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A 60-year-old diabetic patient presented with acute pain and swelling localized to the left acromioclavicular joint. Laboratory and radiological investigations revealed the presence of pus in the left acromioclavicular joint along with bony erosion of the lateral end of the left clavicle. She was treated with open arthrotomy, debridement, and appropriate antibiotics for the causative methicillin-resistant Staphylococcus aureus (MRSA) infection. Prompt diagnosis and timely intervention can reduce the morbidity and mortality due to septic arthritis. We conducted a review of the literature on patients treated for isolated septic arthritis of the acromioclavicular joint.

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Introduction: Septic arthritis (SA) is the inflammation of the joints secondary to an infectious etiology, most commonly affecting the knee, hip, and shoulder. It is often an emergency condition and requires urgent intervention whether medical or surgical at the earliest. This case report highlights one such instance of timely intervention in a challenging scenario. Case Report: In this case report, we encountered a 29-day-old female neonate born at 38 weeks and 4 days to a primigravida mother with a birth weight of 2.8 kg who was diagnosed with the right knee joint SA with neonatal sepsis. The neonate was also found to be suffering with acyanotic congenital heart disease. Early arthrotomy with exploration of joint with antibiotic cover was the chosen line of treatment. Conclusion: Arthrotomy is a very good and established method to deal with SA. Early intervention is advised in these cases to ensure proper recovery without any complications.

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Synovial lipomatosis or lipoma arborescens is a very uncommon pseudo-tumorous lesion of the synovium which more commonly affects the knee joint. The most probable cause of this pathological lesion is degenerative articular disorders of the joint and improper fat accumulation. It is characterized by presence of villous proliferation of the synovium and replacement of the sub-synovial tissue by mature adipocytes which is infiltrated by dense chronic inflammatory cells like lymphocytes, plasma cells and eosinophils. This condition is rarely seen in smaller joints. Its aetiology is still unknown. We report a patient who presented with features of septic arthritis which on intraoperative and histopathological assessment showed features of synovial lipomatosis.

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In managing orthopedic trauma, Hoffa's fracture, a rare intra-articular fracture affecting the femoral condyle, presents a unique challenge. We report a case of a 45-year-old male patient who had a traumatic injury and complained of substantial knee discomfort and limited range of motion. The patient had a medial femoral comminuted Hoffa's fracture. Subvastus arthrotomy was employed to handle the fracture successfully, and then a locking reconstruction plate, Herbert screws, and 4 mm cannulated screws were used for precise reduction and fixation. At the one-year follow-up, the patient showed acceptable postoperative results, including recovered knee function and radiographic indications of fracture repair.

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Lateral tibial plateau fractures are generally present as depressed fractures. The lateral tibial plateau is more common than the medial tibial plateau, often due to a bumper injury. If depressed fragments are more than 8-10 mm, then surgical management is usually needed. Anterolateral fixation is frequently used for unicondylar lateral tibial plateau fractures. Here, we present an articular depressed lateral tibia plateau fracture in a Schatzker type 3 case. The fracture was managed through an anterolateral approach with sub-meniscal arthrotomy, allowing for direct visualization and subsequent fixation using bone cement and a cannulated cancellous screw. Postoperative imaging confirmed proper reduction, and the patient had a satisfactory outcome..

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Within the synovial membrane, cartilaginous nodules form as a result of a relatively rare joint condition called synovial chondromatosis. This case study describes the open surgical treatment of a male patient, age 25, who had severe discomfort in his right knee. The patient had synovial chondromatosis. The choice for open surgery was made because of the large and difficult nature of the lesions, even though arthroscopic procedures are commonly used in the management of this problem. The patient's history included a restricted range of motion, edema, and chronic right knee discomfort. Multiple intra-articular loose bodies were discovered during the clinical examination and imaging examinations, which led to the decision to do surgery. Owing to the size and position of the chondromatous lesions, an open surgical technique was considered suitable. Given the favorable result in this young adult patient, open surgical management of synovial chondromatosis may be an effective treatment option, especially in cases with complicated or widespread involvement.

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INTRODUCTION: Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes. MATERIALS AND METHODS: We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy. RESULTS: 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes. CONCLUSION: There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.

