CASES:We report 2 rare cases of irreducible traumatic hallux interphalangeal joint dislocation caused by sesamoid ossicle interposition in otherwise healthy young men. Delays between the injury and treatment (4 and 6 weeks) required open surgical reduction using a medial approach. Both patients achieved a favorable outcome at 5- and 2-year follow-up. CONCLUSION:This rare condition requires a high index of suspicion and prompt percutaneous or open surgical reduction to ensure a favorable outcome. These cases contribute to the limited global literature on this condition and may support future research.
CASE:A 41-year-old man presented with bilateral distal biceps tendon ruptures at the distal myotendinous junction, sustained in 2 separate incidents 15 months apart. This injury pattern is rare and differs from the more common avulsion from the radial tuberosity. Initial imaging was inconclusive, and the diagnosis was aided by physical examination. He elected to undergo open repair of the right side after persistent weakness with elbow flexion and supination. CONCLUSION:This case illustrates an uncommon location of distal biceps rupture and emphasizes the importance of careful clinical evaluation, surgical decision-making, and focused rehabilitation to achieve functional recovery.
CASE:A 22-month-old previously healthy woman developed chronic tibial osteomyelitis. Debridement uncovered a 10-cm wound with necrotic tibia, and cultures grew Proteus mirabilis. Intravenous antibiotics transitioned to 6 weeks of oral therapy. Fibular tibialization was performed with K-wire fixation, followed by 2 weeks of postoperative antibiotics. Six-week radiographs showed early callus formation, and K-wires were removed. At the 1-year follow-up, she was fully healed with full knee and ankle range of motion and no pain. CONCLUSION:Fibular tibialization is a viable salvage option for significant tibial bone loss when grafting or transport is unfeasible.
CASE:An otherwise healthy 10-year-old boy presented with severe bilateral shoulder dysfunction because of lateral scapular winging. He underwent bilateral modified Eden-Lange tendon transfers, resulting in near-normal restoration of shoulder range of motion at the 1-year follow-up. Intraoperatively, he was found to have bilateral absent trapezial muscles and an anomalous scapuloclavicular muscle spanning from the superomedial scapula to the posterolateral clavicle. CONCLUSION:This case represents the only known report of bilateral absent trapezius muscles without involvement of other trunk musculature or congenital abnormalities. In addition, the patient exhibited a previously unidentified anomalous muscle.
CASE:A 35-year-old woman with prior bilateral open carpal tunnel release presented with recurrent right-hand pain, numbness, tingling, nocturnal awakening, and weakness. Examination showed positive Phalen compression and Tinel signs at the carpal tunnel. Electrodiagnostic testing revealed mild median neuropathy, and ultrasonography demonstrated a bifid median nerve with focal enlargement. Revision exploration identified an accessory flexor digitorum superficialis (FDS) indicis muscle within the carpal tunnel. Repeat decompression, muscle excision, and hypothenar fat flap coverage resulted in resolution of symptoms at 5 months postrevision surgery. CONCLUSION:Accessory FDS indicis is a rare but possible structural cause of recalcitrant carpal tunnel syndrome.
Case: A 63-year-old man with poorly controlled diabetes presented with severe low back pain and radiculopathy. Magnetic resonance imaging revealed L4–L5 spondylodiscitis. Computed tomography –guided biopsy identified Leclercia adecarboxylata, a rare Gram-negative bacillus, sensitive to all tested antibiotics. He received intravenous broad-spectrum antibiotics followed by oral ciprofloxacin for 3 months, achieving complete recovery without relapse. Conclusion: As far as we know, this is the first reported case of isolated L. adecarboxylata spondylodiscitis. This case underlines the potential role of the organism as an uncommon pathogen in spinal infections and stresses the importance of image-guided biopsy and microbiological culture to provide an accurate diagnosis and appropriate therapy.
