JOS Case Reports最新文献

Background

An Image Fusion System was developed and clinically applied to project preoperative planning images onto intraoperative fluoroscopic images. We herein report a case of corrective osteotomy for cubitus varus using the Image Fusion System.

Case presentation

The present case is a 34-year-old female with cubitus varus. The patient had a varus elbow deformity and elbow pain due to the malunion of a distal humerus fracture in childhood. We performed corrective osteotomy under general anesthesia using the Image Fusion System.

Bone union was achieved approximately 3 months after surgery. The Mayo elbow performance score increased from 60 before surgery to 100 after surgery. The postoperative carrying angle of the elbow joint increased from −17° before surgery to 7° after surgery.

Conclusion

The Image Fusion System may be one of the methods used to assist corrective osteotomy for cubitus varus.

Background

In the cases of Achilles tendon sleeve avulsion with a larger tendon defect, the surgeon should be prepared to perform reconstruction of the tendon insertion as well as the tendon defect. This report details a case of a chronic Achilles tendon sleeve avulsion in a 52-year-old female who was successfully treated with a combination of V–Y tendon plasty and suture bridge technique.

Case presentation

A 52-year-old female presented to our hospital with a 3-month history of persistent posterior ankle pain. Based on physical examination and image findings, the patient was diagnosed with chronic Achilles tendon sleeve avulsion and treated operatively. Because of a large tendon defect, a combination of V–Y tendon plasty and suture bridge technique was performed. At 2 years postoperatively, the patient had no symptoms or functional impairment.

Conclusions

Although a long-term follow-up is required in this case, this operative procedure yielded good short-term results.

Background

Bacillus Calmette-Guérin (BCG) is a vaccine to prevent tuberculosis. Complications in infants and children include BCG osteitis and osteomyelitis of the metaphysis or epiphysis of long bones. There have been few reports of long-term follow-up. We investigated 10-year outcomes based on X-rays and physical examinations.

Case presentation

We described two individuals who developed BCG osteomyelitis after vaccination (Tokyo 172 strain) at 3 months old. Both cases underwent a biopsy of the infected epiphyseal lesion, irrigation from the metaphysis through the center of the growth plates, and received two anti-tuberculosis drugs: rifampicin and isoniazid. At the 10-year follow-up, the affected epiphysis had regenerated and both cases showed a leg-length discrepancy of less than 1 cm due to overgrowth.

Conclusions

This study reported on the long-term outcomes of two cases of BCG epiphyseal osteomyelitis in infants, revealing favorable results with regenerated epiphysis and minimal leg-length discrepancy.

Background

Lumbar puncture for myelography can cause incidental vascular injury, but rarely results in spinal hematoma formation.

Case presentation

A 73-year-old man without coagulopathy underwent preoperative myelography for lumbar revision. Magnetic resonance imaging revealed L2/3 and L4/5 canal stenoses. A subsequent atraumatic lumbar puncture was performed in the previously decompressed L3/4 interlaminar space. After the procedure, the patient presented with gradually worsening neurological disorder. Emergency magnetic resonance imaging revealed localized subarachnoid hematoma at the L3-4 level. The neurological disorder improved remarkably after L2-L5 laminectomy and hematoma removal.

Conclusions

During preoperative myelography for lumbar revision, lumbar puncture of a previously decompressed segment should be avoided if canal stenotic lesions exist in both craniocaudal adjacent segments. Incidental vascular injury and impaired cerebrospinal fluid flow due to adjacent canal stenoses may cancel the washout process of hemorrhage and cause subarachnoid hematoma.

Background

Malignant glomus tumors are extremely rare soft tissue tumors that are rich in tumor vessels. Due to its rarity, no treatment strategy other than resection has been established. Pazopanib, a multikinase inhibitor, is expected to improve the prognosis of patients with soft tissue sarcoma. However, there are no reports on the clinical outcomes of pazopanib in patients with malignant glomus tumors.

Case presentation

A 74-year-old man with a history of neurofibromatosis type 1 was diagnosed with a malignant glomus tumor on his left thigh, with multiple lung metastases at initial presentation. Doxorubicin was administered followed by pazopanib; however, tumor progression was not arrested.

Conclusion

To the best of our knowledge, this is the first reported case of a malignant glomus tumor treated with pazopanib. Further investigations on chemotherapy in patients with malignant glomus tumors are needed.

