Introduction:Osteoblastomas are rare, benign, osteoid-producing primary bone tumors that typically occur in adolescents and young adults. They constitute only 1% of all bone tumors and are exceptionally rare in the hand and wrist. Carpal bone involvement is exceedingly uncommon, with only 9 cases reported in the literature involving the hamate. This case is important to report because the occurrence of this neoplasm in the fifth decade of life is extremely rare, making it one of the very few reports of hamate osteoblastoma in late adulthood. Case Report:A 51-year-old male presented with a 2½ year history of persistent pain and progressive swelling over the dorsal aspect of the ulnar side of the left wrist. The pain was unrelieved by painkillers and worsened after minor trauma. Clinical examination revealed a firm, tender swelling accompanied by joint stiffness. Radiographs showed a well-defined lytic lesion with a sclerotic rim in the hamate, whereas further imaging demonstrated blood-fluid levels. Histopathology confirmed the diagnosis of osteoblastoma. He underwent extended curettage followed by filling the defect with an autologous cancellous bone graft. The patient experienced rapid symptomatic relief, returned to routine activities with full range of motion, and showed no signs of recurrence at the 18-month follow-up. Conclusion:This case report demonstrates that despite its rarity, osteoblastoma should be considered in the differential diagnosis of persistent, non-traumatic wrist pain, even in older adults. This original case is of particular interest to the orthopedic specialty, as it advances our clinical knowledge by proving that joint-preserving methods can ensure structural stability and resolve symptoms. Early recognition and meticulous surgical management with extended curettage and bone grafting provide excellent long-term outcomes while minimizing recurrence risk and avoiding radical resections that significantly impair wrist mobility.
Introduction:Melorheostosis is a rare, sporadic sclerosing bone dysplasia characterized by cortical hyperostosis with the classical "dripping candle wax" appearance on radiographs. It predominantly affects long bones of the appendicular skeleton and may mimic neoplastic or inflammatory bone disorders, creating diagnostic challenges. Case Report:A 28-year-old male presented with progressive pain and diffuse swelling of the right lower limb for 2 months. Examination revealed a hard swelling extending from the knee to the foot, fixed to the underlying bone with preserved joint mobility and no inflammatory signs. Radiographs demonstrated irregular cortical hyperostosis along the tibial shaft with the characteristic "dripping candle wax" appearance, with additional sclerotic involvement of the distal femur and multiple tarsal bones. Bone scintigraphy showed increased tracer uptake in the affected regions, whereas magnetic resonance imaging revealed cortical thickening without aggressive periosteal reaction or soft-tissue mass. Histopathology confirmed dense lamellar bone with osteoblastic rimming and no evidence of malignancy. A diagnosis of polyostotic melorheostosis was established. The patient was managed conservatively with analgesics and remained clinically stable with symptomatic improvement on follow-up. Conclusion:Polyostotic melorheostosis should be considered in patients presenting with unilateral limb pain and cortical hyperostosis. Recognition of the characteristic radiographic appearance is critical for accurate diagnosis and to avoid unnecessary invasive or aggressive treatment.
Introduction:Glomus tumor is a rare benign vascular neoplasm arising from the glomus body, a specialized thermoregulatory arteriovenous shunt concentrated in the digits. Although small in size, these tumors produce disproportionate pain and significant impairment in quality of life. Delayed diagnosis is common due to non-specific presentation and subtle imaging findings. Case Report:A 21-year-old male presented with severe localized pain over the left thumb for 6 months. The pain was insidious in onset, progressive in nature, and associated with marked cold hypersensitivity. The patient described excruciating pinpoint pain near the nail bed, aggravated while washing hands and during exposure to cold weather. There was no history of trauma, smoking, steroid use, or systemic illness. Clinical examination revealed localized tenderness over the subungual region without visible swelling or deformity. Plain radiographs demonstrated subtle cortical scalloping of the distal phalanx. Magnetic resonance imaging (MRI) revealed a well-defined subungual lesion that was hypointense on T1-weighted images and hyperintense on T2-weighted images, consistent with glomus tumor. The patient underwent complete surgical excision through a nail-sparing paraungual approach. Histopathological examination confirmed the diagnosis of glomus tumor. Postoperatively, the patient experienced dramatic pain relief with restoration of normal thumb function and no evidence of recurrence during follow-up. Conclusion:Glomus tumor should be considered in patients presenting with chronic fingertip pain, cold sensitivity, and localized tenderness even in the absence of obvious swelling. MRI plays a crucial role in diagnosis and surgical planning. Complete surgical excision using a nail-preserving approach provides excellent symptomatic relief and functional outcome.
