Streeter's dysplasia, also known as amniotic band syndrome (ABS), is a rare congenital condition characterized by a wide spectrum of malformations, deformities, and, in severe cases, limb amputations. Other manifestations associated with ABS include clubfoot, distal finger or toe hypoplasia, and syndactyly. Although several theories have been proposed, the exact etiology of this syndrome remains unclear. In this case report, we present the 14-year follow-up of a patient diagnosed with ABS at birth who has been managed through a multidisciplinary approach since infancy. This report highlights the patient's clinical progression over the years and emphasizes the importance of multidisciplinary collaboration in achieving favorable clinical and functional outcomes.
Presentation: A 65-year-old female with a prior right-sided cephalomedullary nail fixation for a pertrochanteric neck of femur fracture fell from a gate onto her right hip. She was unable to weight-bear on her right leg and presented to the emergency department. Diagnosis: X-ray imaging in the emergency department diagnosed a peri-implant subcapital neck of femur fracture at the base of the lag screw threads. Treatment: After evaluation of multiple treatment options, the patient was managed conservatively with physiotherapy, progressive weight-bearing and bone protection interventions. Discussion: An unusual case of a peri-implant femoral neck fracture that is not well described by current classification systems is presented. This case presents interesting questions in the management of a rare complication of cephalomedullary nailing.
Background:The menisci provide mechanical stability and shock absorption in the knee joint, distributing stress across the tibial plateau. Root tears to the menisci are functionally equivalent to a total meniscectomy, frequently leading to rapidly progressive degenerative osteoarthritis within the knee joint. The majority of medial meniscal bony avulsions have been reported in younger, skeletally immature patients. Cases of bony avulsions in older patients have sparsely documented. Care Presentation:In this case report, we highlight the case of a 45-year-old male with a history of osteoporosis who sustained a twisting injury to the right knee which subsequently resulted in a bony avulsion injury of his medial meniscal root. MRI imaging was acquired, showing injury to the medial meniscus concurrent with an avulsion of the posterior root. A transtibial pullout repair was performed, anchoring the bony avulsion into its insertion site to allow for direct bone-to-bone healing. Conclusion:This case presents a unique mechanism of injury, as most medial meniscal root injuries in older patients involve a tear of the root rather than avulsion of the bone. Additionally, meniscal bony avulsions have been reported to mainly be a consequence of acute traumatic injury. We hypothesize that this patient's history of osteoporosis contributed to his bony avulsion, especially because of his age and his relatively nontraumatic mechanism of injury.
Purpose:We aim to present a novel approach to decompression of a periscapular abscess in the pediatric patient. Case:We present a 2-year-old male transferred to a Level 1 pediatric trauma center (PTC) from outside hospital (OSH) with MRSA positive blood cultures in sepsis. Before presentation to the OSH, the patient had several days of right upper arm pain with any movement and developed a fever the day before. Magnetic resonance imaging (MRI) of the right shoulder at PTC revealed subscapularis and supraspinatus abscesses. Utilizing a modified Judet approach, the supraspinatus abscess was directly decompressed. Through the same approach, a corticotomy of the scapular body was performed with a high-speed burr, and the subscapularis abscess was indirectly decompressed. Two drains were placed, and appropriate antibiotic therapy continued. Results:The patient was discharged on postoperative day 3 after transition to oral antibiotics by infectious disease. The patient was followed up in pediatric clinic on postoperative day 15 without recurrence of infection and with full painless range of motion. At that time, the incision was well healed without drainage or erythema. The patient was continued on oral Bactrim for two more weeks. To date, the patient has had no recurrence. Conclusion:We present a viable option for decompression of periscapular abscesses in the young pediatric population when traditional approaches such as deltoid split or deltopectoral would not be possible given the altered anatomy of the young and immature patients.
Fibrous dysplasia (FD) is a benign bone disorder characterized by replacement of normal bone with fibrous tissue and immature woven bone. Although rib involvement is not uncommon, large symptomatic lesions are rare. We report a case of giant monostotic FD of the sixth rib managed successfully in a resource-limited rural setting. A 22-year-old man presented with a progressively enlarging, painful swelling over the left chest wall for 3 years. Examination revealed a hard, immobile mass measuring 10 × 6 cm. Imaging showed a well-defined expansile lytic lesion with ground-glass matrix arising from the left sixth rib without cortical breach. Core biopsy confirmed FD. Owing to the lesion size, symptoms, and limited access to thoracoscopic facilities, open posterolateral thoracotomy with en bloc rib resection was performed. The resulting 8 × 6 cm defect was reconstructed using rib approximation without prosthetic mesh and covered with a pedicled latissimus dorsi flap. The postoperative course was uneventful, with complete recovery and no recurrence at 1-year follow-up. This case highlights that complete surgical excision provides excellent clinical outcomes for symptomatic rib FD and demonstrates that effective, low-cost reconstruction without synthetic materials is feasible in selected patients in resource-constrained settings.