Case: A 32-year-old man with end-stage renal disease (ESRD) from anti-neutrophil cytoplasmic antibody-associated vasculitis and tertiary hyperparathyroidism, presented with progressive right hip pain. A giant cell-rich lesion biopsy confirmed Brown tumor. Despite cinacalcet and vitamin D, hyperparathyroidism persisted, necessitating parathyroidectomy complicated by hungry bone syndrome and a pathological right hip fracture. Surgical fixation and prosthetic replacement were deferred due to high risk factors such as, ESRD and fracture pattern, as well as potential for postoperative implant failure and infection. Teriparatide was initiated to promote bone remodeling, leading to pain relief and radiographic improvement. Conclusion: To our knowledge, this is the first reported long-bone Brown tumor successfully treated with teriparatide.
Case: A 63-year-old man sustained multiple bilateral rib fractures, left scapula, and clavicle displaced fractures after being gored by a bull. He underwent surgical stabilization of the ribs, and the shoulder injuries were managed nonoperatively. Three months later, the patient presented with scapula and clavicle malunions and disabling shoulder ankylosis, which were addressed in a single reconstruction. Six-year follow-up manifested in nearly asymptomatic, normal function. Conclusion: Single-staged reconstruction of all indicated fractures in forequarter lateral implosion injuries is recommended.
Case: A 17-year-old right-hand dominant boy presented with severe, progressive wrist pain refractory to conservative treatment. Imaging confirmed Stage IIIB Kienböck disease with lunate collapse and fixed scaphoid rotation. Despite his young age and advanced stage, proximal row carpectomy was selected after shared decision-making to preserve motion and rapidly relieve pain. At the 2-year follow-up, the patient was pain-free, had full wrist motion and strength, and returned to competitive basketball. Conclusion: This case highlights that, in carefully selected adolescents, proximal row carpectomy can achieve excellent outcomes, challenging traditional age-based and stage-based contraindications and emphasizing individualized, patient-centered surgical decision-making.
Case: We present 2 cases of spinal astrocytoma in infants mistaken for brachial plexus birth injuries (BPBI). (1) A 5-month-old infant had upper-extremity weakness resembling a global plexus injury. An magnetic resonance imaging (MRI) and biopsy revealed a low-grade cervical astrocytoma. The patient underwent chemotherapy with partial recovery of upper extremity motor function. (2) A 5-month-old infant had upper-extremity weakness resembling upper trunk BPBI. MRI and biopsy revealed pilocystic astrocytoma. The patient underwent spinal decompression and proton therapy but did not regain function. Conclusion: A high degree of suspicion for neoplasia in the setting of presumed brachial plexus birth injury can prevent incorrect diagnosis allow timely treatment.
Case: We previously described a 3D planned, corrective osteotomy of acromion and glenoid which restored normal scapular anatomy in a 40-year-old patient suffering from pain and mild glenohumeral osteoarthritis associated with static posterior shoulder subluxation. Recentering of the joint and pain-free, full shoulder function as documented at 24 months persisted at 5 years, without any evidence of progression of osteoarthritis. Conclusion: Normalizing the malformations of acromion and glenoid typically associated with posterior shoulder subluxation can revert static subluxation and at least halt progression of osteoarthritis until 5 years postoperatively at least in the absence of advanced glenoid destruction.
Case: A 50-year-old man underwent reconstruction of 4 left and 3 right rib nonunions using approximately 30 cc of left iliac crest bone graft (ICBG). At 6 weeks, left flank discomfort and swelling developed. CT scan at 8 months revealed hernia at ICBG harvest site. The patient underwent robotic hernia repair 14 months postoperatively. At 20 months, he had returned to work, no recurrence of symptoms, and pain resolution. Conclusion: Major complication of iliac crest bone harvest, abdominal hernia, may result by supra-iliac repair attrition or insufficient abdominal wall reattachment to the bony crest, underscoring importance of surgical site closure.
Case: A 21-year-old woman with a surgical history of 2 prior right hip surgeries presented with ongoing right hip pain. Radiographic findings demonstrated a labral tear, osteoarthritic changes, and cam over-resection. Arthroscopic iliotibial band autograft labral reconstruction and bony remplissage of the femoral defect using a greater trochanter autograft were performed. Conclusion: Arthroscopic bony hip remplissage is a viable treatment option for young patients who present after failed hip arthroscopy with cam over-resection.
