Persistent Pain and Purulent Discharge: A Case of Infected Bipolar Hemiarthroplasty.

Prosthetic joint infection (PJI) remains a significant complication following joint arthroplasty, necessitating prompt recognition and intervention to optimize patient outcomes. This case report describes a 65-year-old male who presented with persistent pain, swelling, and purulent discharge from the right hip, three years post-bipolar hemiarthroplasty following a road traffic accident. Clinical examination revealed signs suggestive of PJI, prompting surgical intervention with total hip arthroplasty. Postoperatively, the patient experienced resolution of symptoms and satisfactory recovery. This case underscores the challenges associated with infected joint arthroplasty and highlights the importance of a multidisciplinary approach for effective management. Early diagnosis, appropriate surgical intervention, and comprehensive postoperative care are essential for minimizing morbidity associated with PJIs and optimizing patient outcomes.

A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint.

Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.

Diagnosis and Management of Monostotic Fibrous Dysplasia of the Tibia in an Adolescent Patient: A Case Report.

A rare benign bone condition called monostotic fibrous dysplasia (MFD) is characterized by the growth of fibrous tissue in place of a normal bone. It may lead to deformity in the affected bone, pain, and a pathologic fracture due to bone weakness. Hereunder, a case report of MFD in a 17-year-old male adolescent presenting to the hospital with localized bone pain and swelling in his right tibia is presented. After clinical examination and radiographic imaging, a provisional diagnosis of benign osteolytic lesion was considered. A magnetic resonance imaging (MRI) scan of the leg suggested the possibility of fibrous dysplasia or adamantinoma. The patient was managed with an intralesional curettage of the dysplastic bone and packing the cavity with blocks of a synthetic bone. The excised material was sent for histopathology, which established the diagnosis of fibrous dysplasia.

Management of Vancouver B3 Periprosthetic Femur Fracture Using a Modular Uncemented Long Femoral Stem Prosthesis With Cerclage Wiring Technique.

Periprosthetic fractures (PPF) of the femur in connection with total hip arthroplasty are becoming common and also frequently challenging to repair. Such patients typically are frail, elderly, and have osteoporosis. Owing to a scarcity of research there are no clear strategies for its effective management. However, the Vancouver classification may help in facilitating treatment decisions. For fractures around a loose femoral prosthesis (types B2 and B3), revision using a modular uncemented long stem, with or without additional fracture fixation, has been known to provide a reliable outcome. It is prudent to treat osteoporosis for fracture healing and to prevent further fractures. In this case report, we share our experience with the use of an uncemented modular long femoral stem prosthesis with a cerclage wiring technique for the management of Vancouver type B3 PPF of the left femur in a 63-year-old male patient. Revision arthroplasty using a long stem prosthesis with a cerclage wiring technique can provide better fixation, stability, and functional outcomes for the patient.

A Comprehensive Review of Genetic Variations in Collagen-Encoding Genes and Their Implications in Intervertebral Disc Degeneration.

This comprehensive review examines the intricate relationship between genetic variations in collagen-encoding genes and their implications in intervertebral disc degeneration (IVDD). Intervertebral disc degeneration is a prevalent spinal condition characterized by structural and functional changes in intervertebral discs (IVDs), and understanding its genetic underpinnings is crucial for advancing diagnostic and therapeutic strategies. The review begins by exploring the background and importance of collagen in IVDs, emphasizing its role in providing structural integrity. It then delves into the significance of genetic variations within collagen-encoding genes, categorizing and discussing their potential impact on disc health. The methods employed in studying these variations, such as genome-wide association studies (GWASs) and next-generation sequencing (NGS), are also reviewed. The subsequent sections analyze existing literature to establish associations between genetic variations and IVDD, unraveling molecular mechanisms linking genetic factors to disc degeneration. The review concludes with a summary of key findings, implications for future research and clinical practice, and a reflection on the importance of understanding genetic variations in collagen-encoding genes to diagnose and treat IVDD. The insights gleaned from this review contribute to our understanding of IVDD and hold promise for the development of personalized interventions based on individual genetic profiles.