Background:Acute exertional compartment syndrome (AECS) is a rare but limb-threatening condition that typically occurs in athletes or military recruits in the absence of trauma. Although the anterior compartment of the leg is most commonly affected, isolated lateral compartment involvement is distinctly uncommon. Delayed recognition is frequent and may result in serious complications, including acute kidney injury (AKI) and amputation. Case Presentation:We report the case of a 37-year-old previously healthy man who presented with severe lateral leg pain, progressive swelling and acute foot drop approximately 12 h after a high-intensity interval training (HIIT) session. Initial investigations revealed markedly elevated creatine phosphokinase, myoglobin and creatinine levels, and he was admitted with a provisional diagnosis of rhabdomyolysis-induced AKI. Despite aggressive intravenous hydration, his biochemical parameters worsened and leg pain intensified. Clinical assessment demonstrated a tense lateral compartment and a diagnosis of acute exertional lateral compartment syndrome was made, and urgent fasciotomy was performed. Postoperatively, pain rapidly improved and renal function normalised over several days. At 2-year follow-up, the patient had residual weakness of ankle dorsiflexion (MRC Grade 4) but had returned to moderate physical activity. Conclusion:Acute exertional lateral compartment syndrome is an exceptionally rare diagnosis and may present atypically, leading to delayed treatment. Clinicians should maintain a high index of suspicion in patients presenting with severe leg pain and neurological deficit following exercise. Early diagnosis and prompt fasciotomy remain critical to optimising functional outcomes.
Implant fracture is a rare but devastating complication of total hip arthroplasty (THA). We present the case of a patient with a history of prior acetabular fracture who underwent conversion to a dual mobility (DM) THA and subsequently fractured at the neck of the femoral component 7 years after surgery. At revision, both the femoral and acetabular components were noted to be clinically retroverted, suggesting chronic anterior impingement as the cause of the catastrophic failure.
Case:We present a case of a 10-year-old boy with a distal third both-bone forearm fracture, who developed delayed median nerve dysfunction following closed reduction and intramedullary nailing. The child later developed a nonhealing ulcer and sensory loss over the middle finger. Surgical exploration confirmed the nerve trapped within the callus; neurolysis and primary repair were performed. The patient showed progressive neurological recovery and complete sensory and motor restoration at 1-year after repair. Conclusion:Median nerve entrapment should be considered in cases of persistent pain or neurological symptoms following pediatric forearm fracture fixation. Early diagnosis and timely surgical intervention yield excellent functional outcomes.
Case:A 38-year-old woman was found to have a closed, chronically displaced left distal femur fracture sustained 5 years prior while living in South America. Prompt surgical intervention in her home country was inaccessible, leading to non-union, functional impairment, leg shortening, and soft tissue contractures. Dual-plate fixation, bone grafting, and quadricepsplasty were performed and the patient's function and mobility were restored to a degree commensurate with daily requirements. Conclusion:Chronically displaced distal femur fractures with nonunion, shortening, and soft tissue contractures can be safely and effectively managed with dual-plating, bone grafting, and quadricepsplasty.
Case:A 72-year-old Caucasian man presented with left knee osteoarthritis and underwent Mako robotic-assisted total knee arthroplasty (TKA). Two months postoperatively, he complained of mild discomfort in his left quadriceps and limited flexion, with an active range of motion (ROM) from 0° to 60°. At 10 months, his ROM had not improved, and plain radiographs revealed a large, calcified mass in the distal femur, which appeared to be emanating from the tracker pin sites used during Mako robotic-assisted TKA, raising concern for heterotopic ossification (HO). He subsequently underwent excision of the HO and was started on indomethacin. Conclusion:Surgeons performing robotic-assisted TKAs should be aware of the potential for HO formation at tracker pin sites as a possible complication, particularly in patients presenting with postoperative stiffness.
