Unusual presentation of congenital radioulnar synostosis with osteoporosis,fragility fracture and nonunion:A case report and review of literature

BACKGROUND Congenital radioulnar synostosis(CRUS)is a rare deformity of the upper extremity.It is characterized by loss of rotation of the involved forearm and functional limitations in daily activities.No studies on CRUS with osteoporosis have been reported to date,and osteoporosis is usually recognized as an important dimension of genetic disorder in children.We discuss the possible relationship among this disorder,osteoporosis and fracture nonunion,investigate the strict surgical indications and recommended treatments.CASE SUMMARY A 14-year-old male patient with bilateral CRUS with osteoporosis,fragility fracture and nonunion of fractures in ulna and radius presented our institution for further treatment,complaining of limitation in rotation.The bone mineral density of the hip and lumbar spine was 0.687 g/cm2 and 0.705 g/cm2,respectively,and the Z-score for both was-2.1,which revealed osteoporosis and a high risk of fracture.Tow serum bone turnover markers indicated an imbalance of bone metabolism.Reoperation for ulna fracture with autogenous bone grafting and a postoperative physiotherapy program were adopted rather than the separation of pathological synostosis.Radiological examination,observational posture assessment and limb function scale were evaluated before and 1 year after surgery.At 1 year,the fracture nonunion had almost recovered,forearm movement function on the fracture side was restored,and function on the healthy side was significantly improved compared with that before rehabilitation.CONCLUSION Surgical indications for CRUS vary from person to person.Surgery should not be the first choice of treatment,and physiotherapy is not inferior to surgical treatment.

Multiple rare causes of post-traumatic elbow stiffness in an adolescent patient: A case report and review of literature

BACKGROUND Joint stiffness after elbow surgery is not a rare complication,and is always accompanied by deformity.The causes of joint stiffness are multiple in different patients,and divided into intrinsic and extrinsic causes.Herein,we report an unusual case of posttraumatic elbow stiffness due to multiple and rare causes.CASE SUMMARY A 19-year-old male was hospitalized with the loss of motion of the left elbow for over ten years.Left limb computed tomography revealed left elbow stiffness with bony block and connection.The patient underwent surgery,and the etiology of joint stiffness was found to be a rare combination of common and uncommon causes.During an 18-mo follow-up period,the patient’s left elbow had normal motion and he was symptom-free.CONCLUSION However,this case combined with multiple and rare causes highlights that the patient with scar physique is likely to be accompanied with more severe soft tissue,nerve contracture,and heterotypic ossification,even during recurrence.

Old unreduced obturator dislocation of the hip:A case report

Obturator dislocation is a rare type of hip dislocation,accounting for about 2%-5%of all hip dislocations.The occurrence of old unreduced obturator dislocation is even more infrequent,with only 17 cases reported in nine studies,most of which were from the 1950s to 1980s in developing countries.CASE SUMMARY A 38-year-old woman from Hunan Province,China presented with stiffness of the left hip in abduction,flexion,and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior.Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture.Open reduction was performed,resulting in restoration of the concentric alignment of the left hip.After surgery,6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk.At 3 mo after surgery,the patient reported experiencing some pain,which did not affect the function of the affected limb,and some movement restriction but no abduction deformity or claudication was present.An X-ray showed that the left hip was homocentric,and there was no sign of posttraumatic arthritis or avascular necrosis.CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.

Modified pararectus approach for treatment of atypical acetabular anterior wall fracture:A case report

BACKGROUND Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare.It is different from anterior wall fracture classified by Judet and Letournel.Few studies have reported cases treated by open reduction and internal fixation via the Smith-Petersen or iliofemoral approach.CASE SUMMARY We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m.Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim.First,the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d.Then,we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate.At the 9-mo follow-up,the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification,and the X-rays and computed tomography scan reconstructions showed good bone union.CONCLUSION The modified pararectus approach described here can facilitate exposure,reduction,and osteosynthesis for atypical acetabular fracture with less invasiveness.