Traumatic glenoid osteochondral injuries are rare with limited evidence for their optimal management. Arthroscopic osteochondral autograft transplantation, which is effective for knee cartilage repair, has rarely been reported for the shoulder. We report the clinical outcomes of arthroscopic osteochondral autologous transplantation.
Case presentation
A 20-year-old male sustained pain in his left shoulder when he tackled with his left shoulder hyperflexed during a martial art practice. Imaging confirmed an anteroinferior glenoid cartilage defect with subchondral bone damage. Arthroscopic transplantation was performed using two 4.5-mm diameter osteochondral plugs harvested from the knee, supplemented by labral repair. At one-year follow-up, the patient was pain-free, had fully recovered range of motion, and returned to competitive martial arts.
Conclusion
Arthroscopic osteochondral autograft transplantation effectively treats traumatic glenoid osteochondral injuries with promising short-term outcomes. Further long-term follow-up is needed to evaluate the risk of developing osteoarthritis.
{"title":"Arthroscopic osteochondral autograft transplantation for traumatic glenoid osteochondral injuries: a case report","authors":"Taiga Furukawa, Tasuku Arifuku, Takeshi Kokubu","doi":"10.1016/j.joscr.2026.03.004","DOIUrl":"10.1016/j.joscr.2026.03.004","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic glenoid osteochondral injuries are rare with limited evidence for their optimal management. Arthroscopic osteochondral autograft transplantation, which is effective for knee cartilage repair, has rarely been reported for the shoulder. We report the clinical outcomes of arthroscopic osteochondral autologous transplantation.</div></div><div><h3>Case presentation</h3><div>A 20-year-old male sustained pain in his left shoulder when he tackled with his left shoulder hyperflexed during a martial art practice. Imaging confirmed an anteroinferior glenoid cartilage defect with subchondral bone damage. Arthroscopic transplantation was performed using two 4.5-mm diameter osteochondral plugs harvested from the knee, supplemented by labral repair. At one-year follow-up, the patient was pain-free, had fully recovered range of motion, and returned to competitive martial arts.</div></div><div><h3>Conclusion</h3><div>Arthroscopic osteochondral autograft transplantation effectively treats traumatic glenoid osteochondral injuries with promising short-term outcomes. Further long-term follow-up is needed to evaluate the risk of developing osteoarthritis.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 3","pages":"Pages 73-77"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856185","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}
Nonunion is a notable complication of pediatric humeral lateral condyle fractures, and inappropriate treatment can result in severe upper extremity dysfunction. However, few articles are available on the long-term postoperative results of established nonunion.
Case presentation
Three patients who underwent osteosynthesis with or without corrective osteotomy at least 9 years after the injury were followed for more than 20 years. At the final follow-up, all three patients achieved bone union and preserved functional alignment and joint space on the plain radiographs. The average range of motion was −20° of extension and 135° of flexion, and the preoperative ulnar nerve neuropathy in two patients, pain, and apprehension were relieved.
Conclusion
Established nonunion is a highly challenging condition to treat. However, our case series demonstrated that optimal surgical intervention provided favorable radiographic and functional outcomes during the long-term follow-up.
{"title":"Surgical management of established nonunion of humeral lateral condyle fracture: A case series with minimum 20-year follow-up","authors":"Hiroki Kozuki , Kenso Kozuki , Masashi Izumi , Masahiko Ikeuchi","doi":"10.1016/j.joscr.2026.01.001","DOIUrl":"10.1016/j.joscr.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Nonunion is a notable complication of pediatric humeral lateral condyle fractures, and inappropriate treatment can result in severe upper extremity dysfunction. However, few articles are available on the long-term postoperative results of established nonunion.</div></div><div><h3>Case presentation</h3><div>Three patients who underwent osteosynthesis with or without corrective osteotomy at least 9 years after the injury were followed for more than 20 years. At the final follow-up, all three patients achieved bone union and preserved functional alignment and joint space on the plain radiographs. The average range of motion was −20° of extension and 135° of flexion, and the preoperative ulnar nerve neuropathy in two patients, pain, and apprehension were relieved.</div></div><div><h3>Conclusion</h3><div>Established nonunion is a highly challenging condition to treat. However, our case series demonstrated that optimal surgical intervention provided favorable radiographic and functional outcomes during the long-term follow-up.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 2","pages":"Pages 25-28"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060324","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}
Avascular necrosis (AVN) of the femoral head is a serious complication of pediatric femoral neck fractures. We report a case of femoral neck fracture in childhood who was treated with prolonged offloading to get healing without femoral head collapse.
