A Missed Diagnosis of Intraprosthetic Dislocation in a Dual-Mobility Bearing Following Closed Reduction.

Dual-mobility bearings have been found to reduce the rate of dislocation following both primary and revision total hip arthroplasty. Their unique design involves two articulating surfaces which increases construct stability but also leaves them susceptible to a unique complication known as intraprosthetic dislocation (IPD). We report the case of a 33-year-old female who sustained an IPD following closed reduction. Following a missed radiographic diagnosis, the patient experienced pain and mechanical symptoms secondary to her implant failure. Surgical removal of the dislodged liner with component revision was required. This case highlights several crucial steps in the management of patients with dislocated total hip arthroplasties including implant identification and careful review of postreduction radiographs. We also discuss several strategies to properly diagnose, manage, and avoid IPD.

Tiger Attack Resulting in a Humeral Defect Treated with Proximal Humeral Replacement and Latissimus Dorsi Flap: A Case Report.

CASE: A 69-year-old woman presented with a type IIIB left proximal humerus fracture with a 500-square-centimeter soft tissue defect, 10-cm bone defect, and radial nerve laceration after a tiger attack. The surgical intervention included proximal humeral replacement with muscular integration, radial nerve repair, and latissimus dorsi flap coverage. CONCLUSION: This case presents an exceedingly rare injury mechanism resulting in a significant soft tissue and bone defect. Its novelty lies in the complexity of the injury, which required a well-coordinated multispecialty treatment approach. This strategy applies to injuries with similar extensive soft tissue and bone defects.

Total Hip Arthroplasty With Prophylactic Fixation of Greater Trochanter and Distal Femur in a Patient With a History of Multiple Myeloma and Breast Cancer.

Multiple myeloma is the most common primary malignancy of the bone marrow and may present as bone pain and/or pathologic fracture(s) in affected patients. Treatment of bone lesions typically consists of chemotherapy and radiation and may include prophylactic fixation in patients meeting specific criteria. This report reviews a case of a 74-year-old female with a history of multiple myeloma and breast cancer, previously treated with chemotherapy and radiation, who sustained a pathologic femoral neck fracture with associated ipsilateral lesions of the femoral shaft and peritrochanteric region. This patient received a total hip arthroplasty with a greater trochanteric claw plate and extended femoral stem for prophylactic fixation of the distal femur. In this report, the current literature surrounding the use of extended femoral stems for prophylactic fixation of femoral diaphyseal lesions will be reviewed and the above case will be presented. This case serves as a bridge between orthopedic oncology and arthroplasty as an extended femoral stem was used to prevent future pathologic fracture of distal femur lesions.

Bilateral Posterior Four-Part Fracture-Dislocation of the Proximal Humerus After First-Time Seizure.

This report presents a previously undescribed case and treatment of bilateral four-part proximal humerus (PH) fracture-dislocations presented in a 61-year-old Caucasian male patient following a first-time seizure episode. The patient was treated with bilateral reverse total shoulder arthroplasty due to pre-existing glenohumeral arthritis and rotator cuff atrophy. The surgery was successful, and the patient's postoperative recovery was uneventful. Fractures of the proximal humerus are a relatively common adult osteoporotic fracture; however, posterior fracture-dislocations of the PH, frequently related to motor vehicle accidents, seizures, or electrical shock, are remarkably scarce. A treatment algorithm for these injuries is lacking.

Operative Intervention for a Chronic Fifth Carpometacarpal Dislocation: A Case Report and Review of Literature.

INTRODUCTION: Carpometacarpal (CMC) dislocations are infrequent hand injuries that are often missed in the acute care setting, resulting in inappropriate treatment and significant morbidity. CMC dislocations occur in a volar or dorsal direction, and volar dislocations are traditionally subclassified as either volar-ulnar or volar-radial. While various treatment methods and injury identification techniques have been reported in the literature, there remains a lack of standardization in the treatment of these injuries. This case report reviews the current literature on the subject in an attempt to further our knowledge on the subject. CASE REPORT: A 73-year-old right hand dominant male presented to the clinic complaining of persistent pain on the ulnar aspect of his left hand for the past 3 months. The injury had been missed in the urgent care and emergency settings before his arrival to the office. Radiographs demonstrated a volar-ulnar dislocation of the fifth CMC joint. The patient subsequently underwent open reduction with internal fixation to correct his deformity. Post-operative QuickDASH and grip strength measurements were gathered at post-operative visits. CONCLUSION: This paper provides a literature review on the diagnostic techniques and management options of the fifth CMC dislocations. It further provides a treatment algorithm for a chronic volar-ulnar fifth CMC dislocation being amenable to open reduction and Kirschner wire fixation with an excellent outcome.

Early Aseptic Failure of the Tibial Component-Cement Interface in ATTUNE® Total Knee Arthroplasty: A Report of Three Cases.

Total knee arthroplasty (TKA) systems are designed to maximize the longevity of the implant. However, an unusually high rate of aseptic tibial tray loosening was observed in the DePuy ATTUNE® total knee arthroplasty system (DePuy Synthes, Warsaw, USA). Affected patients noted symptoms of instability and reproducible pain at the bone-implant interface. However, there was no radiographic evidence of lucency or implant failure. Intra-operatively, the tibial component was grossly loose and lacked adhered cement. We hypothesize that the loosening is due to the smooth architecture of the undersurface of the tibial component, lacking either grit blasting or porous coating.

Compartment Syndrome of the Hand Presenting as Bullous Edema.

Compartment syndrome of the hand can be a challenging diagnosis to ascertain. The difficulty in diagnosis is in part due to the absence of an established diagnostic criteria. Additionally, when a patient presents obtunded or with an altered sensorium, the identification of compartment syndrome of the hand can be further complicated. Despite the potential difficulty in diagnosis, it is of upmost importance for orthopedic surgeons to recognize and treat this entity in an expeditious manner. Without prompt treatment, the risk is increased morbidity including possible amputation. Here, we present a unique and thought-provoking case along with a review of the literature. The purpose of sharing this case is to highlight potential clues to aid in prompt diagnosis and improve patient outcomes.