90° Spinning of Polyethylene Inserts in Mobile Bearing Unicompartmental Knee Arthroplasty

<b>Background</b> The objective of this article is to describe for the first time a case of 90^° spin out of a mobile bearing unicompartmental knee arthroplasty (UKA) polyethylene insert. In this report, we present a 57-year-old gentleman with a medial compartment UKA for osteoarthritis in 2017 who developed dislodgement and 90^° rotation subsequent to traumatic injury when he was involved in a bus crash and impacted the anterolateral knee sustaining a valgus type injury 1 week postoperatively. Following the injury, he reported medial knee pain and a sensation of something moving within the joint. He was initially managed conservatively and progressed to full weight bearing; however, he experienced intermittent symptoms of catching and blocking of the joint, as well as medial knee swelling, that inhibited his ability to perform activities involving walking, kneeling, or pivoting. Imaging taken in 2018 show a 90° rotation of the polyethylene insert. These images showed the longitudinal metallic marker on the insert facing in an anteroposterior direction as opposed to the normal medial-lateral orientation. Failing conservative management, he presented to our clinic in 2019 and proceeded for revision of his UKA. Intraoperatively, his insert was reviewed and seen to easily spin on axis. The liner was therefore removed and upsized from a size 5 medium to a size 7 medium insert which provided excellent stability and stopped any further spinning. He has done tremendously well since the operation and reports full range of motion and no concerns. In patients with a history of pain, swelling, or locking following a UKA, it would be prudent to consider insert spinning, as well as the more common dislocation, through confirming the orientation of the metallic insert marker. Revision surgery to correct the spinning defect has proven effective with good resolution of symptoms and return to full range of motion.

Surgical Treatment of Leg Length Discrepancy and Knee Flexion Contracture Associated with a Congenital Absence of Quadriceps

We report the case of an 18-year-old male with congenital absence of quadriceps and hypoplasia of the patella who presented with a significant leg length discrepancy (LLD) and knee flexion contracture. Surgical management was aimed toward lengthening the limb, stabilizing the joint, and correcting the knee flexion contracture. Correction of a significant congenital LLD and knee flexion contracture poses challenges due to long-standing altered biomechanics. These are rare conditions for which no accepted surgical algorithms exist. It is essential to anticipate the biomechanical consequences of limb lengthening and flexion contracture correction that might arise and plan comprehensive interventions accordingly.

Simultaneous Ipsilateral “Floating Hip” with Hip Dislocation and Femoral Neck and Shaft Fractures Associated with “Floating Knee” Injuries with Patella Fracture and Traumatic Sciatic Nerve Injury

Simultaneous ipsilateral “floating-hip” and “floating-knee” injuries are very rare and severe, and they occur in high-velocity road traffic accidents. A 55-year-old man presented with posterior wall fracture – dislocation of the acetabulum, complete fracture – dislocation of the femoral head, ipsilateral femoral shaft fracture, open patellar fracture, Gustilo type II, tibial fracture, and traumatic sciatic nerve injury/peroneal division. Given the fact that hip dislocation is an orthopedic emergency, we first did closed external tibial fixation, femoral head reduction, osteosynthesis of the acetabular fracture, and partial patellectomy. After 2 days, the patient underwent a second surgery; fixation of the neck and femoral shaft fractures was done, with a self-dynamic internal fixator. After 14 months from the injuries, radiographs show complete healing of all fractures, the patient walks independently without crutches, and the peroneal nerve is partially recovered. Despite the seriousness of the presented injuries, we did not have any complications, and 14 months after the injury, the femoral head is still viable, with no signs of femoral head osteonecrosis.

Arthroscopic Resection of Humeral Enchondroma

Enchondromas are common benign bone tumors. They are often found incidentally and usually do not require any treatment other than clinical surveillance. Signs of lesion progression or nontolerable pain are criteria for surgical resection. We present a case of a 44-year-old woman with long-lasting shoulder pain, diagnosed with enchondroma. Imaging studies showed an enchondroma near the great tuberosity. Shoulder arthroscopy made it possible to diagnose and treat an SLAP lesion as well as to resect by curettage and shaving through the subacromial lateral portal. One year after surgery, the patient had significant pain relief and improved shoulder function. Shoulder arthroscopy seems to be a safe and suitable technique for resection of small-sized humeral enchondromas, with the advantage of allowing to treat other possible concomitant shoulder pathologies.

