Acute Haematogenous Metacarpal Osteomyelitis in Children: A Case Report and Review of Literature

Metatarsal osteomyelitis in children is a very uncommon disease, and this can make diagnosis difficult leading to a delay in treatment that can cause complications like brachymetacarpia or loss of function. We present an infant affected by granulomatous chronic disease with acute haematogenous osteomyelitis of the fourth metacarpal. Serratia marcescens was found to be the pathogenic agent. Treatment was antibiotics and debridement. Bone healed with little length discrepancy but functional result was normal

Fresh Osteochondral Resurfacing of the Patellofemoral Joint

Large osteochondral lesions of the knee in young patients continue to be a challenge for orthopaedic surgeons and the focus of continual research. This is particularly true if the injury is a consequence of a dysplastic trochlea and involves both articular surfaces of the biomechanically complex patellofemoral joint. To obtain a healthy and congruent patellofemoral joint, the use of a bipolar fresh osteochondral allograft transplantation of the patella and trochlea is one of the few options to biologically treat these injuries. This would achieve a replacement of the entire articular surface of the patellofemoral joint with a high number of viable chondrocytes and respect the unique structural characteristics of the cartilage. The aim of this study was to obtain symptomatic and functional improvements while delaying the timing of prosthetic surgery. We present a reproducible although demanding surgical technique to perform a bipolar fresh osteochondral allograft transplantation of the patella and trochlea

Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate

The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol. This is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons' discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery). Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001). A thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures

A lower starting point for the medial cut increases the posterior slope in opening-wedge high tibial osteotomy : a cadaveric study

The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. Controlled laboratory study

Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence

Anterior cruciate ligament (ACL) tear is one of the most common sport-related injuries and the request for ACL reconstructions is increasing nowadays. Unfortunately, ACL graft failures are reported in up to 34.2% in athletes, representing a traumatic and career-threatening event. It can be convenient to understand the various risk factors for ACL failure, in order to properly inform the patients about the expected outcomes and to minimize the chance of poor results. In literature, a multitude of studies have been performed on the failure risks after ACL reconstruction, but the huge amount of data may generate much confusion. The aim of this review is to resume the data collected from literature on the risk of graft failure after ACL reconstruction in athletes, focusing on the following three key points: individuate the predisposing factors to ACL reconstruction failure, analyze surgical aspects which may have significant impact on outcomes, highlight the current criteria regarding safe return to sport after ACL reconstruction

Reproducibilidad y validez de la clasificación de Tönnis para la coxartrosis del adulto joven en estadíos iniciales

Evaluamos la reproducibilidad intra e interobservador y la validez de la clasificación de Tönnis en coxartrosis incipientes de adultos menores de 55 años. Valoramos 61 radiografías de pelvis de 30 pacientes sintomáticos y 31 asintomáticos,por 3 observadores independientes en 2 ocasiones. Los coeficientes de concordancia intra einterobservador fueron pobres(0,20-0-40),mostrando una inaceptable reproducibilidad. Igualmente,la validez medida mediante la correlación entre la clínica y el grado radiológico no muestra resultados significativos. Esto cuestiona la reproducibilidad y validez de esta escala, por lo que habría que replantearse su uso como criterio de indicación quirúrgica en la práctica clínica diaria.Evaluem la reproductibilitat intra i interobservador i la validesa de la calssificació de Tönnis en coxartrosis incipients d' adults menors de 55 anys. Valorem 61 radiografies de pelvis de 30 pacients simptomàtics i 31 assimptomàtics per 3 observadors independents en 2 ocasions. Els coeficients de concordancia intra i interobservador van ser pobres (0,20-0,40), mostrant una inaceptable reproductibilitat. Igualment, la validesa mesurada mitjançant la correlació entre la clínica i el Grau radiològic no mostra resultats significtius. Això, qüestiona la reproductibilitat i la validesa d'aquesta escala, pel que ens hauríem de replantejar el seu ús com criteri de indicació quirúrgica a la pràctica diària

Variació segons edat i sexe del component força de l'escala de Constant de valoració de la funció de l'espatlla

Un dels instruments més utilitzats per a mesurar la funció de l'espatlla és el conegut com a Constant Score on una quarta part del valor total de la valoració funcional de l'espatlla correspon a la força d'aquesta regió anatòmica. En el disseny original del Constant Score no es tingueren en compte les possibles variacions dels valors normals de força en funció de l'edat o del sexe. Aquesta variació no ha estat mai correctament establerta. Aquest treball pretén establir l'existència de diferències en la força de l'espatlla entre diferents grups d'edat i entre sexes