Background

Compartment syndrome of the foot（CSF）can be triggered by Lisfranc fracture dislocations. CSF has been generally treated using a 3-incision approach. We report a case in which CSF with Lisfranc fracture dislocation was treated by a 2-incision approach.

Case presentation

A 50-year-old man who suffered from a motorcycle accident was presented at our hospital. The patient had severe pain and swelling of his foot. A Lisfranc fracture dislocation was observed, and intracompartmental pressure showed 104 mmHg in the medial compartment. We diagnosed CSF with Lisfranc fracture dislocation. Decompression of all compartments of the foot and open reduction and fixation were performed using a 2-incision approach. Six months after surgery, the patient returned to work. The Japanese Society for Surgery of the Foot midfoot scale score was 74 points 13 months after surgery.

Conclusions

The 2-incision approach is useful for CSF associated with Lisfranc fracture dislocations.

Background

We report a case of a child who underwent the Masquelet technique for the reconstruction of bone defects caused by osteomyelitis of the radius.

Case presentation

A 9-year-old girl fell off playground equipment and sustained an open fracture of the forearm. She underwent emergency debridement and K-wire fixation. Swelling and redness of the forearms developed 1 month after the injury. Simple radiography revealed bone destruction of the radius, and osteomyelitis was diagnosed. Debridement was performed, and 6.5 cm of the radius was resected. After 8 weeks of treatment with antibiotics effective against the causative agent Enterobacter cloacae, the bone defect was reconstructed using the Masquelet technique. Bone fusion was achieved 3 months postoperatively, with no recurrence of infection during a 4-year follow-up.

Conclusions

The Masquelet technique could be an effective treatment option for upper-extremity bone defects in children.

Background

Pyrexia and leukocytosis are rare symptoms of paraneoplastic syndrome in patients with solid tumors.

Case presentation

A 56-year-old man presented with a large mass in the left thigh, and intermittent high fevers and leukocytosis. Core-needle biopsy resulted in a pathological diagnosis of dedifferentiated liposarcoma. Laboratory test revealed that granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) production levels were significantly elevated. Soon after surgical excision of the soft tissue sarcoma, the leukocytosis and systemic symptoms had dramatically resolved. After completing adjuvant chemotherapy, no tumor local recurrence or distant metastases have been found during 26 months of follow-up.

Conclusions

To the best of our knowledge, this is the second case report of a patient with dedifferentiated liposarcoma producing both G-CSF and IL-6. Clinicians should be aware that soft tissue sarcoma could cause pyrexia and leukocytosis as part of a paraneoplastic syndrome due to G-CSF and IL-6 production.

Background

Essex-Lopresti injury (ELI) is a rare injury accompanied by radioulnar dissociation with radial head (RH) fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) disruption. The reconstruction of IOM for the acute ELI remains controversial and challenging.

Case presentation

We report an acute ELI successfully treated with RH replacement, triangular fibrocartilage complex (TFCC) repair, and IOM reconstruction using synthetic graft through the radial and ulnar bone tunnels, in a 59-year-old man. Seven years after the injury, he had no complaints of wrist pain. The radiographs revealed no evidence of hardware loosening or enlargement in the size of the bone tunnels, in spite of slight accelerated capitellar wear and osteoarthritic change in DRUJ.

Conclusion

This study presents an alternative treatment for acute ELI by the combination with RH replacement, TFCC repair and IOM reconstruction using a synthetic graft. Longitudinal forearm stability may have reduced load transfer to the RH prosthesis.

Background

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a multiple disease group affecting the bones and joints. However, treatment for severe SAPHO syndrome is sometimes difficult, and treatment strategies have not been constructed.

Case presentation

We experienced a 23-year-old male with isolated chronic aseptic osteitis of the right proximal tibia, which was detected with magnetic resonance imaging and bone scintigraphy. We administered oral nonsteroidal anti-inflammatory drugs and local steroid injection, but his symptoms were not improved. Next, we administered oral methotrexate, which caused improvement effects, including decreased swelling and knee pain. In addition, the contrasted osteitis lesion in the proximal tibia demonstrated by magnetic resonance imaging completely disappeared.

Conclusions

Reports of osteitis in SAPHO syndrome resolved by methotrexate were rare. Although the effect of methotrexate on SAPHO syndrome was controversial, methotrexate should be considered for patients with refractory SAPHO syndrome before biologics.