Total Hip Arthroplasty in a Patient With a Large Proximal Femur Aneurysmal Bone Cyst: A Case Report and Literature Review.

Aneurysmal bone cysts (ABCs) are rare benign bone lesions with a predilection for the metaphysis of long bones. They are often cystic, expansive, and osteolytic and may result in bony deformity. In general, there remains debate about optimal treatment for ABCs; however, the mainstay typically consists of a combination of curettage, bone grafting, and considering the need for internal fixation and osteotomies. The goals of treatment include preserving bony anatomy while eliminating the lesion. There is sparse literature regarding the treatment of osteoarthritis adjacent to benign bony tumors. If total hip arthroplasty is chosen as a treatment option, diligent preoperative planning is required, and the surgeon must assess the patient's bone stock, account for bony deformity, and utilize specific implants and techniques based on the patient's characteristics. We present a case of an adult patient with proximal femur ABC and symptomatic adjacent hip osteoarthritis who underwent treatment with total hip arthroplasty.

Management of Pediatric Supination-inversion Ankle Injuries Involving Distal Tibia and Intraepiphyseal Distal Fibula Fractures.

Pediatric ankle fractures are prevalent injuries that make up a notable portion of all periphyseal injuries. The Salter-Harris classification is the most popular classification about physeal and periepiphyseal injuries. Ogden expanded on this and described type 7 fractures which are completely intraepiphyseal and include propagation of the fracture from the articular surface through the epiphyseal cartilage and do not involve the physis. These injuries are common about the distal fibula in pediatric patients with supination-inversion type injuries. There are no specific guidelines or recommendations on treatment of these injuries in the literature. We present three cases of this injury pattern and describe our chosen management that leads each patient to full, painless ankle range of motion and return to all prior activities and sports without complication. Supination-inversion type pediatric ankle fractures are common injuries that all orthopaedic surgeons will encounter at some point throughout their practice or training. Recognizing fracture variants and understanding treatment options of pediatric ankle fractures are important for the orthopaedic community as a whole.

Subacute Combined Degeneration of the Spinal Cord Induced by Nitrous Oxide Abuse: A Rare Patient Presentation to a Spine Surgery Clinic: Illustrative Case.

Subacute combined degeneration (SCD) of the spinal cord is a disease involving the lateral and posterior columns of the spinal cord that can manifest in patients with vitamin B12 deficiency. Nitrous oxide (N2O)-induced SCD of the spinal cord is a result of N2O interfering with the metabolism of vitamin B12 and results in nervous system demyelination. This is an infrequent complication of N2O anesthesia; however, cases are rising with recreational N2O use. This case report describes a patient with SCD of the spinal cord induced by recreational N2O abuse. The patient presented to a spine surgery clinic with a 3-week history of progressive global weakness and paresthesias. After a detailed history and physical examination, the diagnosis was made and supported by various tests and imaging findings. Despite marked neurologic deficits, the patient's symptoms improved markedly with therapy and vitamin B12 supplementation. Spine surgery clinicians may be confronted with these cases and should be aware of this atypical presentation of SCD. As in our case, patients may present with neurologic deficits of unclear etiology. Neurologic dysfunction may be irreversible; therefore, accurate diagnosis, medical treatment, and complete neurologic evaluation are of the utmost importance to prevent additional progression.

Near-Complete Transection of the Sciatic Nerve After Closed Reduction Attempt of a Dislocated Total Hip Arthroplasty.

Sciatic nerve injuries are rare and devastating complications that can occur following total hip dislocations. These injuries are even more uncommon when resulting from a closed reduction attempt. In the literature, only one other case of sciatic nerve palsy secondary to sciatic nerve laceration has been reported. Conducting a careful neurovascular examination following a closed reduction procedure is crucial in determining the presence of sciatic nerve injury. We present a case of sciatic nerve palsy following a closed reduction attempt of a dislocated total hip arthroplasty (THA). Surgical exploration revealed a near-complete sciatic nerve laceration. The patient subsequently underwent neurolysis and nerve repair. This case highlights the importance of thorough neuromuscular examination following closed reduction of THA, with consideration for surgical exploration when necessary.

Asymmetric Bilateral Hip Dislocations With an Associated Unstable Pelvic Ring Injury: A Case Report.

Asymmetric bilateral hip dislocations are unusually rare injuries in isolation; however, they are even less often associated with unstable pelvic ring injuries. We report a case of asymmetric bilateral hip dislocations with an associated unstable pelvic ring injury and femoral head fracture in a 46-year-old male after being struck by a vehicle as a pedestrian. These injury patterns are typically the result of high-energy trauma, often seen in motor vehicle accidents. A thorough trauma evaluation, including proper radiographic and clinical evaluations, is necessary for the workup of these patients. This case presents an unusual combination of injuries that are associated with severe, potentially life-threatening complications. Ensuring a timely diagnosis and the initiation of early, proper management are essential in preventing poor outcomes in these patients.

An Irreducible Posterior Fracture-Dislocation of the Shoulder: A Case Report.

Posterior fracture-dislocations of the shoulder are exceedingly rare orthopedic injuries. The management of these rare and complex injuries can be challenging from initial presentation through definitive management. Timely diagnosis of these injuries is critical to prevent devastating complications, yet the diagnosis is often delayed. Delays in surgery and poor fracture reduction are associated with a high risk of complications such as avascular necrosis. Additionally, these injuries have the potential to be irreducible. This may occur secondary to osteochondral humeral defects, soft tissue interposition, or entrapment. The long head of the biceps tendon incarceration is one potential block to reduction. Definitive surgical treatment options include open reduction and internal fixation (ORIF) and shoulder arthroplasty. While reoperation rates are higher in patients undergoing ORIF, arthroplasty longevity is a concern among young, active patients with high functional demands. Fibular strut allograft is a useful adjunct when reconstructing complex proximal humerus fractures. We present a case of a 28-year-old male who sustained a significantly comminuted four-part left proximal humerus fracture with an irreducible posterior humeral head dislocation requiring urgent ORIF following a motor vehicle accident.

Pediatric Parotid Chronic Sclerosing Sialadenitis in an African-American Female: A Rare Case and Review of the Literature.

Chronic sclerosing sialadenitis (CSS) or Küttner tumor is an under-recognized, benign fibroinflammatory disease most commonly seen in the submandibular gland of older adult males. Sialolithiasis or bacterial infection was first suspected as an etiology, but CSS is now considered an immunoglobulin G4-related disease (IgG4-RD). IgG4-RD can affect almost every organ in the body, characterized by organ fibrosis with IgG4-positive plasmacytes. Numerous autoimmune-related diseases have been unified under IgG4-RD, including Mikulicz disease (MD), autoimmune pancreatitis, Reidel's thyroiditis, and others. In any organ, IgG4-RD can present similar to malignancy. Due to the ability to mimic malignancy, it is crucial to be aware of this under-recognized clinical entity. CSS is currently of broad and high clinical interest due to increased understanding, multiorgan involvement, and more clearly defined criteria. To increase awareness of this disease, we describe a rare presentation of CSS with a literature review.