Case Reports in Orthopedics

Triceps tendon rupture in females is rare. In this case report, we present a young adult female patient with a distal triceps tendon rupture from bouldering treated with open surgical repair technique using a modified bone tunnel and suture anchor fixation technique. The diagnosis and technique for repair and postoperative rehabilitation are described. A review of the current literature of biomechanical and clinical outcomes of various repair techniques is also presented.

A 17-year-old student athlete suffering from stress-related knee pain asked for help. MRI revealed an unstable osteochondral lesion. Because of time pressure due to the patient’s academic exams and his schedule as a basketball player, an autologous chondrocyte transplantation (ACT) as the standard surgical treatment plan was not accepted by the patient. This was mainly because of its two-step character three weeks in between surgeries. Therefore, a surgical one-step therapy option as alternative treatment to ACT was needed. The patient received simultaneous autologous cancellous bone grafting and minced cartilage procedure in a sandwich technique. After successful rehabilitation, the patient continued his studies of sports science and his active career as a basketball player successfully. Several different procedures are used for the treatment of cartilage defects. The following factors play a significant role: defect size, location, patient age, and sports ambitions. In the case described here, ACT would have been the conventional, but not the ideal option in the perspective of this individual patient because of the two-step surgery and the longer rehabilitation time. Therefore, the minced cartilage method presented a valid alternative, even though long-term data are still missing and prospective studies comparing this procedure with others are needed in the future.

Medial bone excrescence at the base of the distal phalanx of the hallux is a common manifestation which is rarely painful. In this case report, we described the first case of the excrescence becoming symptomatic one year after a metatarsophalangeal (MTP) joint arthrodesis of the great toe in a 74-year-old female. The medial bony excrescence which was obscure preoperatively became obvious postoperatively in the anteroposterior foot radiographs. The patient was successfully treated by an excision of the excrescence. In order to clarify the pathology of the excrescence, we reviewed the radiographs with respect to the excrescence before and after hallux surgeries including 97 metatarsal osteotomies and 33 MTP joint arthrodesis. The width of the excrescence measured in the anteroposterior foot radiographs displayed substantial increment one month after the hallux surgeries (osteotomy group: vs. , ; arthrodesis group: vs. , ). However, there was no significant difference in the width of the excrescence between one month after surgery and at the most recent follow-up of around 20 months in average after the surgery (osteotomy group: vs. , ; arthrodesis group: vs. , ). The present case and our radiographic review suggested that the postoperative medial bony excrescence was not the result of change of position of the preexisting excrescence. The correction of pronation deformity through hallux surgeries could emphasize the medial bony excrescence and cause symptomatic irritation upon shoe contact.

Supracondylar periprosthetic femoral fractures occurring above total knee replacements have been considered a rare entity. However, they continue to increase in frequency with the increasing number of arthroplasties and the improvement in morbidity and mortality in the concerned patient population. The management of periprosthetic distal femoral fractures is a challenging orthopedic problem. In this brief communication, a case of 49-year-old woman with rheumatoid arthritis who sustained a low distal comminuted periprosthetic femoral fracture is presented. Her fracture was eventually managed with an intramedullary fibular strut allograft and bilateral locking plate placement reaching satisfactory healing and restoration of alignment. The primary aim of this report is to provide insight into this novel technique as a successful alternative to other standard surgical options.

Case. We report an 11-year-old male who sustained a lesser tuberosity avulsion fracture of the proximal humerus upon making contact with a baseball during an at-bat. This injury was neglected for 14 months and was eventually detected by an axillary radiograph and subsequent MRI. He successfully underwent an open surgical repair and regained full range of motion and level of activity at 1-year follow-up. Conclusion. In pediatric baseball players, lesser tuberosity avulsion fractures may occur upon striking a baseball with a bat. Even after being neglected for several months, these injuries can be treated successfully with an open surgical repair.

Osteoarthritis of the hip joint (coxarthrosis) is the most common hip disease in adults. Since the 1960s, total hip arthroplasty (THA) has made great progress and is nowadays one of the most frequently used procedures in orthopedic surgery. Different bearing concepts exist in various implant designs. A metal-on-metal bearing can create metal debris and lead to metallosis. We present a unique case of a 78-year old woman, who received hip resurfacing with a McMinn-like prosthesis 15 years ago. Over the cause of time, metallosis developed and created a bone cyst in the Os ilium, and osteolysis led to a dislocation of the femoral implant. A minor stumble fall led to a fracture of the Os ilium. We present our treatment method with implantation of a cemented THA and refill of the bone cyst with bone from allogene femoral heads. The surgery led to a reconstruction of the physiological center of rotation in the hip. Consequently, to the inpatient stay, the patient took part in a follow-up treatment with intensive physiotherapy. Taken together, the results after total hip arthroplasty are more superior to other hip surface replacements in terms of longevity and patient satisfaction. Especially, metal-on-metal bearing couples carry a great risk of metallosis, which goes a long with pseudotumors, osteolysis, and the elevated metal ions in the blood. Since this case is unique in the literature, no guidelines are noted for surgical treatment. In our opinion, a periprosthetic fracture of this type should be performed in a hospital using extensive endoprosthetic expertise.