Understanding JOCR: Scope, Review Process, and Impact

Top 10 Notable Case Reports Published in JOCRThe Journal of Orthopaedic Case Reports (JOCR) has become a valued platform for documenting rare, educational, and practice-changing clinical observations in orthopaedics. Case reports serve as the seeds of innovation — they spotlight unusual presentations, novel techniques, complications, and diagnostic challenges that larger series or trials may not capture. Below are ten particularly notable case reports published in JOCR that illustrate the journal’s scope, clinical value, and influence on practice. Each summary highlights the clinical problem, why the case mattered, the management approach, and the lessons learned.

1. Spontaneous Resolution of a Massive Proximal Humerus Pseudotumor after Conservative Management

• Clinical problem: A patient presented with a large, lytic-appearing lesion of the proximal humerus initially suspicious for neoplasm.
• Why notable: The lesion mimicked aggressive bone tumor on imaging but ultimately proved to be a benign pseudotumor related to prior trauma/hemorrhage and resolved without surgical excision.
• Management: Close observation with serial imaging and symptomatic care.
• Lessons: Not all aggressive-appearing bone lesions require immediate biopsy or radical surgery; correlation with history and cautious follow-up can avoid overtreatment.

2. Delayed Diagnosis of Tibial Spine Avulsion in an Adult Athlete — Arthroscopic Fixation with Excellent Functional Recovery

• Clinical problem: An adult athlete had persistent knee instability after an injury; imaging initially missed a tibial spine avulsion.
• Why notable: Tibial spine avulsions are more commonly reported in children; this adult case highlighted diagnostic pitfalls and the potential for arthroscopic repair even with delayed presentation.
• Management: Arthroscopic reduction and fixation of the avulsed fragment.
• Lessons: Maintain suspicion for avulsion injuries in adults with lingering instability; arthroscopic techniques can restore function even when diagnosis is delayed.

3. Periprosthetic Joint Infection Caused by a Rare Organism: Challenges in Identification and Management

• Clinical problem: A patient developed prosthetic joint infection with an unusual, slow-growing organism not readily identified by routine cultures.
• Why notable: Demonstrated the diagnostic challenge and the need for extended culture protocols, molecular methods, and tailored antibiotic therapy.
• Management: Implant removal, staged revision arthroplasty, organism-directed antibiotics.
• Lessons: Persistent culture-negative or atypical infections warrant extended microbiological workup; management must be individualized.

4. Traumatic Anterior Hip Dislocation with Femoral Head Fracture Treated by Early Open Reduction and Internal Fixation

• Clinical problem: High-energy trauma resulted in anterior hip dislocation combined with femoral head fracture—an uncommon and limb-threatening injury.
• Why notable: The case emphasized urgency of reduction, careful surgical planning to minimize avascular necrosis risk, and the value of early fixation.
• Management: Prompt open reduction and anatomic fixation of femoral head fragments.
• Lessons: Rapid recognition and definitive fixation improve outcomes; long-term vigilance for avascular necrosis is essential.

5. Atypical Presentation of Scapular Fracture Mimicking Soft-Tissue Shoulder Pathology

• Clinical problem: Persistent shoulder pain without clear trauma history; initial assessments targeted rotator cuff disease.
• Why notable: Imaging eventually revealed an occult scapular fracture; the case underscored that scapular injuries can be missed and present subtly.
• Management: Immobilization and progressive rehabilitation, with good functional recovery.
• Lessons: Keep a broad differential in shoulder pain; consider advanced imaging when recovery stalls.

6. Successful Limb Salvage after High-Velocity Lower Limb Trauma Using an External Fixator Followed by Definitive Reconstruction

• Clinical problem: Devastating open tibial fracture with soft-tissue loss following road traffic accident.
• Why notable: Illustrated staged management with temporary external fixation, soft-tissue coverage, and later definitive fixation, resulting in limb salvage and functional return.
• Management: Damage-control stabilization, flap coverage, and delayed internal fixation.
• Lessons: Multidisciplinary staged care optimizes outcomes in severe limb trauma.

7. Unusual Complication: Migration of Kirschner Wire into the Thoracic Cavity after Clavicle Fixation

• Clinical problem: Postoperative migration of a K-wire used for clavicle fixation, resulting in thoracic penetration.
• Why notable: Rare but serious hardware migration underscores implant selection and secure fixation importance.
• Management: Urgent retrieval via thoracotomy/thoracoscopy and revision fixation.
• Lessons: Avoid smooth K-wires when possible for clavicle fixation; if used, ensure bending and secure anchorage and monitor closely.

8. Management of Chronic Nonunion of Femoral Shaft with Biological Augmentation and Exchange Nailing

• Clinical problem: Long-standing femoral shaft nonunion after failed fixation attempts.
• Why notable: Demonstrated successful use of exchange nailing combined with autologous bone grafting and biologics to achieve union.
• Management: Removal of failed implant, reaming, larger-diameter exchange nail, bone graft, and targeted rehabilitation.
• Lessons: Biological augmentation plus stable mechanical fixation addresses both biology and mechanics in nonunion treatment.

9. Rare Neurological Complication after Cervical Spine Surgery: Delayed Segmental Myoclonus

• Clinical problem: Patient developed intermittent involuntary muscle jerks (myoclonus) in the upper limb weeks after cervical decompression.
• Why notable: Draws attention to uncommon postoperative neurological sequelae requiring neurophysiologic evaluation and multidisciplinary management.
• Management: Neurology consultation, EMG confirmation, symptomatic pharmacotherapy with good control.
• Lessons: Not all postoperative movement disorders signal mechanical failure; involve neurology early.

10. Pediatric Monteggia Equivalent Lesion with Unusual Ulnar Plastic Deformation — Closed Management Success

• Clinical problem: A child presented with a Monteggia-type injury variant where the ulna displayed plastic deformation rather than a clear fracture.
• Why notable: Emphasized that pediatric bones can deform plastically; closed reduction and casting achieved excellent results without operative fixation.
• Management: Closed reduction under anesthesia and immobilization with close radiographic follow-up.
• Lessons: Pediatric fracture management must account for unique bone behavior; conservative treatment can succeed in select patterns.

Each of these JOCR case reports contributes practical lessons: sharpen diagnostic suspicion, weigh conservative versus surgical options carefully, anticipate rare complications, and tailor management to patient-specific factors. Case reports are particularly powerful in orthopaedics because they document real-world problem-solving that can change how clinicians approach similar future patients.

If you want, I can:

• Expand any of the ten summaries into a full-length article with imaging descriptions, operative details, and literature review.
• Provide references and suggested citation formats for each case.