Case Reports in Orthopedics最新文献

Patients with neurological conditions like cerebellar atrophy and ataxia face many challenges when recovering from fractures. This case report details the management and recovery of a 45-year-old woman with severe, pre-existing cerebellar atrophy and ataxia who sustained a right femoral shaft fracture after a fall. Before her injury, her neurological impairment required her to use a walker to move around. She underwent open reduction and internal fixation (ORIF) and was given a 3-month period during which she could not put weight on her leg. Her rehabilitation involved a team approach focused on specific goals, emphasizing early knee range-of-motion exercises. Given her dual diagnosis, the intensive program focused on various training components, including progressive resistance, coordination drills, and challenging balance exercises. These exercises have been shown to reduce ataxia symptoms and improve motor function significantly. The tailored intervention operated on the idea that the quality and difficulty of rehabilitation are key factors for positive outcomes in patients with degenerative cerebellar ataxias (DCAs). After 3 months, the fracture healed well, and the patient moved to full weight-bearing, showing significant improvements in mobility and independence. This case highlights that a unified, specialized, and evidence-based team approach can lead to successful functional recovery, even in complex neuro-orthopedic situations. It aligns with modern rehabilitation methods that focus on enhancing the quality of life by reducing secondary impairments.

Medial-end clavicle fractures are rare, and the published literature is limited. Most injuries can be managed nonoperatively with favorable outcomes; however, displaced or comminuted fractures, symptomatic delayed union/nonunion, or fixation failure may require surgery, and operative management is challenging because of the proximity to vital mediastinal structures. We describe a 38-year-old man with a left medial-end clavicle fracture sustained in a fall from approximately 9-10 m. Two prior plate fixation attempts at an outside clinic failed to maintain stable reduction, with persistent pain and fracture-site prominence. At our facility, computed tomography confirmed an intact sternoclavicular joint but revealed severe comminution at the proximal fracture site with anterosuperior displacement of the distal fragment. We removed the failed hardware and performed revision fixation using a clavicle hook plate, intentionally limiting screw purchase to the distal fragment to reduce mediastinal risk. Postoperatively, teriparatide was administered as an adjunctive therapy because of concern for impaired healing after repeated fixation failure. The implant was removed on 28 October 2024 after radiographic union, and at the final follow-up on 18 April 2025, union was maintained and pain was minimal (VAS ≤ 1/10); standardized functional outcome scores were not available. This single case suggests that hook plate fixation may be a salvage option when safe medial screw purchase is not feasible; interpretation is limited by the case-report design and adjunctive pharmacologic therapy.

The occurrence of isolated tarsal navicular dislocation without fracture is infrequently documented in the orthopedic literature. Over the past century, there have been approximately 15 cases reported of isolated navicular dislocation without a fracture. The majority of these cases resulted from high-energy mechanisms with limited follow-up. The injury mechanism has commonly been explained as a pronation-abduction force applied to the midfoot, leading to a medial dislocation of the navicular with disruption of its ligamentous support. We present a unique case of a 57-year-old female who sustained an isolated tarsal navicular dislocation without fracture following a low-energy mechanism. She underwent successful closed reduction, followed by Kirschner wire fixation of the midfoot in the operating room. The patient was compliant with postoperative recommendations and regularly attended follow-up appointments. Significant progress was noted in pain relief and functional improvement at her 8-month follow-up. Nonetheless, certain long-term sequelae persisted, manifesting as mild chronic midfoot pain by her 15-month follow up. The low energy mechanism in this case not only deviates from what has been previously documented in the literature regarding isolated navicular dislocations but also includes thorough follow-up, a feature often lacking in similar cases.

Case: Osteochondromas are common benign bone tumors. Rarely, these lesions present on the ribs and can be concerning for a breast mass. This case discusses a healthy 21-year-old female with a firm, fixed, painful breast mass. Her initial ultrasound and 6-month follow-up ultrasound were both benign. The mass gradually increased in size with continued pain over 2 years. Almost two and a half years after presentation, the patient had an additional ultrasound and CT chest revealing a bony exostosis from the anterior aspect of the third rib. Excision was performed in a joint case with orthopedic oncology and plastic surgery, with pathology confirming the diagnosis of an osteochondroma.

Conclusion: It is important to consider alternative diagnoses, such as rib osteochondroma, in the differential diagnosis of firm, fixed breast masses in young, postpubescent females.

