Partial tetraplegic syndrome as a complication of a mobilizing/manipulating procedure of the cervical spine in a man with Forestier's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Even if performed by qualified physical therapists, spinal manipulation and mobilization can cause adverse events. This holds true particularly for the cervical spine. In light of the substantial risks, the benefits of cervical spine manipulation may be outweighed by the possibility of further injury.</p> <p>Case presentation</p> <p>We present the case of a 56-year-old Caucasian man with Forestier's disease who went to see a physiotherapist to relieve his aching neck while on a holiday trip. Following the procedure, he was transferred to a local hospital with a partial tetraplegic syndrome due to a cervical 6/7 luxation fracture. Reportedly, the physiotherapist took neither a detailed history, nor adequate diagnostic measures.</p> <p>Conclusions</p> <p>This case highlights the potentially dangerous complications associated with cervical spine mobilization/manipulation. If guidelines concerning cervical spine mobilization and manipulation practices had been followed, this adverse event could have been avoided.</p

Surgical management of hallux valgus and hallux rigidus: An email survey among Swiss orthopaedic surgeons regarding their current practice

Background Various clinical and radiological criteria have been suggested to choose one of the numerous techniques in surgical treatment of hallux valgus and rigidus. We hypothesized that the surgeons' professional background will influence that choice depending on specialization, age, type and institution of training as well as his orthopaedic cultural orientation. Since Switzerland is characterized by regional languages (the most important being German and French), we were interested to learn if the linguistic differences had an influence on the orientation of the surgeons towards e.g. Anglo-American or French surgical traditions and/or sources of literature on the subject. Methods A survey was e-mailed to all members of the Swiss Orthopaedic Society (SGOT-SSOT). Questions were asked regarding respondents’ demographics as well as their preferred treatment for 3 separate cases of (1) moderate and (2) severe hallux valgus and (3) hallux rigidus. The responses were collected and statistically analyzed. Results Two hundred thirty of 322 respondents completed the survey(response rate 46 %). as they perform foot surgery on a regular base; 39 % were members of the Swiss Orthopaedic Foot and Ankle Society (SFAS). Selected surgical treatments differed as follows: in joint sparing procedures older and busier surgeons were more likely to use Chevron osteotomies, however more than 50 % preferred a Scarf-type of osteotomy. Along the so-called "Rösti-Graben" separating the French from the German speaking part of Switzerland no significant difference was found in the choice of operation technique. Nevertheless the fact being a member of SFAS showed significant differences in technical choice in case 2 and 3. Conclusions There are significant associations between the surgeons’ age, expertise and training and their preferred operative intervention. Considerable differences in the surgical management were found in the practice of the general orthopaedic surgeons 72 and the foot and ankle specialists. The cultural background and training is not mirroring the classical Swiss east west discrepancy. Despite the large number of surgical options available for hallux valgus, only a small number were preferred by the majority of surgeons.ISSN:1471-247

Preserving the lower extremity after severe devolving injuries to meet the patient's demand in two cases

Background: Severe injuries of the foot are a life-changing event. They often lead to some form of disability, and are therefore very challenging to manage. Injuries of the extremity, especially the foot and ankle, are distinct predictors of poor outcome in polytrauma patients.Degloving injuries of the lower extremity involving the heel and foot are a rare and unique subgroup of severe foot injuries.Treating degloving injuries is challenging. The surgical approach has to take into consideration both osseous and massive soft tissue injuries aiming to preserve the unique architecture of the lower limb and reconstruct the soft tissue.There are several surgical approaches for treating degloving injuries of the lower limb. Case presentation: We would like to share our experience with two cases of young very active patients who suffered from a complex injury of the lower limb that included a massive degloving injury. It was of paramount importance to salvage the lower limb and keep it functional.Both patients were treated while using the degloved skin as a defatted full thickness skin flap that was replanted on the injured limb followed by application of VAC-therapy. Conclusion: We treated two patients suffering a severe degloving injury of the lower extremity with degloved skin as a full thickness flap in order to preserve both the extremity itself as well as the function of the lower limb according to the individual requirements of the patients. Consequently, we could enable the patient to pursue their professional musical training requiring subtle use of the lower extremity as well as ensuring sufficient function of the lower extremity in everyday use. Keywords: Degloving injury, Complex foot injury, Defatted full thickness skin flap, Salvage lim