Case: A 20-year-old recreational athlete presented with bicondylar osteochondritis dissecans (OCD) of the left knee, which was successfully treated with osteochondral autograft transplantation and retrograde drilling. Eighteen months later, he developed bicondylar OCD in the opposite knee, managed with open reduction and internal fixation. No definite risk factor was found. Conclusion: This uncommon case of sequential bilateral bicondylar OCD emphasizes the importance of careful assessment of limb alignment and tailored surgical strategies, such as fixation and osteochondral grafting, to achieve optimal functional outcomes and minimize the risk of recurrence or disease in the opposite limb.
Case: A right-hand dominant, 38-year-old man presented to clinic with atraumatic left wrist pain of 1 year duration in the setting of bilateral bipartite lunate. Both wrists ultimately became symptomatic and were treated with proximal row carpectomy. The patient had durable pain relief in both wrists after proximal row carpectomy. Conclusion: Bipartite lunate is a rare developmental anomaly that is usually asymptomatic. Operative intervention directed at treating involved osteoarthritic joints is warranted in the rare symptomatic patient. Clinicians should be aware of the pathology given its high rate of misdiagnosis.
CASE:A 75-year-old man presented with left ankle septic arthritis on a background of multiple surgeries for bilateral lower limb necrotizing fasciitis involving free flap and skin grafting. We employed a unique technique of ankle arthrodesis using intra-articular pinning with a combination of Schanz pins and Kirschner wires for ankle arthrodesis after joint destruction from septic arthritis following adequate debridement and curettage achieving partial union at 3 months and complete union by 6 months, with the patient returning to full activities of daily living at 1 year. CONCLUSION:This case demonstrates an effective and viable alternative strategy for ankle arthrodesis using a unique intra-articular pinning construct which functioned as a removable internal fixation construct in a patient with complex soft-tissue envelope.
CASE:A 4-year-old girl with bilateral arthrogrypotic clubfoot underwent posterior release with bilateral V-Y advancement flaps. At 4 months, the patient ambulated independently over moderate distances. One-year follow-up confirmed pain-free functional ambulation, although persistent toe-walking highlighted ongoing neuromuscular challenges and minor correction loss. CONCLUSION:V-Y advancement flaps provide effective soft tissue coverage after posterior release for arthrogrypotic clubfoot. Early multidisciplinary collaboration integrating orthopedic and plastic surgical planning is essential for optimizing outcomes.
CASES:We herein report 2 cases of giant intrapelvic tumors successfully resected using a temporary pubectomy approach: a 16 cm solitary fibrous tumor in a 39-year-old man and a 12 cm leiomyosarcoma in a 49-year-old man. Adding pubectomy to the midline abdominal incision provided adequate surgical exposure of the tumor. Following tumor resection, the pubic bones were reconstructed using internal fixation plates. The postoperative courses were uneventful, and both patients have been tumor-free for 7 and 2 years, respectively. CONCLUSION:Temporary pubectomy allows sufficient access to the pelvic floor and may be considered for treating giant intrapelvic tumors.
CASE:A 28-year-old man with a distal radius fracture and small volar marginal fragment (VMF) underwent fixation using a "through-plate K-wire" technique. Two 1.2 mm K-wires were drilled through distal plate holes into the VMF and then bent over the plate to create a fixed-angle construct. Radiographic union was achieved by 6 weeks. Following elective hardware removal at 6 months, the patient demonstrated excellent clinical outcomes (DASH 4.2) and full range of motion at 1-year follow-up without complications. CONCLUSION:Through-plate K-wire fixation is a simple, cost-effective bailout option for stabilizing distal VMFs when rim plates are unavailable.
CASE:An 82-year-old woman sustained an Anderson Type II odontoid fracture after a fall and underwent halo vest fixation. Eight weeks later, she developed eyelid edema and altered consciousness. Computed tomography revealed intracranial pin penetration, cerebrospinal fluid (CSF) leakage, and pneumocephalus. The halo vest was removed, and subsequent conservative treatment with bed rest and antibiotics led to full neurological recovery. CONCLUSION:This rare case of intracranial pin penetration and CSF leakage following halo vest fixation emphasizes the importance of close monitoring and early imaging in patients presenting with neurological symptoms during prolonged immobilization.