Introduction:Gas within a degenerated lumbar disc is common on computed tomography (CT), but a gas-filled disc herniation producing radiculopathy is uncommon. Recognition usually depends on CT rather than magnetic resonance imaging (MRI). Gas-containing disc herniation produces symptoms through mass effect rather than extrusion of disc material. Case Report:A 62- year-old man presented with chronic right S1 radicular pain, sensory loss, reduced Achilles reflex, and weakness of the gastrocnemius. Imaging showed severe degeneration at L5-S1 with a lesion containing intradiscal gas. Endoscopic inspection demonstrated a tense diverticular outpouching of the disc compressing the descending nerve root. Puncture of the lesion released gas under direct vision, followed by removal of residual pathology. Symptoms improved immediately and remained improved at review. Conclusion:CT is the most reliable modality for detecting intradiscal gas and should be carefully reviewed when symptoms and MRI findings do not align. Gas-filled disc herniation should be included in the differential diagnosis of lumbar radiculopathy when CT demonstrates intradiscal gas adjacent to a nerve root. Endoscopic decompression provides definitive diagnosis and effective treatment.
Introduction:Monteggia fractures account for <2% of all forearm fractures, with malunion or nonunion occurring in approximately 2-10% of cases. Case Report:A 42-year-old female with no significant past medical history presented to the emergency department after a motor vehicle collision and was diagnosed with a Type IIC Monteggia fracture. She underwent open reduction internal fixation and failed to heal in the allotted time frame. A multifactorial approach to heal the nonunion was utilized and consisted of bone allograft, implantable bone stimulator, and platelet-rich plasma injection. With the help of the allograft, the patient was able to heal. Discussion:This case illustrates the importance of considering bone allografts in Type IIC fractures to prevent return to the OR in the case of nonunion. Conclusion:Consideration of bone allograft can prevent unnecessary return to the operating room and guide appropriate treatment.
Introduction: First metatarsophalangeal (MTP-I) arthrodesis is a reliable procedure for end-stage hallux rigidus and selected complex first-ray deformities. Non-union is uncommon but clinically important, particularly when associated with pain, osteolysis, implant fatigue, and loss of correction. Revision is challenging because failure is usually multifactorial rather than the consequence of an isolated implant problem. Case Report: A 62-year-old woman with a 45 pack-year smoking history underwent MTP-I arthrodesis for advanced hallux rigidus with hallux varus and associated lesser-toe deformity. The index procedure used cup-and-cone joint preparation and dorsal plate fixation. Radiographs at 3 months showed maintained alignment but incomplete consolidation. Progressive pain and swelling developed during weight-bearing, and at 6 months radiographs demonstrated dorsal plate breakage. Computed tomography (CT) confirmed established pseudarthrosis with osteolysis involving the base of the proximal phalanx. Before revision, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein were normal; intraoperative cultures obtained during revision were negative. Revision included removal of failed hardware, complete debridement of fibrous pseudarthrosis and sclerotic bone, insertion of a tricortical iliac crest autograft to restore length and bone stock, interfragmentary compression screw fixation, stronger revision dorsal plating, correction of the second-ray deformity, and prolonged post-operative protection. Smoking cessation was achieved after revision. Outcome: The post-operative course was uncomplicated. At 3 months, the patient walked in regular footwear without pain or swelling. CT at 6 months demonstrated graft incorporation, bridging trabecular bone and stable fixation. The American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score improved from 29/100 before revision (pain 0, function 29, and alignment 0) to 85/100 after revision (pain 30, function 40, and alignment 15). Conclusion: Failed MTP-I arthrodesis should be analyzed systematically through biological, mechanical, and whole-forefoot factors. Structural autografting, compression-based revision fixation, correction of associated deformity, and individualized protection can achieve union even after plate breakage and established pseudarthrosis. Keywords: Hallux rigidus , first metatarsophalangeal arthrodesis , non-union , pseudarthrosis , revision arthrodesis , iliac crest graft , plate breakage , smoking , case report