Background:Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are uncommon but severe carpal injuries. Although open or arthroscopic-assisted reduction with capsuloligamentous repair is recommended when feasible, access to suture anchors, appropriate nonabsorbable sutures, wrist arthroscopy, and advanced imaging may be inconsistent in resource-limited trauma settings. In such circumstances, temporary K-wire stabilization without formal ligament repair may represent a pragmatic stabilization strategy. Methods:We retrospectively reviewed 11 consecutive patients with acute PLD or PLFD treated between July 2019 and June 2024 in a single-center retrospective therapeutic case series (Level IV evidence). All patients underwent attempted fluoroscopic closed reduction followed, when necessary, by open reduction. Stabilization consisted of scapholunate and lunotriquetral pinning using two 1.6-mm K-wires, without formal ligament repair; associated fractures were fixed with K-wires as indicated. Outcomes included pain (VAS), QuickDASH, PRWE, Mayo Wrist Score (MWS), wrist range of motion, and grip strength. Radiographs assessed scapholunate distance (SLD) and scapholunate angle (SLA). Results:Mean age was 36.9 years and 81.8% of patients were male. All injuries resulted from high-energy trauma (nine road-traffic accidents and two sports-related injuries). Five patients had PLD and six had PLFD. Closed reduction was successful in three cases; eight required open reduction (six dorsal and two combined dorsal-volar). Mean follow-up was 50.5 months. Mean VAS was 3. Mean QuickDASH was 30.4, PRWE 37.5, and MWS 78.5. Mean flexion-extension arc was 101.8° and mean grip strength was 75.2% of the contralateral side. Mean SLD was 3.0 mm and mean SLA was 61.8°. No pin-tract infection, K-wire migration, avascular necrosis, or radiographic osteoarthritis was observed at mid-term follow-up. Conclusion:In this small Level IV case series, isolated K-wire stabilization without formal ligament repair was associated with heterogeneous mid-term outcomes after acute PLD and fracture-dislocations. Partial functional recovery was observed in many patients, but residual scapholunate malalignment persisted in some cases. These findings are descriptive and hypothesis-generating and should be interpreted cautiously in the absence of a comparative cohort. They should not be viewed as evidence of equivalence to ligament-repair techniques.
Tibial tubercle avulsion fractures are uncommon injuries that typically occur in skeletally immature adolescent males. Traditional fixation methods for these injuries utilize metal hardware, which carries risks including hardware prominence, irritation, need for a removal procedure, and potential interference with future MRIs. In this case report, we describe a surgical technique for the treatment of a tibial tubercle avulsion fracture in a skeletally immature adolescent athlete with a double-row suture anchor technique. A 15-year-old skeletally immature male sustained a left Ogden Type 1B tibial tubercle avulsion fracture while playing basketball. A left knee x-ray series and MRI confirmed a tibial tubercle avulsion fracture with no other knee injuries. After performing a midline, longitudinal approach centered over the fracture site, two double-loaded biocomposite suture anchors were placed just proximal to the fracture site. The sutures were passed from deep to superficial through the distal patellar tendon, just proximal to the fracture fragment. The fracture was reduced and provisionally held with a K-wire. The proximal sutures were tied in horizontal mattress fashion over the tendon. The remaining sutures were incorporated into two distal suture anchors, which were tensioned and placed distal to the fracture site, reducing and compressing the fracture. The patient was placed in a hinged knee brace locked in extension postoperatively. The patient progressed uneventfully through the postoperative course with no complications. At 5 months, the patient had returned to jogging. At 7 months, the patient had returned to sport-specific training and was cleared for full athletic activity. At final follow up at 9 months postoperatively, the patient had returned to playing tackle football without pain, weakness, or any symptoms. This technique has many potential benefits compared to traditional fixation methods, including lower risk of hardware complications or need for future hardware removal procedures.
Background:Coronoid process fractures are a common component of elbow injuries and present significant challenges in surgical management. The all-suture anchor fixation technique, as an emerging method, offers a novel alternative for stabilizing these fractures. By enabling dual-directional fixation, this approach provides bidirectional mechanical support, resulting in enhanced stabilization of the fracture fragment. Case Presentation:A 35-year-old male presented with a complex proximal ulnar fracture involving both the coronoid process (O'Driscoll Type III) and the olecranon. Surgical fixation was performed using an all-suture anchor inserted at the fracture site, with sutures strategically tied to a fixation plate, establishing a stable tension-band configuration. This construct provided controlled traction and stable three-dimensional support of the fragment. Postoperative recovery was uneventful, with full restoration of elbow function and no evidence of fragment displacement or complications. Conclusion:This case illustrates the technical feasibility of the all-suture anchor technique for coronoid fractures. In cases of complex proximal ulnar fractures, this technique allows for simultaneous fixation of the coronoid and olecranon through a single posterior approach, reducing soft tissue disruption.