Subcutaneous Angiofibroma of the Ankle: A Rare, Undescribed Clinical Entity.

Soft tissue angiofibroma is a pathology consisting of a benign fibrous vascularized tumor that mimics low-grade sarcoma. Such tumors frequently arise in the extremities, more commonly in the lower extremities, presenting as a slow-growing, painless swelling. Females are more commonly affected than males. We present the case of a 42-year-old male with a slow-growing, painless mass on the extensor aspect of his left foot. Differential diagnoses considered were soft tissue fibrosarcoma, liposarcoma, and sebaceous cysts. Surgical excision of the tumor was done, and upon histopathology, there were multiple lobules with well-circumscribed, alternating areas of collagenous and myxoid tissues. There was a prominent small vascular network with uniformly arranged spindle cells consisting of pale eosinophil-rich cytoplasm and small ovoid nuclei, fine chromatin, and an indistinct nucleolus. There are not many reported cases of this clinical entity, and every new case reported brings light to the pathology and progression of this tumor. Understanding this pathology is necessary since it mimics many other skin and soft tissue tumors.

Synovial Chondromatosis in a Young Athlete: A Report of a Rare Case.

Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is affected by a metaplastic process which in turn converts it into cartilagenous tissue. Eventually, it gets dislodged and transformed into a loose body in the large joints. We report the case of a 24-year-old young athlete who presented with complaints of painful movements and restriction of joint movements associated with a growing deformity in the right knee joint. This case report aims to describe a rare synovial pathology that necessitated arthroscopic synovectomy and diagnostic arthroscopy to treat, particularly in younger individuals. The atypical feature, in this case, was metaplastic development from the peripheral joint capsule attached to the surrounding cartilage, which, to the extent that the authors are aware, has only been documented in one instance in the record. Magnetic resonance imaging (MRI) was performed which demonstrated evidence of the joint effusion, synovial hypertrophy and a loose calcific body just anterior of the distal femoral condyle causing pressure over the patellar tendon anteriorly as well as a hyper-dense cyst in the popliteal region. Treatment often requires partial or complete synovectomy with either an arthroscopic or open approach.

A Comprehensive Review of Postoperative Analgesics Used in Orthopedic Practice.

Orthopedic surgeries, ranging from joint replacements to fracture fixations, are integral procedures that enhance the quality of life for countless individuals. Effective postoperative pain management is crucial in ensuring optimal patient recovery and satisfaction. This comprehensive review analyzes the diverse array of analgesic modalities employed in orthopedic practice for postoperative pain relief. The review systematically explores the pharmacological landscape of analgesics commonly used in orthopedic settings, including opioids, non-steroidal anti-inflammatory drugs, acetaminophen, and adjuvant medications. Emphasis is placed on their mechanisms of action, efficacy profiles, and potential adverse effects. Special attention is given to the evolving role of multimodal analgesia, which combines various agents to achieve synergistic pain control while minimizing individual drug-related complications. Furthermore, the review addresses the emerging trends and advancements in postoperative analgesia within orthopedics, such as integrating regional anesthesia techniques, peripheral nerve blocks, and novel pharmacological agents. A critical evaluation of evidence-based practices and recent clinical trials is incorporated to guide practitioners in making informed decisions regarding postoperative pain management. Consideration is also given to the individualized nature of pain experiences and the importance of patient-centric approaches. The review underscores the significance of tailoring analgesic regimens based on patient characteristics, surgical procedures, and potential complications, fostering a personalized and effective pain management strategy. In conclusion, this comprehensive review is valuable for orthopedic practitioners, anesthetists, and healthcare professionals involved in postoperative care. By synthesizing current knowledge and highlighting evolving trends, the review contributes to the ongoing dialogue on optimizing pain management strategies in orthopedic practice, ultimately improving patient outcomes and satisfaction.