Introduction:Distal radius fractures commonly result from falls onto an outstretched hand, making them a frequent presentation in orthopedic practice. However, pisiform dislocation associated with a distal radius fracture is uncommon, due to the pisiform's protected anatomical position and the distinct biomechanical forces typically required for its displacement. When this combined injury pattern is further complicated by ulnar nerve neuropraxia, it becomes rare and may be easily overlooked. The clinical subtlety of pisiform dislocation can lead to diagnostic delay, potentially resulting in inappropriate management if not recognised early. Case Repoprt:We report a rare clinical scenario involving a right-hand dominant woman in her early 50s who sustained a distal radius fracture along with a scaphoid fracture and pisiform dislocation complicated by ulnar nerve neuropraxia following a high-velocity motorcycle-related trauma. At presentation, the patient exhibited severe wrist pain, swelling, and notable sensory impairment within the ulnar nerve distribution. Initial standard radiographs identified distal radius and scaphoid fractures. Following closed reduction of the radius fracture, a pisiform dislocation was revealed radiographically and confirmed through computed tomography (CT) imaging. Sagittal CT sections demonstrated volar migration of the pisiform relative to the triquetrum, with significant widening of the pisotriquetral joint space and complete loss of articular congruity, confirming a volar pisotriquetral dislocation. Closed reduction was successfully performed with the wrist placed in palmar flexion, significantly alleviating ulnar nerve symptoms immediately. A short-arm plaster cast immobilization was utilised, extending to the thumb to stabilize the scaphoid fracture simultaneously. The cast was maintained for six weeks, resulting in complete fracture healing and maintenance of pisiform alignment, as confirmed by follow-up imaging. At 9 months post-injury, structured physiotherapy facilitated a full return to routine activities with excellent wrist and finger mobility and resolution of all neurological deficits. Conclusion:Pisiform dislocation associated with distal radius fracture represents a rare and complex injury combination, further complicated by ulnar nerve involvement. Clinicians must maintain a high degree of suspicion and adopt advanced imaging modalities early to avoid missing such diagnoses. Prompt closed reduction and conservative management can yield favorable outcomes, highlighting the importance of early recognition and appropriate intervention in such uncommon scenarios.
Introduction:Chronic Monteggia fracture-dislocations, characterized by persistent radial head dislocation and ulnar malunion, pose significant reconstructive challenges. While three-dimensional (3D) printing has shown promise in upper extremity deformity correction, its application in chronic Monteggia lesions remains limited. Case Report:We report the case of a 24-year-old male presenting with a 1-year history of forearm pain following failed surgical management of a Monteggia fracture. Radiographs revealed a Bado type I chronic Monteggia fracture-dislocation. A personalized 3D-printed osteotomy guide was designed from pre-operative computed tomography data to assist in corrective ulnar osteotomy. The surgical plan included implant removal, corrective osteotomy using a customized surgical guide, bone grafting, and annular ligament reconstruction if unstable radiocapitellar joint after correction. Postoperatively, the patient initially regained functional elbow motion but later developed oligotrophic non-union. Revision surgery with repeat bone grafting resulted in solid union and complete functional recovery. Conclusion:This case highlights the potential of 3D-assisted pre-operative planning and patient-specific guides in managing chronic Monteggia deformities. It contributes to the growing evidence supporting personalized surgical technologies in complex upper-limb reconstruction.