An investigation of weighting schemes suitable for incorporating large

Multi-model ensembles can be used to estimate uncertainty in projections of regional climate, but this uncertainty often depends on the constituents of the ensemble. The dependence of uncertainty on ensemble composition is clear when single-model initial condition large ensembles (SMILEs) are included within a multi-model ensemble. SMILEs allow for the quantification of internal variability, a non-negligible component of uncertainty on regional scales, but may also serve to inappropriately narrow uncertainty by giving a single model many additional votes. In advance of the mixed multi-model, the SMILE Coupled Model Intercomparison version 6 (CMIP6) ensemble, we investigate weighting approaches to incorporate 50 members of the Community Earth System Model (CESM1.2.2-LE), 50 members of the Canadian Earth System Model (CanESM2-LE), and 100 members of the MPI Grand Ensemble (MPI-GE) into an 88-member Coupled Model Intercomparison Project Phase 5 (CMIP5) ensemble. The weights assigned are based on ability to reproduce observed climate (performance) and scaled by a measure of redundancy (dependence). Surface air temperature (SAT) and sea level pressure (SLP) predictors are used to determine the weights, and relationships between present and future predictor behavior are discussed. The estimated residual thermodynamic trend is proposed as an alternative predictor to replace 50-year regional SAT trends, which are more susceptible to internal variability. Uncertainty in estimates of northern European winter and Mediterranean summer end-of-century warming is assessed in a CMIP5 and a combined SMILE–CMIP5 multi-model ensemble. Five different weighting strategies to account for the mix of initial condition (IC) ensemble members and individually represented models within the multi-model ensemble are considered. Allowing all multi-model ensemble members to receive either equal weight or solely a performance weight (based on the root mean square error (RMSE) between members and observations over nine predictors) is shown to lead to uncertainty estimates that are dominated by the presence of SMILEs. A more suitable approach includes a dependence assumption, scaling either by 1∕N, the number of constituents representing a “model”, or by the same RMSE distance metric used to define model performance. SMILE contributions to the weighted ensemble are smallest (<10 %) when a model is defined as an IC ensemble and increase slightly (<20 %) when the definition of a model expands to include members from the same institution and/or development stream. SMILE contributions increase further when dependence is defined by RMSE (over nine predictors) amongst members because RMSEs between SMILE members can be as large as RMSEs between SMILE members and other models. We find that an alternative RMSE distance metric, derived from global SAT and hemispheric SLP climatology, is able to better identify IC members in general and SMILE members in particular as members of the same model. Further, more subtle dependencies associated with resolution differences and component similarities are also identified by the global predictor set.ISSN:2190-4987ISSN:2190-497

Staphylococcus hyicus bacteremia in a farmer

Bacteria known in animal infectious diseases can cause challenges in human diagnostic laboratories. We present pitfalls in the identification and susceptibility testing of Staphylococcus hyicus, a pathogen that typically causes exudative epidermitis in pigs. In this case, the coagulase-positive staphylococcus isolated from a septic patient was misidentified as Staphylococcus aureus

Additional file 1: of Surgical management of hallux valgus and hallux rigidus: an email survey among Swiss orthopaedic surgeons regarding their current practice

Appendix: Questionnaire. (DOCX 32 kb

Intraoperative imaging of the distal radioulnar joint using a modified skyline view

G. Klammer, M. Dietrich, M. Farshad, L. Iselin, L. Nagy and A. Schweize

Arthroscopic versus open cam resection in the treatment of femoroacetabular impingement

Lorenz Büchler, Mirjam Neumann, Joseph M. Schwab, Lukas Iselin, Moritz Tannast and Martin Bec

Sutures versus sterile strips for closure of ankle arthroscopy portals: prospective crossover trial

BACKGROUND: Either a nylon single suture or adhesive tape in the form of Steri strip are commonly used for the closure of portals in ankle arthroscopy. The purpose of this study was to compare the two methods with regards to their safety, complications and cosmetic result. METHODS: This was a prospective cross over study of 100 patients who underwent ankle arthroscopy. Materials used for wound closure were either a 3-0 nylon suture or a single Steri strip. Portals were reviewed according to a validated wound scoring system. Parameters such as the age and gender of the patients, the duration of tourniquet use and the use of an intraarticular corticosteroid injection at wound closure were also studied. RESULTS: Ninety-five patients were included in the statistical analysis. No technique was found to be superior in terms of the wound description (p = 0.164), infection grade (p = 0.232), infection treatment (p = 0.557) and the cosmetic appearance (p = 0.371). Seventy-two percent of patients had a good to excellent cosmetic result. There were two cases of infection requiring administration of antibiotics, one from each method of closure. Of the independent parameters, the use of cortisone was related to a lower infection treatment score (p = 0.013). Patients with signs of infection had a shorter total tourniquet time compared to the patients with no infection (p = 0.002). CONCLUSION: The use of either a single suture or Steri strip in the closure of ankle arthoscopy portals has equivalent results. Both methods were safe with equivalent cosmesis and low infection rates.Peter Stavrou, Panagiotis D. Symeonidis, Lukas D. Iselin and George Dracopoulo