Exostosis of Ulna With Developmental Deformity of the Left Forearm: A Rare Case.

This case report presents a rare occurrence of exostosis of the ulna associated with a developmental deformity of the left forearm in a 15-year-old female. The patient reported a history of trauma resulting in a supracondylar humerus fracture managed conservatively eight years prior. The patient presented with a two-year history of pain and swelling over the left forearm. Clinical examination revealed a firm, non-tender, immobile swelling closely associated with the ulna, accompanied by a 20-degree cubitus varus deformity and forearm shortening. Radiographs and computed tomography scans confirmed the presence of a solitary external bony protuberance over the ulna shaft, communicating with the medullary cavity. A preliminary diagnosis of osteochondroma was established based on clinical and imaging findings. The patient underwent extraperiosteal en bloc resection of the lesion under supraclavicular nerve block anesthesia. A histopathological examination confirmed the diagnosis. Postoperative physiotherapy was initiated, and at the one-month follow-up, the patient reported being pain-free. This case highlights the rarity of exostosis of the ulna with associated developmental deformity, emphasizing the importance of a comprehensive diagnostic approach. Early surgical intervention resulted in a successful outcome, underscoring the significance of timely management in improving patient outcomes and quality of life.

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty.

Total knee arthroplasty (TKA) patients express minimal comfort regarding postoperative pain management. The use of parenteral opioids or epidural analgesia may have unfavorable adverse impacts that interfere with quick healing and rehabilitation. It is uncertain if periarticular multimodal drug injections (PMDI) are effective at easing pain following total knee or total hip arthroplasty (THA). We conducted this study to assess the effectiveness of PMDI following TKA or THA. Articles were sourced using the following keywords on Pubmed, Google scholar, and the Web of Science: multimodal drug cocktail in total knee arthroplasty OR hip arthroplasty, periarticular injections AND multimodal drug cocktail, epidural versus periarticular injections AND pain management after total joint arthroplasty. After screening 438 articles and abstracts, 200 pertinent studies were found, of which a total of 10 articles were included in the study. From this review, we want to conclude that despite the various ways to address postoperative pain, there is no acknowledged gold standard for postoperative pain management following total joint arthroplasty. To reduce narcotic intake and prevent narcotic-related adverse reactions, multimodal techniques utilizing regional anesthetics appear to be on the rise such as periarticular injections, or patient-controlled analgesia with or without femoral nerve block. Even though the ideal duration and kind of medications are unclear, preoperative pain management or preemptive analgesia with anti-inflammatory drugs and opioid analgesics seem to be useful in lowering postoperative pain.

Limb Salvage Surgery With Mega-Prosthesis in a Case of Chondrosarcoma: A Case Report.

Chondrosarcoma is a kind of bone tumor that can be anywhere in the body but most commonly affects the pelvis, glenohumeral joint, proximal femur, and proximal one-third of the tibia including condyles. It accounts for 20-25% of all bone sarcomas. Chondrosarcomas with clear cell variants are extremely uncommon, making up just around 6% of all cases. We are presenting a case of a 52-year-old male with a bony lesion over the epiphysis of the left tibia. He was managed with resection of the tumor followed by a limb salvage procedure with mega-prosthesis. Chondrosarcoma affects men in the third to fourth decades of their life more commonly than females. Long-standing localized pain over a prolonged duration is the most common presenting symptom. There are various treatment modalities available for clear cell chondrosarcoma, ranging from wide local resection and intralesional therapy to amputation. The decision of tumor resection followed by prosthesis was chosen over amputation here, as the patient had the lesion for 2 years and there were no signs suggestive of metastasis after thorough screening. Limb salvage gave a better outcome for the patient in our study. A large-segment prosthesis is a suitable reconstructive alternative to amputation. At the majority of the anatomical sites where the prosthesis was employed, the functional results were good or exceptional after this type of treatment. The patient now has a functional limb and is able to resume his life as before, making mega-prosthesis a better alternative and treatment of choice for patients with large lesions.