Coccygectomy is the definitive treatment of coccygodynia refractory to conservative therapy, but post operative wound infection poses a significant challenge in these patients. We introduce a novel peri-operative technique incorporating a specific pre-operatively dietary regimen, polyethylene glycol enema, and prophylactic antibiotics. Post-operatively, patients adhered to strict hygienic protocols in addition to receiving antibiotics. This technique successfully reduced the incidence of surgical site infection post coccygectomy to a rate of 0.0%. A retrospective review was conducted on 21 patients who underwent partial or complete coccygectomy for coccygodynia refractory to 6 months of conservative therapy. Patients were treated using our novel protocol to minimize the infection risk and significant improvement in their pain. All of the patients experienced uneventful post operative recovery except for 1 solitary case of delayed wound healing. This case was treated with a silver impregnated dressing and demonstrated full wound recovery 1 week later. Additionally, pain scores showed a significant reduction of pain before and after surgery. These results highlight the efficacy of our enhanced peri-operative protocol in preventing surgical site infection as well as substantial pain relief. Our findings are consistent with the existing literature, demonstrating that an enhanced peri-operative protocol not only effectively prevents post-operative infections but also facilitates significant pain relief in patients undergoing coccygectomy. This novel peri-operative protocol may offer a new standard for managing post-surgical outcomes in coccygectomy, though prospective studies are needed to further validate these results.

Rationale: Sinding–Larsen–Johansson syndrome (SLJS) is an osteochondrosis of the inferior patellar pole that typically affects adolescents and usually resolves with conservative treatment. Persistence into adulthood is rare, particularly when associated with symptomatic ossicle formation, and the optimal management of such cases remains uncertain. Patient concerns: A 21-year-old male recreational basketball player presented with chronic anterior knee pain persisting for 6 years, aggravated by kneeling and jumping, despite prior extensive conservative management during adolescence. Diagnoses: Clinical examination revealed a firm, mobile swelling distal to the patella, with preserved motion and knee stability. Serial imaging demonstrated progression to a discrete ossicle at the inferior patellar pole, consistent with stage IV-B SLJS. Interventions: Surgical excision of the symptomatic ossicle was performed through a midline approach with minimal patellar tendon disruption. Bone wax was applied to the exposed cancellous surface of the patella. Outcomes: Postoperative recovery was uneventful. The patient achieved early mobilization, regained full function by 1 month, and experienced complete resolution of symptoms. Histopathology confirmed benign mature bone. Lessons: This case demonstrates that adult persistence of SLJS with ossicle formation, though exceptionally rare, may require surgical excision when conservative therapy fails. Careful resection with preservation of the extensor mechanism can provide reliable pain relief and restoration of full function.

BackgroundChronic coccydynia is a debilitating condition often exacerbated by any activity that applies pressure to the coccygeal area. While diagnosis is primarily clinical, dynamic X-ray imaging has emerged as a valuable tool for identifying structural abnormalities like hypermobility or subluxation. For patients unresponsive to conservative treatments, coccygectomy (surgical removal of the coccyx) remains a definitive option. However, predicting surgical success remains challenging. ObjectiveThis narrative review synthesizes recent evidence (2015–2025) on the role of dynamic imaging in diagnosing coccydynia and its utility in predicting positive coccygectomy outcomes. Materials and MethodsA review of the literature was conducted to assess studies published between 2015–2025 focusing on dynamic X-ray imaging for identifying structural abnormalities (hypermobility, subluxation) and its role in predicting surgical outcomes for coccydynia. ResultsFindings suggest that patients with coccygeal instability, retroversion, or subluxation on dynamic imaging tend to experience better postoperative pain relief and quality-oflife improvements compared to those with normal or immobile coccyx. For instance, hypermobility (>25∘ flexion) or traumatic etiology may correlate with favorable surgical results, while idiopathic cases or normal anatomy often yield poorer outcomes. Despite these insights, limitations like small sample sizes, inconsistent imaging protocols, and lack of long-term data highlight the need for standardized guidelines. ConclusionClinical observations, along with our team’s decade-long experience, reinforce that dynamic imaging can refine patient selection by distinguishing those most likely to benefit from surgery. Future research should prioritize large, prospective studies with uniform imaging criteria and integrate psychosocial factors to optimize predictive accuracy. By addressing these gaps, dynamic imaging could evolve into a cornerstone of precision medicine for coccydynia, ensuring tailored treatments and improved surgical outcomes.

Lymphomas are a heterogeneous group of aggressive lymphoid malignancies characterized by frequent extranodal involvement. Musculoskeletal manifestations, although uncommon, represent a clinically significant and under-recognized presentation that often mimics primary bone tumors, soft tissue sarcomas, and infectious conditions, leading to diagnostic delays and inappropriate initial management. This narrative review synthesizes current evidence on the clinical presentation, imaging characteristics, pathology, and biological basis of musculoskeletal T-cell lymphomas, with particular emphasis on implications for orthopedic practice. A structured literature search was conducted across major databases from 2000 to the present, and evidence was integrated across clinical, radiologic, pathologic, and therapeutic domains. Musculoskeletal involvement most commonly presents with localized bone pain, soft tissue masses, or pathological fractures, with imaging features such as diffuse marrow infiltration, soft tissue extension, and relatively preserved cortical bone serving as important diagnostic clues. Definitive diagnosis relies on tissue biopsy with comprehensive immunophenotypic and molecular characterization. Emerging insights into the tumor microenvironment highlight its role in disease progression and therapeutic response, offering potential avenues for targeted treatment strategies. Management is subtype-specific and centers on systemic therapy, with selective roles for radiotherapy and orthopedic intervention in cases of structural compromise. Early recognition through integrated clinical, imaging, and pathological assessment, combined with multidisciplinary collaboration, is essential to optimize outcomes in this rare but challenging disease entity.

Tibial spine avulsion injuries represent a distinct pattern of anterior cruciate ligament (ACL) injury in children and adolescents, reflecting the unique anatomical and biomechanical properties of the skeletally immature knee. Unlike midsubstance ACL ruptures, these injuries involve avulsion of the tibial insertion and pose specific diagnostic and therapeutic challenges. Management strategies remain heterogeneous, particularly for partially displaced fractures, with variation in surgical indications, fixation techniques, and rehabilitation protocols. This narrative review provides a structured synthesis of current evidence on the anatomy, biomechanics, clinical presentation, and management of pediatric tibial spine avulsion injuries. Nonoperative and operative approaches are compared, with attention to fixation strategies, complications, physeal considerations, and rehabilitation principles. Return-to-sport (RTS) outcomes are examined, with available evidence suggesting that RTS rates may be comparable between operative and nonoperative management in selected patients, although interpretation is limited by heterogeneous and predominantly retrospective data. Early mobilization appears important for reducing arthrofibrosis risk, while rehabilitation should be individualized. RTS decision-making remains inconsistent, with commonly used criteria largely extrapolated from ACL reconstruction literature and lacking validation in pediatric populations. Multifactorial assessment incorporating functional testing and patient-reported outcomes is increasingly advocated, although evidence for psychological readiness remains limited. Overall, the current literature is characterized by methodological heterogeneity and limited comparative data, restricting definitive conclusions. This review provides a clinically oriented synthesis while highlighting key uncertainties and priorities for future research.