Introduction:Chondrosarcoma is the second most common primary malignant tumor accounting for 20-27% of these. These are malignant cartilaginous tumor found most commonly in the pelvis, followed by the proximal femur. Perivascular epitheloid cell tumor (PEComa) is a rare mesenchymal neoplasm. These tumors all share a distinctive cell type, the perivascular epithelioid cell (which has no known normal tissue counter - part).These are post commonly found in visceral sites such as gastrointestinal and uterus, in retroperitoneum and abdominal pelvic sites, rarely affecting skeletal system. Case Report:A 45-ycar-old female was presented in the orthopedic outpatient department with a 2-year history of pain and swelling in her right hip with recent weight-bearing difficulties for 1 week after trivial slip and fall. X-rays revealed a lytic lesion in her right proximal femur along with neck of femur fracture. Biopsy revealed perivascular epitheloid tumor. Diagnosed with primary bone PEComa without metastasis in the right proximal femur, the patient underwent wide local excision and reconstruction using a mega-prosthesis.Post-operative histopathological evaluation surprisingly identified a low-grade chondrosarcoma, but with clear surgical margins. Conclusion:This case highlighted an unusual diagnostic discrepancy between pre-operative and post-operative evaluations. Nonetheless, the adopted strategy was effective, allowing the patient to resume daily activities. Surgeons should remain aware of the potential for primary bone tumors to masquerade as atypical tumors.
Introduction:Heel pad degloving injuries represent one of the most challenging problems in lower-extremity reconstruction because durable soft-tissue coverage must withstand repetitive weight-bearing while minimizing infection, wound breakdown, and limb loss. Case Report:We report the use of staged fish-skin xenograft reconstruction as a limb-salvage strategy in a 24-year-old man who sustained a severe heel pad avulsion with multiple open fractures of the foot and ankle following an all-terrain vehicle accident. Initial management consisted of serial irrigation and debridement, fracture stabilization, and negative-pressure wound therapy; however, progressive heel pad necrosis resulted in a 22 × 15 × 0.5 cm full-thickness plantar soft-tissue defect extending to the calcaneus despite aggressive wound management. The patient was subsequently counseled regarding below-knee amputation due to the severity of soft-tissue loss but elected to pursue limb salvage following multidisciplinary discussion of reconstructive options. Three sequential applications of a fish-skin acellular dermal matrix (Kerecis) were performed over 8 weeks, resulting in progressive granulation tissue formation and development of a robust, well-vascularized wound bed suitable for definitive reconstruction. Subsequent full-thickness skin grafting to the heel and split-thickness skin grafting to the surrounding soft-tissue defects achieved complete wound closure without infection, graft loss, or wound breakdown. Hypertrophic scarring and contracture that developed during follow-up were successfully treated with fractional carbon dioxide laser therapy. At 1-year follow-up, the reconstructed heel remained completely healed without recurrent ulceration or infection, demonstrating durable soft-tissue coverage capable of tolerating the biomechanical demands of a weight-bearing plantar surface. Conclusion:This case demonstrates the potential role of staged fish-skin xenograft application as a biologically active reconstructive adjunct for wound-bed preparation and limb salvage in complex heel pad degloving injuries. In situations where immediate flap reconstruction is undesirable, and limb salvage remains the patient's goal, staged xenograft reconstruction may expand the reconstructive armamentarium while preserving ambulatory function.
Introduction:Diabetic foot infection complicated by severe ischemia is associated with high morbidity and frequently culminates in major amputation. Case Report:We report the case of a 62-year-old man with poorly controlled type 2 diabetes mellitus (HbA1c 11.0%), severe peripheral arterial disease, and chronic heavy smoking who presented with a chronic gangrenous, non-healing right foot wound after multiple failed partial amputations and lower-extremity angioplasties. The patient repeatedly refused major amputation. A multidisciplinary limb-salvage approach involving vascular surgery, infectious disease, endocrinology, podiatric surgery, and wound care was, therefore, undertaken. Management included repeat revascularization, targeted antimicrobial therapy, serial debridement, proximal midfoot amputation with Achilles tendon lengthening, negative pressure wound therapy, acellular dermal matrix grafting, and local flap coverage. The wound gradually stabilized with progressive granulation and resolution of infection. At 12-month follow-up, the patient remained free of recurrent infection, required no further amputation, reported minimal pain, and was ambulating independently with custom footwear. Conclusion:This case highlights proximal midfoot amputation as a functional alternative to major amputation in selected high-risk patients when supported by sustained multidisciplinary care.