Lateral ankle instability is a common condition in elite football, but returning to play following arthroscopic anatomic ligament reconstruction (AALR) typically requires 4-6 months. We report the case of a 24-year-old professional female football player who achieved a full return to elite competition and national team duties within 12 weeks following arthroscopic ALR of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments using an autologous gracilis graft. Preoperative instability followed recurrent sprains incurred during the World Cup, with examination and imaging demonstrating complete lateral ligament complex insufficiency. Arthroscopic exploration identified a complete ATFL/CFL rupture, anterolateral impingement, and a lateral talar chondral rail lesion, which were treated by synovectomy, debridement, and AALR. Rehabilitation followed an intensive, criterion-based protocol integrating immediate full weight-bearing, progressive range of motion, neuromuscular training, strength symmetry targets, and field-based functional testing. At 12 weeks, the athlete achieved full functional symmetry: AnkleGO score 25/25, FAAM-ADL and FAAM-Sport 100%, ALR-RSI 100%, symmetric hop performance, and unrestricted football-specific metrics. She returned to international duty without restrictions and completed full match participation. This case illustrates that arthroscopic anatomic reconstruction combined with structured high-performance rehabilitation can enable ultrafast return to elite football, challenging conventional timelines while illustrating an accelerated, criterion-based return in a single elite athlete rather than a generalizable target.
Femoral fractures are common injuries, typically demonstrating favorable outcomes with appropriate treatment. However, nonunion may occur due to several reasons. Osteoperiosteal decortication with bone grafting, initially described by Judet in 1969, has been recognized as a safe and effective method for managing nonunions. In this study, we aimed to determine the efficacy of this technique based on our experience in treating femoral nonunion. This case series included patients with femoral fracture nonunion who were treated with osteoperiosteal decortication performed by a single surgeon between April 2011 and January 2020. Data was collected from patients' medical records and hospital documents. The primary outcome measure was the attainment of clinical and radiographic unions during the follow-up period. The study included eight patients, including seven patients with diaphyseal fractures. Union was successfully achieved in all the patients. The mean time to union was approximately 6.13±2 months. Five patients resumed full weight-bearing activities before 6 months. No additional procedures were required for any patient. In conclusion, osteoperiosteal decortication with bone grafting is an effective treatment approach for managing nonunions with promising success rates. The outcomes were satisfactory, as evaluated through clinical and radiological examinations.
Background:Necrotizing soft tissue infections (NSTIs) are life-threatening and require emergent surgical debridement. Benign subcutaneous emphysema is a rare, noninfectious condition characterized by subcutaneous gas on imaging without systemic symptoms or abnormal laboratory values typical of NSTIs. Patients with subcutaneous emphysema and risk factors for NSTI can pose a diagnostic challenge. Case Report:We report an 18-year-old female with Ehlers-Danlos syndrome who developed left elbow pain and crepitus following multiple insect bites, freshwater pond exposure, and contact with farm animals. She was afebrile with a benign exam and normal labs, yet imaging demonstrated extensive upper extremity subcutaneous emphysema. Given the concern for NSTI, she was admitted on broad-spectrum antibiotics and underwent surgical exploration. Normal intraoperative findings, along with negative cultures and pathology, confirmed the diagnosis of benign subcutaneous emphysema. She was discharged postoperatively with oral antibiotics and made a full recovery. Conclusion:This case highlights the importance of multidisciplinary evaluation in differentiating benign from life-threatening subcutaneous emphysema to guide appropriate management and avoid unnecessary surgery.
