Case Reports in Orthopedics

Background. Metal hypersensitivity is a rare complication after total hip arthroplasty (THA), and no reliable diagnostic method for metal hypersensitivity to orthopedic metal implants has yet been established. Case report. A 57-year-old woman underwent hemiarthroplasty using a metal implant despite a skin allergy to metal jewelry. Two years after surgery, the patient developed early hemiarthroplasty failure and refractory erythema. Although the patient was clinically suspected to have a hypersensitivity to metal, the preoperative screening test was negative, and patient underwent revision surgery with cemented THA. Postoperatively, the erythema as well as her hip pain disappeared completely. Conclusion. Patients with clinically suspected metal hypersensitivity should undergo primary and revision total hip arthroplasty using hypoallergenic implants regardless of preoperative screening results.

Intraosseous ganglion cysts (IGC) of the carpal bones are frequently reported in the literature, involving at most two carpal bones of the same wrist. Only one case recently described the presence of multiple intraosseous ganglion lesions in the capitate, lunate, and triquetrum, resulting in chronic wrist pain. The following study reports the first case of multiple IGCs causing a unilateral carpal tunnel syndrome (CTS), in a 56-year-old woman, with no previous history of trauma. Failure of conservative management prompted carpal tunnel release and the surgical excision of the ICGs, followed by autologous bone grafting to fill in the defects. Consequently, IGCs must be considered in the differential diagnosis of unilateral CTS due to the expansile nature of the bone lesions.

Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.

Background. Traumatic hip dislocation (THD) is an orthopaedic emergency that requires rapid reduction. THD is generally encountered in high-energy trauma. THD with low-energy trauma is extremely rare, even more so in the elderly. Methods/Results. We report the case of a 72-year-old woman who presented to the emergency department with anterior superior left hip dislocation after a low-energy trauma. Results. The patient was initially treated with closed reduction. Because of recurring dislocation, closed reduction was performed a second time. Magnetic resonance imaging showed no soft tissue interposition. At 12 week follow-up, the patient complained of intractable hip pain and was treated with total hip arthroplasty. The post-operative course was uneventful with a return to pre-injury functional mobility. We also conducted a review of the literature with regard to anterior hip dislocation in the population aged 70 years or more. Conclusion. THD can be associated with significant morbidity. Time to reduction is considered essential in improving functional outcomes. In the case of poor functional outcomes, total hip arthroplasty should be considered.

Introduction. Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder where patients present with hypophosphatemia, chronic diffuse bone pain, and occasionally fractures. Benign phosphaturic mesenchymal tumors (PMT) are responsible for the TIO and are largely soft tissue tumors. Cases. Two male patients with TIO secondary to PMT were reported—one in the bony scapula and the other in the plantar foot soft tissue. The first case describes a 63-year-old Caucasian male, who sustained an intertrochanteric proximal femur stress fracture and approximately two years of diffuse bone pain and hypophosphatemia. Wide excision of a left scapula boney lesion resulted in immediate resolution of his electrolyte abnormalities and bone pain. Case 2 describes a 58-year-old male with four years of multifocal bone pain and atraumatic fractures. A ⁶⁸Ga-DOTATATE-positron emission tomography/computed tomography (PET/CT) scan identified a soft tissue tumor in his plantar foot, which was ultimately excised. He also experienced near immediate resolution of his pain and no additional fractures. Conclusion. TIO is a rare condition presenting with chronic multifocal bone pain, stress fractures, and hypophosphatemia. These two cases highlight that the causative tumor may originate in soft tissue or bone. Furthermore, a high index of suspicion, along with fibroblast growth factor-23 testing and DOTATATE-PET/CT localization, can help with diagnosis and minimize treatment delays.

There is widespread use of matrix-induced autologous chondrocyte implantation. Initial use of autologous bone grafting in combination with the matrix-induced autologous chondrocyte implantation procedure has shown efficacy in small- to medium-sized osteochondral lesions. This case report demonstrates use of the “Sandwich” technique in a large, deep osteochondritis dissecans lesion of the medial femoral condyle. Technical considerations that are key to containment of the lesion and outcomes are reported.