Good long-term patients reported outcomes, return-to-work and return-to-sport rate and survivorship after posterior cruciate ligament (PCL)-based multiligament knee injuries (MLKI) with posteromedial corner tears as significant risk factor for failure

Altres ajuts: acords transformatius de la UABTo assess the survival rate and associated risk factors of a wide cohort of patient's underwent surgical treatment for posterior cruciate ligament (PCL)-based multiligament knee injury (MLKI) at long-term follow-up and to investigate the long-term patient's reported outcomes (PROMS) and functional activity. All cases of PCL-based MLKI performed at one single sport-medicine institution were extracted and patient's with a minimum 2 years of follow-up included. VAS, Lysholm, KOOS, Tegner Activity level scores, the incidence and time of return to sport (RTS) and return to work (RTW) were collected before, after surgery and at final follow-up. A multivariate logistic regression was performed to investigate the outcomes associated with the patient's acceptable symptoms state (PASS) for each sub-score of the KOOS. The Kaplan-Meier method with surgical failure (re-operation to one of the reconstructed ligaments) as endpoint was used to perform the survivorship analysis for the entire cohort. Forty-two patients were included and evaluated at an average of 10 years. All PROMS significantly improved from pre- to post-surgery (range η 2 0.21-0.43, p < 0.05) except for the Tegner score which significantly improved from pre-surgery and to final follow-up (η 2 = 0.67, p < 0.001). RTW was achieved in the 95.2% after 2.4 ± 1.9 months. RTS was achieved in 78.6% after 6.7 ± 5.0 months. The higher number of surgeries were the significant negative predictors of PASS for the KOOS sub-scales Sport (p = 0.040) and Quality of Life (p = 0.046), while the presence of meniscal lesions was a significant negative predictor of PASS only for the KOOS sub-scale of Sport (p = 0.003). Six patients (14.3%) underwent reoperation and were considered as surgical failures. The global survivorship was 95.2%, 92.6%, 87.1%, and 74.7% at 2, 5, 12, and 15 years, respectively. The survivorship in patient undergoing PMC reconstruction surgery was significantly lower (p = 0.004; HR 7.1) compared to patients without a PMC lesion. Good-to-excellent PROMS could be obtained and maintained at long-term follow-up after surgery, with the higher number of surgeries and meniscal lesions as significant negative predictors of the PASS. Moreover, the presence of a PMC lesion significantly increases the risk of the PCL reconstruction failure. III

Polyurethane Scaffold vs Fascia Lata Autograft for Hip Labral Reconstruction : Comparison of Femoroacetabular Biomechanics

The integrity of the acetabular labrum is critical in providing normal function and minimizing hip degeneration and is considered key for success in today's hip preservation algorithm. Many advances have been made in labral repair and reconstruction to restore the suction seal. To compare the biomechanical effects of segmental labral reconstruction between the synthetic polyurethane scaffold (PS) and fascia lata autograft (FLA). Our hypothesis was that reconstruction with a macroporous polyurethane implant and autograft reconstruction of fascia lata would normalize hip joint kinetics and restore the suction seal. Controlled laboratory study. Ten cadaveric hips from 5 fresh-frozen pelvises underwent biomechanical testing with a dynamic intra-articular pressure measurement system under 3 conditions: (1) intact labrum, (2) reconstruction with PS after a 3-cm segmental labrectomy, then (3) reconstruction with FLA. Contact area, contact pressure, and peak force were evaluated in 4 positions: 90º of flexion in neutral, 90º of flexion plus internal rotation, 90º of flexion plus external rotation, and 20º of extension. A labral seal test was performed for both reconstruction techniques. The relative change from the intact condition (value = 1) was determined for all conditions and positions. PS restored contact area to at least 96% of intact (≥0.96; range, 0.96-0.98) in all 4 positions, and FLA restored contact area to at least 97% (≥0.97; range, 0.97-1.19). Contact pressure was restored to ≥1.08 (range, 1.08-1.11) with the PS and ≥1.08 (range, 1.08-1.10) with the FLA technique. Peak force returned to ≥1.02 (range, 1.02-1.05) with PS and ≥1.02 (range, 1.02-1.07) with FLA. No significant differences were found between the reconstruction techniques in contact area in any position (P >.06), with the exception that FLA presented greater contact area in flexion plus internal rotation as compared with PS (P =.003). Suction seal was confirmed in 80% of PSs and 70% of FLAs (P = .62). Segmental hip labral reconstruction using PS and FLA reapproximated femoroacetabular contact biomechanics close to the intact state. These findings provide preclinical evidence supporting the use of a synthetic scaffold as an alternative to FLA and therefore avoiding donor site morbidity