Intrapelvic Cup Migration Following Revision Total Hip Arthroplasty: A Case Report and Review of the Literature.

Intrapelvic acetabular cup migration is a rare but serious complication that can occur following either primary or revision total hip arthroplasty. Medial acetabular wall weakening is considered the main predisposing factor for acetabular protrusion. A thorough preoperative plan is essential to advocate proper pelvic anatomy reconstruction, including osteosynthesis of the pelvis, if necessary, preservation of muscle and bone stock, and selection of the right prosthetic components without damaging adjacent anatomical structures. We present a rare case of an 84-year-old woman with a hip dislocation and complete intrapelvic migration of the acetabular component, nine years after her second revision surgery of a hip prosthesis placed 60 years ago due to congenital hip dysplasia. The protruded acetabulum was not removed since preoperative CT and digital subtraction angiography (DSA) revealed no vascular compromise. A non-cemented, tantalum acetabular cup, reinforced by a short flange titanium acetabular cage, was placed with a cemented, polyethylene-bearing surface, which was revised to a cemented, constrained acetabular insert three months postoperatively due to dislocation after mobilization on the bed. We conducted a literature review to elucidate the causes, proper diagnostic tools, and preoperative planning of this rare occurrence while trying to evaluate a potential treatment protocol.

Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma: A Case Report and Literature Review.

BACKGROUND Posterior shoulder dislocation is an uncommon injury, accounting for less than 5% of all glenohumeral dislocations. Bilateral locked posterior shoulder fracture-dislocation is an extremely rare entity with an incidence of 0.6 cases/100 000 people/year. A few reports have been published in the literature, predominantly associated with epileptic seizures. CASE REPORT We present a rare case of a 55-year-old male patient with a history of epileptic seizures, who presented with bilateral, locked, posterior fracture-dislocation of the shoulder following an epileptic seizure. The patient was diagnosed with a cavernous hemangioma, which caused his epileptic episode. He was treated operatively, with a modified McLaughlin procedure performed on both sides, at 1 stage, by 2 surgical teams. The cavernous hemangioma was also resected 2 months later. After a follow-up period of 18 months, no recurrent episodes of instability or dislocation were identified. Full range of motion was present on both sides, with good clinical and radiological outcomes. We also conducted a literature review to elucidate the causes of this rare incidence, along with diagnostic workup and treatment options. We were able to identify 36 cases, involving 72 shoulders of bilateral posterior fracture-dislocations in 30 case reports and 2 case series. CONCLUSIONS Bilateral posterior fracture-dislocation of the shoulder is uncommon. Treatment strategy depends on the chronicity, involvement of the humeral head, and the patient's age and functional level. The target is to restore shoulder anatomy and maintain a functional range of motion.

Terrible Triad of the Shoulder: A Case Series and Literature Review.

INTRODUCTION: The shoulder terrible triad is an underdiagnosed injury pattern consisting of anterior shoulder dislocation, rotator cuff tear, and nerve injury from the brachial plexus in its original description. The purpose of this study is to raise awareness of the condition, suggest treatment strategies, and emphasize the difficulties in treating this condition. METHODS: This case series of seven patients from the same institution. All patients underwent x-rays before and after the reduction of the dislocation, MRI to assess the musculoskeletal injuries, and EMG and clinical examination to assess the nerve lesions. Early arthroscopic repair was opted for the rotator cuff tears. A conservative approach was chosen for the nerve lesions. Active forward flexion and external rotation, Constant score, and Visual to Analogue Scale (VAS) were recorded pre- and post-operatively. RESULTS: All the patients showed an improvement in function postoperatively. However, four of the seven patients did not recover fully. The mean Constant and VAS scores were improved from 15.2 +/- 2.8 (12 to 19) to 67 +/- 16.6 (44 to 86) and from 7.5 +/- 1 (6 to 9) to 2.3 +/- 0.8 (1 to 3), respectively. The patients were followed up for a mean time of 28.2 +/- 10.1 months (18 to 43 months). Time-to-surgery shorter than four weeks showed better results, but not statistically significant. CONCLUSIONS: The diagnosis of the shoulder terrible triad requires a high level of suspicion. Early arthroscopic repair for the rotator cuff tears and waiting for the nerve recovery is suggested. Delayed time from injury to surgery might be related to worse outcomes, but higher-level research is needed in this direction.

Osteoid Osteoma of the Trapezium: A Rare Case Report and Literature Review.

Osteoid osteoma is the most common benign osteogenic bone neoplasm. Osteoid osteomas are typically located in the metaphysis and diaphysis of long bones, especially the tibia and femur. However, less common sites of the skeleton can be affected as well, including carpal bones. Among carpal bones, the scaphoid and the capitate are the most affected. Osteoid osteoma of the trapezium is an extremely rare entity, with only seven cases reported in recent literature. We present a case of a 29-year-old male with persistent left wrist pain who was diagnosed with an osteoid osteoma of the trapezium bone. The diagnosis was based on the patient's history, clinical examination and findings from the CT scan, MRI, and plain radiographs. The patient was treated with an excision biopsy with no additional bone grafting. After a follow-up period of 12 months, no pain or signs of recurrence were present. We conducted a literature review to elucidate the clinical presentation as well as the proper diagnostic tools and therapeutic methods for this rare occurrence.

