EC Orthopaedics

Introduction and Importance: PJK/PJF are well-recognized consequences of long construct fusion, commonly seen post deformity correction in adults with pre-existing osteoporosis. However, it is not well understood in terms of all its manifestations and ways to treat it. This case report highlights a feature of PJK/PJF.

Case Presentation: An elderly man with multiple comorbidities and a very complex spinal surgical history sustained a rib fracture following the development of asymptomatic PJK after the revision of his degenerative kyphoscoliosis correction. This case emphasizes the importance of careful postoperative monitoring and management in patients with extensive surgical and medical histories, particularly those at high risk for complications such as PJK.

Management and Outcome: After a thorough review of the case and investigation, we decided to cut down the rods and remove the top end screw, in addition to augmenting the fracture site with a bone graft. This approach aimed to reduce pain, hasten recovery, and aid in rehabilitation. Regular follow-ups and tailored physiotherapy was implemented to ensure optimal healing and functional improvement.

Conclusion: Rib fractures may occur in the setting of fused stable PJK/PJF, manifesting as sudden acute pain at the site of PJK/PJF in thoracic spine. A thorough history, physical examination, and appropriate imaging are essential for accurate diagnosis. Recognizing this potential complication can lead to timely and effective management, improving patient outcomes.

Keywords: Rib Fracture; Proximal Junctional Failure; Proximal Junctional Kyphosis; Scoliosis; Long Construct

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