A case report of neglected patellar dislocation with postoperative complication of thyroid storm mimicking infection - A double whammy

We report a case of 22year old male admitted with the history of 4-year-old post traumatic neglected patellar dislocation initially treated with native treatment, presented to us with painful and restricted knee ROM and extensor lag. After complete pre operative work up, diagnostic knee arthroscopy...

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Bibliographic Details
Published in:Journal of arthroscopy and joint surgery 2020-10, Vol.7 (4), p.235-238
Main Authors: Singhi, Prahalad Kumar, Raju, Sivakumar, Raghavakumar, V.P, Somashekar, Venkatappa
Format: Article
Language:English
Subjects:
Neglected patellar dislocation
Postoperative infection
Thyroid storm
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Summary:We report a case of 22year old male admitted with the history of 4-year-old post traumatic neglected patellar dislocation initially treated with native treatment, presented to us with painful and restricted knee ROM and extensor lag. After complete pre operative work up, diagnostic knee arthroscopy with open reduction, combined proximal and distal realignment procedure (medial retinacular, VMO repair and tibial tuberosity transfer) was done. Postoperatively patient developed high-grade fever, tachycardia, hypertension and investigations were not correlating with infection. Further clinical manifestations made us to think of some other hyper metabolic state and thyroid function test was done which revealed thyrotoxicosis. A diagnosis of thyroid storm was made in our case according to Burch-Wartofsky score and Japanese thyroid association criteria. Patient was treated with antithyroid drugs, beta-blockers and steroids and responded well. Timely recognition and aggressive management helped to prevent high mortality and morbidity in this case. He was subjected to aggressive rehabilitation after 6 weeks and on regular follow up tibial tubercle transfer healed well with excellent outcome on Kujala Anterior Knee Pain Scoring at latest follow up of 2 years in spite of an unexpected dreadful complication. A complex case of neglected patellar dislocation well planned and executed surgery an unexpected, unusual complication of thyroid storm with very high mortality was timely diagnosed and managed well hence this double whammy experience is worth sharing.
ISSN:2214-9635
2214-9635
DOI:10.1016/j.jajs.2020.09.003