Bilateral Hoffa Fractures of the Medial Femoral Condyles: A Case Report and Review of the Literature.

Introduction: Intra-articular distal femoral fractures in the coronal plane, widely described as Hoffa fractures, are a rare entity. Lateral femoral condyles are mostly affected, while diagnosis can be challenging. Bilateral medial femoral condyle fractures are exceedingly scarce, with only one case being published in recent literature. Case Report: We present a case of a white 65-year-old man with bilateral medial femoral condyle Hoffa fractures caused by a crush injury. The patient was treated operatively by two different teams operating simultaneously on both sides, with good clinical and radiological outcomes after a follow-up period of 3 months. Conclusion: A literature review was conducted to analyze the potential mechanism of injury, diagnostic methods, and therapeutic approach. Bilateral medial Hoffa fractures are rare injuries concerning the orthopedic trauma field and this is the first case described, that was treated operatively with good functional outcomes.

Pseudoaneurysm of the Superior Lateral Genicular Artery of the Knee Following Arthroscopic Irrigation and Debridement and Review of Literature.

Knee arthroscopy is among the most popular surgical procedures performed worldwide. Following knee arthroscopy, complications are infrequent, with vascular damage being extremely rare. We present a case of a 16-year-old man with a superior lateral genicular artery pseudoaneurysm of his right knee. The pseudoaneurysm developed after arthroscopic irrigation and debridement for septic arthritis following previous arthroscopic meniscal repair. Diagnosis was confirmed by computed tomography angiography and the patient underwent intravascular embolization. We conducted a literature review to demonstrate the incidence of vascular injuries following knee arthroscopy, vessels that are more at risk, clinical presentation and current treatment options. Although vascular injuries following knee arthroscopy are uncommon, high clinical suspicion can lead to early detection and treatment of this severe complication.

Prosthetic Knee Joint Infection by Brucella melitensis.

Prosthetic joint infection following arthroplasty is a serious complication associated with high morbidity and prolonged hospitalization. Treatment consists of a combination of surgical intervention and long-acting antibiotic therapy targeted to the responsible microorganism(s). Brucella species-related prosthetic joint infections are uncommon. Diagnosis can be challenging, especially in non-endemic countries, and is confirmed by serological studies and joint aspiration results. We present a rare case of a 78-year-old man with Brucella melitensis infection in a prosthetic right knee joint, seven years after the primary procedure. The patient was treated with a two-stage surgical intervention and a four-month period of antibiotic therapy. After a follow-up period of 12 months, no clinical or laboratory findings of infection were present and the patient was able to return to his everyday activities.

Traumatic Bilateral Brachial Plexus Injury.

Traumatic brachial plexus injuries are serious, life-changing injuries that are becoming more common worldwide. A thorough physical examination, as well as radiologic and electrodiagnostic tests, are all part of the initial evaluation. Parameters such as injury patterns, the timing of intervention, patients' expectations, and pre-injury functional level should always be considered. A bilateral brachial plexus injury is a very uncommon occurrence. To our knowledge, only one case of a bilateral brachial plexus injury associated with trauma has been published in recent literature. We present a rare case of a 19-year-old man who sustained a bilateral brachial plexus injury after a motorbike accident. The patient underwent exploration of the left brachial plexus and a modified Oberlin procedure on his left arm. The right plexus injury was managed conservatively. After a follow-up period of 12 months, the patient completely returned to his previous functional level.

A Case of Reconstruction of an Open Tibial Fracture (Gustilo-Anderson Type IIIB) With Severe Skin and Bone Loss Using Corticocancellous Bone Plugs From the Iliac Crest and an Ilizarov Frame.

Gustilo-Anderson type IIIB fractures include open fractures with extensive soft tissue injury with periosteal stripping and bony exposure. They are usually associated with massive contamination and can be challenging even for experienced surgeons. A multidisciplinary approach among plastic and trauma surgeons is often required. We present a case of a 58-year-old man with a type IIIB open tibial fracture initially managed with a bridging external fixation and primary skin closure using a fasciocutaneous sural flap. Two months later, there was no evidence of fracture healing and an Ilizarov device was applied with corticotomy at the proximal tibial metaphysis, which was modified five months later without changing the frame, placing autogenous iliac bone plugs at the fracture site using the mosaicplasty harvesting technique. Seven months after its initial placement, the Ilizarov device was removed allowing full weight-bearing, with callus formation present at 10-month follow-up. Finally, the patient showed acceptable radiological and functional outcomes after a follow-up of two years. The Ilizarov method should be considered as a therapeutic option for complicated open fractures with severe bone and skin loss. The patient should be fully informed about the complexity of these fractures and the necessity of multiple surgical interventions in order to have realistic expectations.