Nathan Jones’s research while affiliated with Philadelphia College of Osteopathic Medicine and other places

Introduction This review of case series and case reports explores conservative management strategies for paraspinal compartment syndrome (PCS), a rare clinical condition. Extremity compartment syndrome has been shown to be managed most effectively with emergent surgical release of the fascial compartment. Given the rarity of PCS and the paucity of research in the literature, some authors have suggested the possibility of conservative treatment. There has been no study to date that has specifically investigated the cases of non-operative management of PCS. Materials and Methods There are 16 case reports in the literature with 22 cases of PCS treated conservatively. The authors reviewed these cases, specifically viewing the clinical courses, why the decision was made to manage conservatively, and the reported outcomes. Results The etiology of PCS varied, with weightlifting being the primary cause in 11 out of 22 cases, followed by strenuous sporting events and postsurgical complications. All patients in this review were male, aged between 18 and 61 years old. Acute presentations exhibited severe back pain, rigid paraspinal musculature, and subjective paraspinal paresthesias. Magnetic Resonance Imaging findings of the spine revealed profound bilateral symmetric intramuscular edema. Among the cases, 8 explicitly reported a return to normal function, while 8 continued to experience symptoms related to the initial injury. Nine cases chose conservative measures primarily because of delayed presentation, seven instances reported successful outcomes with conservative measures; one case cited concerns about infection risk. Discussion The probability of underreporting related to PCS may result in a substantial number of cases being omitted from medical literature. Pathologically, PCS is characterized by increased intra-compartmental pressure, triggering rhabdomyolysis due to significant soft tissue damage. Emergent surgical intervention is the treatment of choice for any compartment syndrome; however, conservative management of these cases has shown satisfactory clinical outcomes. Hyperbaric oxygen therapy emerges as a potential adjunctive treatment to enhance tissue viability, though its efficacy and accessibility warrant further investigation in the context of PCS management. Conclusion Early recognition and treatment of PCS are critical in preventing chronic pain and permanent complications. Given the limitations identified in non-operative management, further research is imperative to optimize treatment strategies.

Introduction: Neurofibromatosis type I (NF1) is an autosomal dominant disorder that typically results in Café-au-lait macules and peripheral nerve sheath tumors (i. e, neurofibromas). While peripheral neurofibromas are common, intra-articular knee neurofibromas are rarely described in the literature. To date, there only have been two other case reports noting intra-articular knee neurofibromas. The authors present the case of a patient with NF1 who was found to have an intra-articular knee neurofibroma incidentally discovered during the surgical approach to a retrograde femoral nail. Case Report: The patient is a 65-year-old female who presented to the emergency room after a fall from standing height with left distal thigh pain. X-rays were obtained and demonstrated a left supracondylar, extra-articular distal femur fracture. The patient had known NF1 with widespread cutaneous neurofibromas and was noted to have a large palpable soft-tissue mass over the anterior aspect of the knee on pre-operative examination. After an incision was made for a retrograde femoral intramedullary nail, the large soft-tissue mass prevented adequate surgical visualization. The mass was noted to track laterally around the patellar tendon, into the knee joint, communicating with Hoffa’s fat pad. The mass was resected and sent for pathology. The case proceeded uneventfully. The mass sent for pathology was positive for a neurofibroma. Clinical features alongside radiographic, computed tomography, and histopathological findings are presented. Conclusion: Intra-articular knee neurofibromas are rare and there is a paucity of literature on the topic. While found incidentally in our patient, the discovery of an intra-articular neurofibroma underscores the need for further investigation into its potential association with neuropathic arthropathy and other associated joint disorders. Keywords: Neurofibromatosis, intra-articular lesion, distal femur fracture.