Case presentation
A 6-year-old girl sustained a left femoral neck fracture (Delbet-Colonna type III) following a skiing accident. Closed reduction and internal fixation were performed four days post-injury. AVN was diagnosed 5-month postoperatively, after implementing a stepwise protocol of restricted weight-bearing, beginning with complete non-weight-bearing and gradually progressing to partial weight-bearing. Due to her young age and absence of collapse, conservative management with prolonged offloading was continued. At 12 months, MRI showed reduced necrotic area with preserved femoral head architecture. The patient was discharged without recurrence after achieving full weight-bearing at 14 months.
Conclusion
In pediatric patients with post-traumatic AVN, prolonged offloading may reduce necrotic area and prevent femoral head collapse, thereby lead to favorable long-term outcomes.
{"title":"A case of the pediatric avascular osteonecrosis after femoral neck fracture: Prevention of collapse of the femoral head with long-term non-weight-bearing therapy","authors":"Daigo Shiraishi , Junya Shimizu , Hiroki Fujita , Toshiki Zeniya , Ima Kosukegawa , Makoto Emori , Atsushi Teramoto","doi":"10.1016/j.joscr.2026.02.003","DOIUrl":"10.1016/j.joscr.2026.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Avascular necrosis (AVN) of the femoral head is a serious complication of pediatric femoral neck fractures. We report a case of femoral neck fracture in childhood who was treated with prolonged offloading to get healing without femoral head collapse.</div></div><div><h3>Case presentation</h3><div>A 6-year-old girl sustained a left femoral neck fracture (Delbet-Colonna type III) following a skiing accident. Closed reduction and internal fixation were performed four days post-injury. AVN was diagnosed 5-month postoperatively, after implementing a stepwise protocol of restricted weight-bearing, beginning with complete non-weight-bearing and gradually progressing to partial weight-bearing. Due to her young age and absence of collapse, conservative management with prolonged offloading was continued. At 12 months, MRI showed reduced necrotic area with preserved femoral head architecture. The patient was discharged without recurrence after achieving full weight-bearing at 14 months.</div></div><div><h3>Conclusion</h3><div>In pediatric patients with post-traumatic AVN, prolonged offloading may reduce necrotic area and prevent femoral head collapse, thereby lead to favorable long-term outcomes.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 2","pages":"Pages 50-54"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060343","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}
Although rare, chondral knee injuries in pediatric and adolescent patients are clinically significant. Children may develop symptomatic chondral lesions without a distinct traumatic event. Reports of chondral lesions in this age group remain limited, and mid-term outcomes following surgical fixation are poorly documented. Herein, we present two cases of chondral lesions.
Case presentation
Case 1 involved a 13-year-old female volleyball player with a trochlear chondral lesion treated with PLLA pin fixation and lateral retinacular release. The patient returned to sports 4 months postoperatively and remained asymptomatic at 6 years, continuing to compete in collegiate athletics. Case 2 involved a 12-year-old male soccer player with a medial femoral condyle lesion and incomplete lateral discoid meniscus. We underwent fixation with concomitant saucerization.
Result
The fixation of pure chondral fragments, combined with adjunctive procedures aimed at modifying the mechanical environment, resulted in favorable mid-term outcomes at six years of follow-up in these two pediatric patients.
{"title":"Mid-term outcomes of fixation for chondral lesions in pediatric knees with mechanical environment modification: A report of two cases","authors":"Kyohei Nakata , Kazuhiro Tsukisaka , Akinori Nekomoto , Atsuo Nakamae , Nobuo Adachi","doi":"10.1016/j.joscr.2025.12.002","DOIUrl":"10.1016/j.joscr.2025.12.002","url":null,"abstract":"<div><h3>Back ground</h3><div>Although rare, chondral knee injuries in pediatric and adolescent patients are clinically significant. Children may develop symptomatic chondral lesions without a distinct traumatic event. Reports of chondral lesions in this age group remain limited, and mid-term outcomes following surgical fixation are poorly documented. Herein, we present two cases of chondral lesions.</div></div><div><h3>Case presentation</h3><div>Case 1 involved a 13-year-old female volleyball player with a trochlear chondral lesion treated with PLLA pin fixation and lateral retinacular release. The patient returned to sports 4 months postoperatively and remained asymptomatic at 6 years, continuing to compete in collegiate athletics. Case 2 involved a 12-year-old male soccer player with a medial femoral condyle lesion and incomplete lateral discoid meniscus. We underwent fixation with concomitant saucerization.</div></div><div><h3>Result</h3><div>The fixation of pure chondral fragments, combined with adjunctive procedures aimed at modifying the mechanical environment, resulted in favorable mid-term outcomes at six years of follow-up in these two pediatric patients.</div></div>","PeriodicalId":100743,"journal":{"name":"JOS Case Reports","volume":"5 2","pages":"Pages 35-39"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148060326","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}
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