Introduction:Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by significant bone fragility and progressive skeletal deformities. While cubitus varus (CV) is a common complication after pediatric supracondylar fractures, deformities exceeding 40° in patients with OI are exceptionally rare. This report describes a severe case managed through a staged surgical strategy to overcome challenges associated with bone fragility. Case Report:A 4-year-old male with OI presented with a 45° CV deformity of the right elbow following recurrent fractures. Due to extreme bone fragility and the complexity of the 3D deformity, a staged surgical plan was implemented. The initial surgery prioritized osteotomy site stability and coronal correction using a stepped cut osteotomy. Once bone union was achieved, a second corrective wedge osteotomy was performed a year later to refine the alignment. At the final follow-up at age 7, the patient maintained a 15° carrying angle and a good range of motion. The improved alignment successfully prevented further fractures. Conclusion:For complex pediatric elbow deformities with underlying bone fragility, a staged approach prioritizing stability over immediate anatomical perfection is a realistic strategy. Establishing a shared understanding with the family regarding the potential necessity of multiple procedures is essential for clinical success and safety.
Introduction:Serratia marcescens is an opportunistic Gram-negative bacterium infrequently implicated in septic arthritis, with ankle involvement reported only in isolated cases. Case Report:We present a 45-year-old male with systemic lupus erythematosus on long-term corticosteroids, prior ischemic stroke with residual left hemiparesis, and end-stage renal disease on hemodialysis through a permanent catheter, who developed septic arthritis of the left ankle following a recent episode of presumptive hospital-acquired pneumonia. Concurrent blood and joint aspirate cultures both confirmed S. marcescens with antimicrobial susceptibilities largely retained (resistant only to ceftriaxone and cefoperazone-sulbactam), supporting. Conclusion:This case highlights the importance of considering a broad range of pathogens in immunocompromised patients with acute monoarthritis, the value of concurrent blood and synovial cultures in identifying the infectious source, and the use of ring fixator arthrodesis as a biologically appropriate solution for infected, systemically compromised joints.
Introduction:The proximal humerus is the most common site for primary malignant tumors of the upper limb, with chondrosarcoma, Ewing sarcoma, and osteosarcoma being the most frequent malignancies. Conservative treatment presents significant challenges regarding oncological resection due to the complex neurovascular anatomy and subsequent bone defect reconstruction. Case Report:We report the case of a 29-year-old North African male managed for Ewing sarcoma of the proximal humerus. Locoregional staging showed tumor extension to the triceps, but no involvement of the deltoid, rotator cuff, or neurovascular bundle. Distant staging revealed pulmonary nodules. The patient underwent neoadjuvant chemotherapy with complete resolution of pulmonary nodules and soft-tissue extension. The patient underwent tumor resection with reconstruction using a non-vascularized fibular graft and fixation with an anatomical plate and intramedullary pin, achieving good functional outcomes (Musculoskeletal Tumor Society Score [MSTS] of 80%) and no recurrence at 30 months of follow-up. Conclusion:Limb-sparing management of proximal humeral tumors faces several challenges: achieving oncological resection due to the complex musculotendinous and neurovascular anatomy of the shoulder, and the subsequent challenge of reconstructing the bone defect. Indications and functional outcomes depend heavily on the involvement of the deltoid, axillary nerve, glenoid, and rotator cuff. Biological reconstruction represents a valuable alternative to prosthetic replacement in appropriately selected cases.