The glomus tumor (GT) is a rare benign neoplasm, generally located in the subungual region of the distal phalanx of the fingers as a single nodule. While approximately 90% of digital GTs are correctly diagnosed (pain, cold sensitivity, and point tenderness), extradigital forms often present with silent or atypical features, complicating diagnosis. The treatment of choice is surgical excision, associated with low recurrence rates. In October 2022, a 64-year-old man presented with a painful, palpable mass in the distal third of the right femur. Magnetic resonance and computed tomography revealed a solid lesion involving the distal third of the femur. A needle biopsy confirmed the diagnosis of GT with hemangiopericytoma-like features. In January 2023, surgical excision was performed, and histology confirmed the diagnosis. The patient had a significant oncologic history: In 1994, he underwent wide resection and adjuvant chemotherapy for a high-grade undifferentiated sarcoma of the right thigh. In November 2012, he reported a painful mass in the right ankle, and excisional biopsy with immunohistochemistry led to a diagnosis of multifocal GT. At his last follow-up in November 2025, he was in good general health under oncologic surveillance. We conducted a search on PubMed and Scopus using the keywords “extra digital glomus tumor” and included articles reporting extra digital GTs of the lower limb. The literature review identified 143 patients with extradigital GT with lower limb involvement. This case represents a rare presentation because of its unusual lower limb location, with lesions in the ankle in 2012 and the femur in 2022. We report a rare case of a late metachronous extradigital GT of the lower limb in an unusual anatomical site.
This case describes a previously underreported case of flexor tenosynovitis. A 23-year-old male slaughterhouse employee presented with several weeks of increased pain and swelling in their left third digit. They failed nonoperative management, including anti-inflammatory medication and oral steroids, followed by corticosteroid injection. Intraoperative pathology demonstrated subacute flexor tenosynovitis due to a rare parasitic infection of Dirofilaria immitis. Dirofilaria immitis, a parasitic roundworm commonly found in dogs, rarely causes zoonotic infections in humans. In cases when this parasite infects humans, it primarily impacts pulmonary, ocular, and subcutaneous tissues. This diagnosis was ultimately only able to be made due to pathologic analysis, as they had negative cultures. This case highlights that tissue pathology is essential in atypical infections, especially culture-negative tenosynovitis.
Background:Brachial plexus schwannomas are rare tumors requiring individualized surgical planning. Despite established surgical principles, the optimal approach varies substantially by tumor location, and direct comparative data across techniques remain limited. Cases:We present three cases illustrating distinct surgical strategies. A 59-year-old woman with foraminal and intradural extension underwent staged posterior laminectomy followed by supraclavicular resection, who recovered with no clinically significant neurologic deficits. A 69-year-old woman with upper trunk involvement had successful supraclavicular excision with complete symptom resolution. A 68-year-old man with a retroclavicular tumor required transclavicular access via clavicular osteotomy; he experienced immediate pain relief but developed osteotomy nonunion requiring revision fixation before achieving full functional recovery at 2.5 years. Conclusion:These cases demonstrate that approach selection should be driven by tumor location, anatomical extent, and intradural involvement. Careful anatomical assessment and multidisciplinary collaboration are important considerations for maximizing resection while preserving neurological function.
Osteochondroma, or osseocartilaginous exostosis, is the most common benign bone tumor, accounting for approximately 30%-35% of benign bone lesions and predominantly arising from the metaphyseal regions of long bones in young males. Mid-diaphyseal origin and multilobed morphology are exceptionally uncommon and may present diagnostic and surgical challenges. We report a rare case of a solitary, multilobed osteochondroma arising from the posterior humeral midshaft in an 18-year-old male. The patient presented with a 1-year history of a gradually enlarging, painless mass over the lateral aspect of the left upper arm, without functional limitation or neurovascular symptoms. Physical examination revealed a firm, immobile, nontender mass with intact distal neurovascular status. Magnetic resonance imaging demonstrated a pedunculated osseous lesion measuring 6.5 × 3.3 × 2.3 cm, exhibiting continuity with the humeral medullary cavity and a distinctive three-lobed configuration, including a bilobed stalk. The cartilage cap thickness measured approximately 4 mm, with no surrounding soft tissue abnormalities. Surgical excision was performed via a posterior longitudinal approach, with careful identification and preservation of the radial nerve. Intraoperatively, three distinct pedunculated bony stalks arising from the posterior humeral midshaft were excised en bloc. Histopathological analysis confirmed a benign osteochondroma, showing mature trabecular bone capped by hyaline cartilage without atypia or malignant features. To the best of our knowledge, no previous report has specifically described this combination of posterior humeral mid-diaphyseal location and multilobed morphology. This case expands the anatomical and morphological spectrum of osteochondroma and highlights the critical role of advanced imaging in preoperative planning, particularly for lesions in proximity to major neurovascular structures. Recognition of such atypical presentations is essential to ensure accurate diagnosis, safe surgical management, and avoidance of iatrogenic complications.
