Cerebrospinal fluid fistulas after iliosacral screw removal in post-traumatic pseudomeningocele

Sacral fractures are rare but severe injuries. They are often associated with neurological impairment and pelvic instability. We present a case of a 28-year-old woman who sustained an H-type fracture of the sacrum with complete cauda equina syndrome treated with cauda equina decompression and pelvic percutaneous stabilization with an iliosacral screw. Two years after she underwent screw removal, but complained of back and nape pain after the operation. A lumbosacral MRI showed the presence of a lytic lesion involving the S1 and S2 bodies that was judged to be a pseudomeningocele leaning against the sacral screw hole and cerebrospinal fluid fistulas through this. To our knowledge, this is the first case of such a complication after sacral screw removal to be reported

Computer-Aided Diagnosis System for Bone Fracture Detection and Classification: A Review on Deep Learning Techniques

Bone fracture detection and classification was a large discussed topic over the last few years and many researchers proposed different technological solutions to tackle this task. Despite this, a universal approach able to support the classification of fractures in the human body still does not exist today. We aim to provide a first discussion concerning a selection of research works done in the technological domain, with a specific focus on Deep Learning. The objective was to underline a picture on the most promising studies for stimulating a knowledge improvement in the specific focus of bone fracture classification, necessary to start the development of an optimal shared framework. The evaluation has been made involving a first qualitative assessment based on strengths and weaknesses, providing a usage scenario evaluation. This could support the development of a helpful Computer Aided Diagnosis (CAD) system able to drive doctors in diagnosis tasks reducing diagnosis time, especially in the most complex tasks, and supporting the reduction of wrong diagnosis issues, especially during stressful working conditions, as what frequently happens in many emergency departments

Preventing acute infection in total hip prostheses implanted after external fixation of the femur: is there a need for a staged procedure?

We report two cases of acute infection of an uncemented femoral component in a hip prosthesis implanted after external fixation of a femoral fracture. In both cases, the surgical access did not cross over the pin scars. When the prosthesis was implanted the stem crossed one or more pin tracts. The preoperative clinical examination, laboratory tests and bone scintigraphy with marked granulocytosis did not show signs of local infection in either case. We suggest that every patient destined to receive a prosthesis after external fixation should be treated with a staged procedure, the first step being excision of the soft tissues around the pin tracts and curettage or drilling of the bony holes, followed by prosthesis implant

Cystic Echinococcosis of the Pelvic Bone with Recurrences: A Case Report

Hydatid cysts commonly affect the liver and the lung. However, they rarely involve bones with vertebral column. We hereby report a case of a female patient with cystic echinococcosis of the hip bone and ilium. She presented with a long history of frequent recurrences highlighting the dismal prognosis at this rare site. Resection of the hydatid cyst from the sacroiliac region was done with allograft and autograft (rib graft) with lumbosacroiliac fixation. Follow-up of the patient at 6 months showed no detectable abnormality on radiology and the patient was doing well

Bicruciate-retaining total knee arthroplasty: What's new?

Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA

Pelvic ring fractures: External fixation comparative numerical structural analysis

External fixation (EF) is commonly practiced for pelvic ring fractures management. Many parameters influence mechanical performances of external fixators. Our virtual 3D model of the pelvic ring introduces the advantage of differentiating the mechanical properties of cortical and cancellous bone along with the complex boundary conditions of major ligaments. We assessed stiffness variations by increasing fixator pins depth and we evaluated dislocation related to load intensity and sitting angle

Ceftriaxone bone penetration in patients with septic non-union of the tibia

SummaryObjectivesA main determinant of clinical response to antibiotic treatment is drug concentration at the infected site. Data on ceftriaxone (CFX) bone penetration are lacking. We measured CFX concentrations in infected bone to verify their relationship with pharmacodynamic microbiological markers.MethodsEleven patients undergoing debridement for septic non-union of the tibia and receiving intravenous CFX were studied. Plasma and bone specimens were collected intraoperatively at a variable interval after CFX administration. Drug concentrations were measured by high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method.ResultsBone samples were extracted at a mean of 3.3h (range 1.5–8.0h) since the start of CFX infusion. The mean±standard deviation intraoperative CFX plasma concentration was 128.4±30.8mg/l; the corresponding bone concentrations were 9.6±3.4mg/l (7.8%) in the cortical compartment and 30.8±8.6mg/l (24.3%) in the cancellous compartment. The mean 24-h area under the concentration–time curve (AUC24) values were 176.8±62.2 h*mg/l in cortical bone and 461.5±106.8 h*mg/l in cancellous bone. The time above the minimum inhibitory concentration (T>MIC) was 24h in all compartments. The estimated mean free AUC/MIC ratios and T>MIC were 140 and 24.4h, respectively, in cancellous bone and 42.4 and 21h, respectively, in cortical bone.ConclusionsCFX bone penetration was poor (<15%) in the cortical compartment and satisfactory in the more vascularized cancellous bone. The T>MIC and AUC/MIC ratios suggest that CFX achieves a satisfactory pharmacokinetic exposure in cancellous bone as far as pathogens with a MIC of <0.5 are concerned. However, considering free drug concentrations, pharmacokinetic/pharmacodynamic targets may not be fully achieved in cortical bone. As antibiotic exposure can be suboptimal in the infected cortical compartment, and drug penetration may be impaired into necrotic bone and sequesters, a radical surgical removal of purulent and necrotic tissues appears essential to shorten treatment duration and to prevent treatment failures