Traumatic Avulsion Fracture of the Origin of the Brachioradialis Muscle: A Case Report and Review of the Literature

Avulsion fracture of the brachioradialis muscle origin at the proximal two-thirds of the lateral supraepicondylar ridge of the humerus is an extremely rare fracture with only 4 reported cases in the literature so far. In this article, we describe the case of a 50-year-old male patient who had sustained a closed fracture of the latter after falling from a height of 1.5 m on a flexed elbow and pronated hand. The patient was managed with immobilization of the elbow and wrist with a posterior splint in neutral position for 3 weeks, followed by wrist and elbow therapeutic mobilization sessions for 3 months. At the final follow-up, the patient had painless active and passive full range of motion of the elbow along with good flexion strength. The unique mechanism by which this avulsion fracture occurred is explained on the basis of the mode of injury, position of the limb, and structure and function of the brachioradialis muscle.

A Seldom Cause of Exercise-Related Leg Pain in a Young Soldier-Athlete: A Case Report

Chronic leg pain is a common problem for young soldier-athletes. Differential diagnosis of this issue is extensive and includes more common entities such as medial tibial stress syndrome and tibial stress fracture and other scarce causes. Therefore, making a correct diagnosis proves to be vital for appropriate care. This topic discusses the case of a 36-year-old soldier who was diagnosed with a schwannoma of the left tibial nerve as a rare cause of leg pain. Its literature is scarce and intends to add further data about recommendations for investigation and management for this kind of lesion.

“Low Cost” Negative Pressure Wound Therapy for Acute and Chronic Wounds: A Case Series

Negative pressure wound therapy (NPWT) is an alternative to standard treatment of acute wounds (such as traumatic or postoperative wounds) but also in that of chronic wounds (such as ulcers or stage 3 and 4 pressure ulcers). With cellular, extracellular effects and bacterial clearance, it leads to the rapid formation of healthy budding granulation tissue, which provides wound bed for directed healing or secondary coverage by skin graft or flap. However, the exorbitant cost of VAC (vacuum-assisted closure) devices for our limited resources health facilities and their unavailability led us to opt for a “low cost” solution using wall suction and disposable materials readily available in all surgical departments. We present the technique used in our department and its results through a series of 3 cases with both acute and chronic lesions evolving in septic environment and where NPWT enabled us to ensure a genuine care protocol until healing while reducing the cost of therapy, the number of dressings and the length of hospital stay.

Snapping Scapula Syndrome in the Setting of Elastofibroma Dorsi: A Case Report

A 54-year-old woman presented with a 15-year history of progressively worsening left snapping scapula syndrome (SSS) in the setting of ipsilateral elastofibroma dorsi. Her pain was refractory to multiple conservative measures. She was successfully treated with focal ultrasound-guided corticosteroid injection to the superomedial border of the scapula. There was demonstrable improvement in findings between pre- and post-procedural MRI examinations. Despite the underlying cause of SSS, trials of nonoperative treatment techniques are warranted before considering surgical options. Focal ultrasound-guided corticosteroid injection, in conjunction with physiotherapy, is one such example.

Localized Tenosynovial Giant Cell Tumor: An Incidentally Found Lesion in the Shoulder

The concept of localized and diffuse tenosynovial giant cell tumors (TSGCT) is recent and may still cause some confusion among surgeons. This disorder constitutes a family of proliferative lesions characterized by their origin in the articular synovium, tendon sheaths, or bursa. It is not always easy to diagnose this pathology, especially due to its multitude of presentation. We describe an incidentally found localized TSGCT intra-articularly located in the shoulder. The localized lesions are considered a more benign form that usually present not with specific symptoms but rather a manifestation of the disturbance in the affected joint or the surrounding soft tissues. MRI is indispensable for its diagnosis, and the standard treatment is complete surgical resection. Due to its low incidence, it is difficult to find literature that goes beyond clinical reports or small case series. With this report, we intend to call readers’ attention for the variable presentations, the different diagnostic and treatment strategies, and the expected outcomes.