Introduction:Clavicle fractures are common injuries encountered in orthopedic practice, but the combination of bilateral pneumothorax, extensive subcutaneous emphysema, and pneumoscrotum without rib fractures is rare and potentially fatal. These complications are usually accompanied by pneumomediastinum and air leak in cases of blunt chest trauma. Case Report:A 74-year-old male fell and sustained a fracture of the right clavicle and scapula. While in hospital, he presented with respiratory symptoms and widespread chest wall, neck, back, and scrotal subcutaneous emphysema. Thoracic computed tomography revealed bilateral pneumothorax, extensive subcutaneous emphysema, and no rib fractures. He was intubated, and a drain was placed in an intercostal space. The fractured clavicle was treated with open reduction and internal fixation with a plate and screws. After the removal of the intercostal drain (ICD), the patient had recurrent subcutaneous emphysema with respiratory distress that required re-intubation and re-insertion of the ICD. The patient recovered with further conservative management and was discharged well. Conclusion:Pneumoscrotum with extensive subcutaneous emphysema after clavicle fracture without rib fracture is rare. Potential air leak and pneumomediastinum should be thought of, and close monitoring with late removal of the ICD is required to avoid recurrence.
Introduction:Giant cell tumor of bone (GCTB) is a benign but locally aggressive neoplasm that predominantly affects the epiphyses of long bones. Pelvic involvement is uncommon, and acetabular GCTB presents particular diagnostic and therapeutic challenges because of the complex pelvic anatomy, proximity to neurovascular structures, and critical weight-bearing function of the hip. Case Report:We report the case of a 50-year-old female who presented with progressive left hip pain, restricted movements, and inability to bear weight following a trivial fall. Radiographs and cross-sectional imaging demonstrated an extensive expansile lytic lesion involving the entire left acetabulum, with cortical thinning and breach, weight-bearing dome involvement, and protrusio acetabuli with medial migration of the femoral head. Computed tomography-guided core needle biopsy confirmed GCTB, Campanacci grade II-III. The patient underwent extended intralesional curettage using a high-speed burr with phenol as a local adjuvant. The resultant acetabular defect was reconstructed using structural corticocancellous and cancellous bone grafts, supplemented by an acetabular reinforcement cage and total hip replacement to restore acetabular stability, hip biomechanics, and limb length. Results:At 6 months of follow-up, the patient demonstrated pain-free hip movement, restoration of limb length, satisfactory hip stability, and independent mobilization. Radiographs showed maintained implant position and no evidence of local recurrence or early mechanical failure. The functional outcome was excellent, with a Musculoskeletal Tumor Society score exceeding 25/30. Conclusion:Extensive acetabular GCTB with protrusio acetabuli represents a challenging surgical entity requiring individualized oncological and reconstructive planning. Extended intralesional curettage combined with local adjuvant therapy, structural bone grafting, acetabular cage reconstruction, and total hip replacement can provide satisfactory early functional and radiological outcomes in appropriately selected patients. Long-term clinical and radiographic surveillance remains essential because of the risk of delayed local recurrence and prosthetic complications.
Introduction:Torticollis is an abnormal head posture with a broad differential diagnosis. Posterior sternoclavicular joint (SCJ) dislocation is a rare and potentially life-threatening injury because of its proximity to the mediastinal structures. Torticollis as the presenting feature of posterior SCJ dislocation has not been previously described. Case Report:A 16-year-old male kabaddi player presented with acute right-sided torticollis and left upper limb pain 3 days after a tackle injury. Imaging confirmed a posterior left SCJ dislocation without vascular compromise. Closed reduction under general anesthesia using abduction-traction-extension under fluoroscopic guidance restored SCJ alignment and completely resolved the torticollis. The patient was immobilized and subsequently underwent gradual rehabilitation. At 6-week and 2-year follow-up, he had full, pain-free shoulder motion, no residual deformity, and had returned to sports. Conclusion:Posterior SCJ dislocation can rarely present as acute torticollis, possibly because posterior clavicular displacement alters the mechanics of the sternocleidomastoid muscle. This case emphasizes early imaging, multidisciplinary planning, and cautious closed reduction in stable patients without vascular compromise.