An 81-year-old woman underwent total hip arthroplasty for a femoral neck fracture. Five days after surgery, she fell and sustained a periprosthetic fracture, for which she subsequently underwent revision surgery. Her postoperative course was uneventful; however, 4 years after surgery, she noticed redness and warmth over her left hip several days after receiving acupuncture. Purulent discharge subsequently developed, prompting her to visit our hospital. Imaging studies revealed abscess formation and osteolysis around the left hip, leading to a diagnosis of periprosthetic infection. After conservative treatments failed, surgical debridement and continuous local antibiotic perfusion therapy were performed. Her condition improved, and she was discharged home, ambulatory with a cane. Although serum inflammatory markers remained mildly elevated, suggesting a low-grade infection, there has been no recurrence of purulent discharge, and she has returned to her usual daily activities. Periprosthetic infection is a highly challenging complication, often resulting in the removal of implants and leading to a significantly diminished quality of life. Although acupuncture is generally regarded as safe, this case illustrates that deep infection can occur in patients with prosthetic joints. While a complete cure was not achieved in this case, the use of CLAP therapy contributed to clinical improvement and functional recovery, highlighting its potential role as an adjunctive treatment strategy. Given the potential risks of infection, physicians should inform patients with artificial joints about the potential infectious risks of acupuncture.

Introduction: Septic arthritis is an uncommon but severe complication of intra-articular procedures and is associated with significant morbidity and mortality when diagnosis or source control is delayed. Large cohort data have demonstrated adverse joint and systemic outcomes even when surgical washout is performed.

Case presentation: We report the case of a 64-year-old woman with Type 2 diabetes mellitus who developed septic arthritis of the knee 2 days after intra-articular hyaluronic acid injection, a procedure generally considered safe but known to carry a small risk of infection. Synovial fluid cultures identified Streptococcus anginosus and subsequently Streptococcus gordonii, organisms recognised for their propensity to cause invasive and disseminated infections. Despite prolonged hospitalisation and exposure to multiple sequential broad-spectrum antibiotic regimens, the infected joint was not surgically drained. During treatment, the patient developed persistent diarrhoea, abdominal pain and systemic inflammatory features. Repeated testing for Clostridioides difficile was negative, despite recognised associations between antibiotic exposure, acid-suppressive therapy and enteric complications. Computed tomography later demonstrated intestinal dilatation and ultimately pneumoperitoneum. Emergency bowel resection was performed, but the patient died shortly thereafter from multiple organ failure. Histopathological examination revealed extensive inflammatory ulceration of the colon.

Conclusions: This case illustrates a complex and fatal clinical course occurring in the context of persistent septic arthritis managed without joint drainage and prolonged antimicrobial exposure. Although causality cannot be established from a single report, the case reinforces the importance of timely source control in native joint septic arthritis, highlights the consequences of prolonged empirical antimicrobial therapy in the absence of adequate surgical debridement and underscores the need for early multidisciplinary reassessment when gastrointestinal symptoms arise during prolonged hospitalisation.

Humeral shaft fractures are prevalent, with the majority receiving nonoperative treatment using a functional brace. However, some patients necessitate surgical intervention either as an initial approach or in cases where nonunion arises despite conservative management. This case report presents a patient who initially sustained a closed humeral shaft fracture managed nonoperatively with a Sarmiento brace. Unfortunately, she progressed to nonunion, prompting the need for surgical intervention via open reduction and internal fixation. Following surgery, she experienced hardware failure but ultimately achieved union after returning to her Sarmiento brace.

We report a case of a 14-year-old Asian male who presented with a Salter-Harris Type II injury of the proximal tibial epiphysis and a fibular fracture following a minor mechanism of injury. The patient was emergency transported to our hospital with complaints of pain and flexion deformity around the left knee following a contusion. Imaging studies confirmed the diagnosis of a Salter-Harris Type II injury of the proximal tibial epiphysis. Given the minor mechanism of injury, blood tests revealed vitamin D deficiency. Under general anesthesia, manual reduction and percutaneous pin fixation were performed, resulting in good bone union and functional recovery. This case highlights the importance of considering vitamin D status when managing pediatric fractures following minor mechanisms of injury or unusual fractures and epiphyseal injuries.

Multiple hereditary exostosis (MHE) is a rare autosomal-dominant disorder marked by multiple osteochondromas arising from the metaphyses of long bones. Parameniscal cysts, often linked to meniscal tears, can also expand and compress nearby vessels, posing a potential vascular risk. We present a 28-year-old male with MHE and a parameniscal cyst causing popliteal artery compression. The patient's intermittent claudication resolved completely following surgical cyst decompression and meniscal repair. This case report highlights the importance of considering vascular compression in patients with MHE who present with lower extremity symptoms.

Muscle amyotrophy and infarction are known to be rare complications of patients with diabetes mellitus and poor glycemic control. However, primary pyomyositis, an especially rare infection of the primary muscles, is also a problem that cannot be ignored. Primary pyomyositis typically begins as a subacute condition and is probably due to transient bacteremia. Here, we report on two patients with Type 2 diabetes mellitus and poor glycemic control who developed primary pyomyositis, which manifested as abscesses of the adductor and pectineus muscles. Both patients underwent surgical drainage, and one patient additionally underwent internal fixation while receiving a continuous local antibiotic perfusion. Both patients were well and without signs of recurrence at their final follow-up visit. Primary pyomyositis, in addition to muscle amyotrophy and infarction, should be included in the differential diagnosis of infections occurring in patients with painful lesions in the lower extremities and Type 2 diabetes mellitus with poorly controlled glycemia.