Surgical Repair of an Avulsed Distal Flexor Carpi Radialis Tendon in a Boxer: A Case Report Case: A 25-year-old professional boxer presented with a right distal flexor carpi radialis (FCR) tendon avulsion after sustaining an injury while boxing. The avulsion was identified and confirmed with magnetic resonance imaging, and the tendon was successfully reinserted into the trapezium. The patient returned to professional boxing 10 months later without complication. Conclusions: Distal FCR tendon avulsions are rare. Occasionally, this tendon can avulse after an application of excessive force. For some patients, unrepaired distal FCR tendon avulsions may prevent competitive performance. In this case, the tendon was reattached to the trapezium to aid wrist motion and stability, which are essential for professional boxing.

Return to Collegiate Hockey After Repair of Chronic Biceps Femoris Tendon Transection at the Knee: A Case Report Case: A 22-year-old man sustained complete transection of his right distal biceps femoris tendon by a hockey skate. He experienced persistent pain and disability, symptoms of peroneal neuritis, and an inability to return to hockey. At 3-months postinjury, he underwent biceps femoris repair and peroneal neurolysis. At 9-months postoperatively, the patient returned to full activity and played a full season collegiate hockey. Conclusions: Isolated distal biceps femoris transection is rare and may be associated with peroneal neuritis. Primary repair and peroneal neurolysis is a viable treatment option (even 3 months postinjury), with satisfactory outcomes and full return to high-level activity.

Lytic Lesion in the Proximal Humerus After a Flu Shot: A Case Report Case: There has been a recent campaign to vaccinate patients in an effort to prevent widespread flu pandemic. Although the complication rate after vaccine is low, there have been reports of Guillain-Barré syndrome and shoulder injury related to vaccine administration (SIRVA). In this case presentation, we discuss a patient who developed a large lytic lesion in the proximal humerus after a deeply administered flu shot. Conclusions: SIRVA is a rare cause of shoulder pain after injections, but one that progresses and often necessitates operative management. Clinicians should be wary of persistent shoulder pain after a flu shot.

Facial Numbness and Paresthesias Resolved with Anterior Cervical Decompression and Fusion: A Report of 3 Cases Case: We report 3 patients with classic trigeminal neuropathy (TN) findings, which were due to compressive cervical radiculopathy, and provide a brief anatomic explanation for this association. In each case, left-sided disk herniation between the C5 and C7 levels caused TN and classic (dermatome appropriate) cervical radicular findings, all of which resolved with anterior cervical decompression and fusion (ACDF). Conclusions: To our knowledge, this is the first report of TN caused by radicular compression in the caudal subaxial (C5-C7) cervical spine, which resolved after ACDF.

Dynamic Stress MRI of Midfoot Injuries: Measurable Morphology and Laxity of the Sprained Lisfranc Ligament During Mechanical Loading: A Case Report Case: Our 26-year-old patient is a professional ballet dancer who suffered a classic Lisfranc joint injury while performing a dancing maneuver with his foot in full plantar flexion. Initial workup with radiographs revealed borderline Lisfranc interval widening without definitive joint instability. Further evaluation with an innovative dynamic stress magnetic resonance imaging (MRI) revealed mild interosseous Lisfranc ligament laxity and sprain, which allowed the orthopaedic surgeon to pursue conservative management, rather than surgery. After physical therapy, our patient reports a successful return to dancing. Conclusions: Dynamic stress MRI may become a useful technique in evaluating equivocal cases of midfoot injury through the use of new imaging-based criteria.

Closed Distal Dislocation of the Intermediate Cuneiform in a Complex Lisfranc Fracture-Dislocation: A Case Report Case: A 21-year-old, active duty male sustained an irreducible, complex Lisfranc fracture-dislocation with distal extrusion of his intermediate cuneiform. He was treated in a staged manner with external fixator placement, followed by an extended midfoot fusion with autograft bone. At 19 months, he could perform all activities of daily living independently with minimal pain using an Intrepid Dynamic Exoskeletal Orthosis. Conclusions: Complex Lisfranc injuries are severe and often result in chronic pain and disability after operative management. To our knowledge, this is the only case report describing a Lisfranc fracture-dislocation with a distally extruded intermediate cuneiform treated with a fusion.

Hypermobile Medial Meniscus: A Case Report Case: A 21-year-old college soccer player suffered from knee joint pain, but neither preoperative clinical examination nor magnetic resonance imaging could detect a precise diagnosis. Arthroscopy showed that medial meniscus hypermobility led to impingement of the femorotibial joint surface. After inside-to-outside meniscus suture, the abnormal hypermobility could no longer be observed. The player returned to sports without any previously experienced symptoms. Conclusions: We present a case report of the hypermobile medial meniscus without substantial tear treated by meniscal suture. A careful arthroscopy inspection was the key element of the diagnosis and subsequent successful surgical treatment.

Inflammatory Reactions to Xenogenic Nerve Wraps: A Report of Three Cases Case: Recurrent carpal tunnel syndrome is a challenging problem. Nerve wraps have been introduced as a barrier to prevent scar traction neuritis for use during revision carpal tunnel surgery. We present 3 cases of inflammatory responses to bovine collagen and porcine subintestinal mucosal nerve wraps in patients undergoing revision carpal tunnel surgery. No patient had evidence of infection, and pathology revealed acute and chronic inflammation. All 3 patients responded favorably following wrap removal. Conclusions: We recommend caution with the routine use of nerve wraps in the setting of revision carpal tunnel surgery.

Compressive Femoral Mononeuropathy Secondary to Acetabular Labral Tear Associated With Paralabral Ganglion Cyst of an Osteoarthritic Hip: A Case Report Case: A 61-year-old man presented with a 5-year history of left hip pain and a 6-month history of left groin swelling associated with hypoesthesia and proximal muscle weakness. Radiograph of the left hip showed degenerative joint disease. Magnetic resonance imaging revealed a large, anteriorly displaced paralabral cyst of the left hip joint. Neurophysiologic studies were corroborative of left femoral mononeuropathy. Complete excision of the cyst along with total hip replacement were performed. At 4-year follow-up, there was complete remission with resolution of symptoms. Conclusions: Our experience emphasizes the importance of identifying and addressing the underlying primary pathologic disease for a satisfactory functional outcome.

Post-operative Orthopedic Infection with Monomicrobial Leclercia adecarboxylata: A Case Report and Review of the Literature Case: An 65-year-old immunocompetent female developed a Leclercia adecarboxylata infection following the repair of closed olecranon fracture. L. adecarboxylata is associated with polymicrobial infections, infections in immunocompromised patients and penetrating or open wounds. Following speciation, intravenous ceftriaxone was started. Two weeks later, the patient presented with leukopenia and neutropenia. Per infectious disease recommendations, the patient was switched to intravenous ertapenem with resolution of both infection and neutropenia. The olecranon fracture went on to heal fully. Conclusions: This case describes a rare postoperative monomicrobial infection with L. adecarboxylata in an immunocompetent host following musculoskeletal trauma and identifies L. adecarboxylata as a potential emerging hospital-acquired pathogen following orthopedic surgery.