Introduction:Traumatic high-grade thoracolumbar spondylolisthesis is rare and is often accompanied by severe neurological injury. We report a patient with an initial complete spinal cord injury (SCI) after a traumatic D11-D12 Meyerding Grade IV translation who subsequently achieved substantial neurological and functional recovery. Case Report:A 39-year-old woman sustained a fall of approximately 10-12 feet, resulting in severe D11-D12 translation and a complete neurological deficit, American Spinal Injury Association Impairment Scale (AIS) grade A, with a lower extremity motor score (LEMS) of 0/50. She underwent posterior reduction and D10-L1 pedicle screw fixation within 24 h of injury. Neurological and functional status were assessed serially using AIS, the International Standards for Neurological Classification of SCI, the spinal cord independence measure III (SCIM III), and the walking index for SCI II (WISCI II) at discharge and at 2 weeks, 6 weeks, 3 months, and 6 months. Neurological status improved from AIS A at presentation to AIS C at discharge and AIS D at 6 months. LEMS rose from 0/50 to 27/50, and SCIM III improved from 15/100 to 56/100 while WISCI II improved from 0/20 to 9/20, reflecting a change from dependent, non-ambulatory status to assisted ambulation. Function above the injury level remained intact throughout. Conclusion:Severe traumatic Meyerding Grade IV thoracolumbar spondylolisthesis with an initial complete neurological deficit does not preclude meaningful recovery. Serial standardized neurological and functional assessment over at least 6 months is essential for accurate prognostication after severe traumatic SCI.
Introduction:T-condylar (T-Y) distal humerus fractures are rare intra-articular injuries in adolescents (<2% of pediatric elbow fractures). The coexistence of a capitellar coronal shear fragment is exceptionally uncommon and can be easily missed on radiographs. We report successful management of this rare injury using computed tomography (CT)-guided planning and stable screw fixation. Case Report:A 12-year-old boy presented after a fall with a displaced T-condylar distal humerus fracture. CT demonstrated an associated capitellar coronal shear fragment. Open reduction through a posterior paratricipital approach was performed using a triangular cannulated cancellous screw construct with Herbert screw fixation of the capitellum. Fracture union was achieved uneventfully, implants were removed after union, and the patient regained nearly full elbow motion without deformity, instability, or neurovascular deficit. Conclusion:Pre-operative CT is crucial for identifying associated capitellar injuries. A triangular cannulated screw construct combined with Herbert screw fixation provides stable fixation, facilitates early mobilization, and can achieve excellent radiological and functional outcomes in selected adolescent T-condylar fractures.
Introduction:Ureaplasma urealyticum is a fastidious, urease-producing bacterium typically responsible for urogenital infections. In immunocompromised hosts, a full-thickness mucosal breach may be complicated by hematogenous spread, leading to septic arthritis in distant joints U. urealyticum is difficult to isolate on routine culture and requires special media or 16S rRNA polymerase chain reaction for detection. Case Report:We report a 26-year-old immunocompromised female with neuromyelitis optica on long-term cyclosporine and Grave's disease, who developed chronic right knee U. urealyticum septic arthritis. She presented with the right calf pain; knee aspiration was turbid but culture-negative on routine testing. Despite 6 weeks of empirical antibiotics, symptoms persisted, and arthroscopic biopsy with 16S molecular testing eventually identified U. urealyticum. She was treated with multiple antibiotic regimens, including intravenous (IV) aztreonam, vancomycin, oral levofloxacin, and IV azithromycin, and her immunosuppression was reduced. Despite this, she developed medial tibial plateau osteomyelitis, an intra-articular abscess, and a sinus tract, requiring multiple debridements, cement spacer insertion, external fixation, and eventually two-stage revision knee replacement with flap reconstruction. Cultures remained persistently positive for U. urealyticum despite prolonged therapy and repeated surgery. One year after the index revision attempt, she underwent above-knee amputation for source control, followed by hip disarticulation 1 month later due to persistent stump infection. With aggressive wound care, including negative pressure wound therapy and staged dressing de-escalation, the wound achieved complete healing. She was discharged 180 days after hip disarticulation and, at 2-year follow-up, was ambulant with a hip prosthesis, independent in activities of daily living, and had returned to work. Conclusion:This case highlights the diagnostic challenge and potential severity of U. urealyticum septic arthritis in immunocompromised hosts, which may progress to refractory osteomyelitis and necessitate radical surgical measures, including amputation, for definitive source control despite prolonged targeted antibiotic therapy.