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Penetrating injuries to the musculoskeletal system pose common challenges for orthopedic surgeons in emergency departments (EDs). The complexity escalates when a joint is affected, increasing the risk of severe complications such as infection and post-traumatic arthritis. Given the potential importance of these injuries, early diagnosis and a meticulous treatment plan are crucial. In this paper, we present a unique case of penetrating trauma, resulting in an intra-articular defect on the lateral femoral condyle of an adolescent girl. This case underscores the importance of tailored interventions in managing complex musculoskeletal injuries.

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Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.

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Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow. The aim of this review is to optimize patient care and outcomes.

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Anterior ankle impingement syndrome can frequently present in athletes and post-traumatic patients who have osteophytes contributing to limited dorsiflexion and pain. Surgical treatment options include arthroscopy, open arthrotomy, arthrodesis, and total implant arthroplasty. For many, joint-sparing arthroscopy or arthrotomy yield satisfactory results if significant debridement is performed. If debridement is not aggressive, patients may not obtain the desired improvement. In cases where a larger amount of bone must be removed, or the patient does not have an anatomic appearing talar neck due to osteophytic changes, we have found that an open approach is necessary to achieve good results. To the best of our knowledge, no such technique has been previously published detailing a standard approach to open ankle arthrotomy. Our technique is coined the "Aggressive Open Anterior Ankle Cheilectomy" and involves a systematic 3-step approach. First, the tibial osteophytes are resected with an osteotome; second, the ankle gutters are addressed, and all hypertrophic bones removed; and third, an anatomic talar neck is fashioned. We herein describe our surgical technique and case examples.Level of Evidence: 5.

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Osteoid osteomas (OOs) are non-malignant primary bone abnormalities marked by a central nidus surrounded by reactive sclerosis. They typically manifest as aggravated nocturnal pain that responds to non-steroidal anti-inflammatory drugs (NSAIDs). These growths are most frequently found within the intracortical bone and the diaphysis of elongated bones. Within the realm of uncommon conditions, intra-articular OOs (IAOOs) exhibit distinctive presentations, often leading to postponed or inaccurate diagnoses. We present a patient with OO at the distal femur, accessible through the knee joint, which was intraoperatively identified and localized using a needle pricking technique and treated by arthrotomy and mosaicplasty.

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Introduction: In today's world, high-cost procedures are being examined, and alternative procedures are being developed. In this context, one frequently examined procedure is total knee replacement. Purpose: This study aims to examine the three different closure techniques used in total knee replacement. Methods: This study is a prospective randomized controlled study. Two hundred participants who underwent total knee replacement surgery, were included in the study. Participants were randomly divided into three groups. Arthrotomy was performed using a medial parapatellar approach with a midline incision. Standard femoral and tibial cuts were followed by the implantation of a Smith and Nephew genesis II implant for all participants. Complications, joint range of motion, pain scores, certain movement degrees, and functional scores were investigated. Results: Pre-op and post-op range of motion, knee society score, oxford knee score, certain movement degree values have shown no significant difference. Visual analogue scale values were different significantly between the groups. There is a statistical difference between the range of motion, knee society score, oxford knee score, certain movement degree and visual analogue scale values in repeated measurements. The most common complication was a hematoma. This was observed most frequently in the continuous vicryl suture group. The closure time in the Barbed group was significantly lower than in the other groups. Discussion: Treatment for total knee replacement is a heavy economic burden. Health systems and hospitals are under pressure. The results obtained in our study show that there is no superiority of one closure technique over the other.

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Septic arthritis of the shoulder in pediatric patients should be diagnosed and treated urgently to prevent complications of the disease. However, early detection can be a challenge due to mild symptoms with ambiguous laboratory and radiological findings. We report a case of an eight-month-old girl who presented to us initially with pseudo paresis of her right shoulder without any signs suggestive of infection. After a negative ultrasound, she was discharged with analgesia upon improvement of range of motion. Three weeks later, she presented with recurrent shoulder pain associated with fever, swelling, elevated CRP, and osteomyelitis changes of the humeral head on a plain radiograph. We proceeded with a minimally invasive arthrotomy washout and commenced on IV antibiotics. At one month follow-up, she regained her full range of motion and recovered fully. No recurrence of septic arthritis until six-month follow-up. This write-up discusses the diagnostic challenge of pediatric shoulder septic arthritis and the surgical technique of minimally invasive arthrotomy washout in a pediatric patient.

