Diagnosis of Culture-Negative Septic Arthritis with Polymerase Chain Reaction in an Immunosuppressed Patient: A Case Report

© 2020 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED. Case:We present a 23-year-old woman on immunosuppressive therapy with polyarticular, culture-negative septic arthritis. She underwent irrigation and debridement with empiric antibiotic therapy but had recurrence of septic arthritis despite treatment. Polymerase chain reaction testing eventually identified Ureaplasma as the causative organism. She was successfully treated with an extended course of organism-specific antibiotics.Conclusion:More patients are being treated with immune modulating therapies. Immunosuppressed patients are at risk for atypical infections and may have different presentations than immunocompetent patients. Newer diagnostic modalities can help identify causative organisms and direct treatment in the case of negative cultures. COPYRIGH

Repair of an Acute Latissimus Dorsi Tendon Rupture Using Bicortical Button Fixation

© 2020 Lippincott Williams and Wilkins. All rights reserved. Acute latissimus dorsi tendon rupture is a rare injury, occurring nearly exclusively in athletes engaging in overhead motions. Given this patient population, return to elite function is a goal of treatment, often requiring surgery. When planning surgery, one finds a lack of sufficient evidence to recommend a specific fixation technique. We report a case of acute rupture of the latissimus dorsi in a competitive gymnast. Initial magnetic resonance imaging confirmed the injury and showed that the tendon had retracted 6 cm. Primary repair using bicortical button fixation, a novel fixation technique, was performed. The patient successfully returned to competition and reported personal best scores on high bar and parallel bars. Cadaveric studies comparing cortical buttons to sutures and suture anchors for tendon reattachment found cortical buttons to have higher loads to failure. Overall, this suggests the technique described here may provide superior outcomes for a patient population who will stress the repair at elite levels.Level of Evidence: Level V

Deep Vein Thrombosis after Cement Intravasation during Hip Hemiarthroplasty

© 2020 The Authors Cement intravasation occurs in hemiarthroplasty when pressurization of cement through the medullary canal backflows through the nutrient vessels. This case report describes a 70-year-old woman who underwent hip hemiarthroplasty for a displaced left femoral neck fracture. Postoperative radiographs demonstrated radio-opacity consistent with local cement intravasation. A Doppler ultrasound study subsequently revealed a mobile thrombus at the confluence of the femoral and profunda femoris veins, as well as a nonmobile thrombus within the profunda femoris vein. The more proximal thrombus was determined to be cement that had intravasated during the index operation. The cement likely impeded venous flow, ultimately leading to the development of deep vein thrombosis just distal to the site of cement occlusion

No change in performance metrics in major league baseball players sustaining wrist fractures after being struck by an errant pitch

© 2020 Professor P K Surendran Memorial Education Foundation Objective: This study aimed to determine the effect of wrist fractures on performance metrics in Major League Baseball Players after they were hit by an errant pitch. Methods: Players who sustained wrist fractures after being struck by a pitch were identified and changes in performance metrics were calculated. Results: In both the short- and medium-term analysis, there were no significant differences in all pre- and post-injury offensive statistics following return to play. Conclusion: Wrist fractures sustained after being struck by an errant pitch do not significantly impact professional baseball player performance if the player is able to return to sport

No change in performance metrics in major league baseball players sustaining wrist fractures after being struck by an errant pitch

© 2020 Professor P K Surendran Memorial Education Foundation Objective: This study aimed to determine the effect of wrist fractures on performance metrics in Major League Baseball Players after they were hit by an errant pitch. Methods: Players who sustained wrist fractures after being struck by a pitch were identified and changes in performance metrics were calculated. Results: In both the short- and medium-term analysis, there were no significant differences in all pre- and post-injury offensive statistics following return to play. Conclusion: Wrist fractures sustained after being struck by an errant pitch do not significantly impact professional baseball player performance if the player is able to return to sport

Comparison of Arthroscopy versus Open Arthrotomy for Treatment of Septic Arthritis of the Native Knee: Analysis of 90-Day Postoperative Complications

Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic,  = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14-1.86];  = 0.003), postoperative anemia (OR = 1.71 [1.08-2.75];  = 0.025), and blood transfusion (OR = 1.76 [1.04-3.06];  = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality