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The aim of this study was to systematically review the diagnosis and management of temporomandibular joint synovial chondromatosis (TMJ-SC). Using a systematic study design based on the PRISMA guideline, the researchers implemented and analyzed a cohort of relevant publications indexed by PubMed, Embase, Medline, and LILACS between January 1990 and December 2022. The outcomes of interest were demographics of the primary studies, and Clinical, radiological, and therapeutic data associated with TMJ-SC. The study samples included 8 studies presenting 121 TMJ-SC cases (73.6% female; 100% unilateral; 53.7% left-sided; mean age, 43.3 ± SD 5,80 [range, 21-81]. Non-specific symptoms were mostly reported, including TMJ pain, noise and local inflammation, and/or malocclusion. Radiographically, loose bodies, masses with low-signal foci, and calcification were common charateristics. Until now, there has been no internationally accepted consensus on diagnosis and management of TMJ-SC. Arthroscopic surgery should be performed on masses confined to the superior TMJ space, while open arthroplasty is indicated in cases with the extra-articular extension. A combination of both treatment methods may be necessary, when the lesion locates extending beyond the medial groove of the condyle.

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BACKGROUND: Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2-7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments-arthrocentesis, arthrotomy, and arthroscopy-provides better results in children and when to use them. METHODS: Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings. RESULTS: A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique. CONCLUSIONS: We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it.

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The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.

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Purpose: To evaluate the use of computed tomography (CT) imaging as a diagnostic tool for elbow arthrotomies using a standardized cadaveric arthrotomy model. Method: Nineteen intact fresh frozen cadaver elbows were CT scanned using 2 mm cuts with sagittal and coronal reformats in the plane of the joint and used as controls. An elbow arthrotomy at the posterocentral arthroscopic portal site was performed in all specimens using a 4.5 millimeter trocar. After arthrotomy, all elbows underwent a second CT scan followed by a standard saline load test (SLT). Images were randomized and reviewed by 2 blinded, independent reviewers. Bimodal scoring was performed for each specimen with regard to the presence of an arthrotomy indicated by presence of air in the joint. Regarding the SLT, saline exiting the arthrotomy wound was considered a positive test. Results: CT scans were found to have 100% sensitivity and 86% specificity for diagnosing elbow arthrotomies. Interrater reliability calculated with Cohen kappa statistic was near perfect at r = 0.89. The SLT had a sensitivity of 79% when 20 mL was injected. A total of 25 mL of saline was required to be injected for a sensitivity greater than 95%. Conclusion: This study demonstrates that CT scan is a reliable and less technically demanding method of diagnosis arthrotomies with high interrater reliability and high sensitivity and with results comparable with SLT. This technique may be useful in centers where trained providers are not readily available to perform SLT. Clinical study is required to validate our results. Level of Evidence: Level II.

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The aim of this study was to report a rare case of a giant cell tumor of the patellar tendon sheath. This indicates the diagnostic procedures and treatment options for giant cell tumors of the patellar tendon. This study reported a case of a 13-year-old male patient with a giant cell tumor of the tendon sheath. In our case, open arthrotomy was performed with complete surgical excision of the lesion. Histopathological examination revealed a giant cell tumor. At the last follow-up, 2 years after surgery, no complications were reported. The giant cell tumor of the patellar tendon sheath is an uncommon benign tumor. It mimics common knee symptoms. A differential diagnosis is definitely a challenge. Available operation approaches have demonstrated similar results, which lead to symptom relief and a low recurrence rate.

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Nail gun injuries are relatively common presentations to the emergency department. The majority of these injuries occur to the hands and rarely result in long-term morbidity. However, despite the large number of cases each year, little research is available regarding the optimum emergency management of nails that implant intra-articularly. Initial studies suggested that cases of nails penetrating intra-articular or neurovascular structures warranted operative debridement; however, newer studies have suggested cautious nail removal, wound debridement, irrigation, antibiotic coverage, and tetanus prophylaxis are equivalent to operative intervention for the management of most intra-articular nails. We present a gentleman in his 40s with accidental penetration of a nail fired from a nail gun into his right knee. He was neurovascularly intact. After initial evaluation and management, he was transported to a higher level of care for operative management. However, the nail was ultimately removed bedside utilizing adequate anesthesia.