Shoulder, upper arm and elbow injuries in high school men\u27s American football

In order to reduce shoulder, upper arm and elbow injury rates in American football, identifying injury risk factors and any underlying associations is needed. No prior study has done such characterization at the high school level. A descriptive epidemiology study was performed using data from the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program (NATION-SP) from the years 2011/12 to 2013/14 on high school football athletes. Four hundred and sixty total injuries were found in the dataset. Acromioclavicular (AC) sprains had the highest incidence of all injuries (0.060 injuries per 1000 exposures). Fractures lead to the greatest time lost (42.24 days). Most injuries occurred in older athletes (juniors and seniors, 30% and 32%, respectively), were related to tackling (31%), and in running back and linebacker positions (15% each). Orthopaedic surgeons and other sports medicine specialists can use these findings to educate players, coaches and families about injury risks and for improving injury prevention guidelines

Comparison of 30-day complications between reverse shoulder arthroplasty and open reduction internal fixation for the treatment of proximal humerus fractures

PURPOSE: While the use of open reduction internal fixation (ORIF) has remained stable over the last decade, there has been a significant increase in the use of reverse total shoulder arthroplasty (RTSA) for proximal humerus fractures (PHFs). This study sought to compare the complication profiles of RTSA to ORIF in a large, validated, retrospective cohort. METHODS: Patients who underwent surgical treatment for PHFs with RTSA or ORIF were identified in a national database (NSQIP) using CPT and ICD codes. Demographics and comorbidities were identified for each cohort of patients. Thirty-day complications were analyzed with univariate and multivariate analyses using Chi-square, Fischer\u27s exact and analysis of variance testing. RESULTS: The total number of patients included in this study was 2157.522 (24.2%) underwent RTSA and 1635 (75.8%) underwent ORIF. Patients undergoing RTSA were older with an average age of 73.52 years compared with 63.84 years in those undergoing ORIF (p \u3c 0.001). Patients with RTSA were more likely to experience any complications (p \u3c 0.001), pulmonary complications (p = 0.029), extended length of stay \u3e 3 days (p \u3c 0.001), and perioperative transfusion requirement (p \u3c 0.001) after univariate analysis. After controlling for demographic differences, the only statistically significant complication was perioperative transfusion requirement (OR 1.383). CONCLUSION: After controlling for demographic variables and comorbidities, RTSA placed patients at increased risk for perioperative blood transfusion. Patients undergoing RTSA should be counseled prior to surgery regarding the risk for transfusion and potentially optimized medically through multidisciplinary care if the surgeon elects to proceed with RTSA versus ORIF for the treatment of PHFs

The effect of obesity on complications following isolated posterior cruciate ligament reconstruction

BACKGROUND: This study assessed the risk of 30-day complications for obese patients compared to non-obese patients undergoing isolated posterior cruciate ligament (PCL) reconstruction. METHODS: From 2006 to 2019, the National Surgical Quality Improvement Program database was queried for patients undergoing isolated PCL reconstruction. Two patient cohorts were defined: patients with obesity (BMI ≥ 30.0 kg/m) and patients without obesity (BMI \u3c 30 kg/m). Patients\u27 baseline demographics and medical comorbidities were collected and compared between the cohorts. Postoperative outcomes were assessed using bivariate and multivariate analyses. RESULTS: 414 patients underwent PCL reconstruction. 258 patients (62.3%) were non-obese and 156 patients (37.7%) were obese. Obese patients were more likely to be older, have a higher American Society of Anesthesiologists classification, and have hypertension compared to non-obese patients (p \u3c 0.05 for all). The rates of superficial surgical site infections, wound dehiscence, transfusion necessity, deep vein thrombosis, and re-operation were not significant between obese and non-obese patients. Following adjustment on multivariate analyses, relative to patients without obesity, those with obesity had an increased risk of admission to the hospital overnight (OR 1.66; p = 0.048). CONCLUSIONS: To our knowledge, this is the first study to evaluate obesity on complications in isolated PCL reconstruction. Our results and the heterogeneity in the literature indicate that obesity significantly impacts the rates of hospital readmission for PCL reconstruction. Therefore, surgeons should carefully weigh the risks and benefits of operating on obese patients and plan accordingly as obese patients may require postoperative hospital admission after PCL reconstruction. LEVEL OF EVIDENCE: III