Resuming motor vehicle driving following orthopaedic surgery or limb trauma.

Following elective orthopaedic surgery or the treatment of a fracture, patients are temporarily unable to drive. This loss of independence may have serious social and economic consequences for the patient. It is therefore essential to know when it is safe to permit such patients to return to driving. This article, based upon a review of the current literature, proposes recommendations of the time period after which patients may safely return to driving. Practical decisions are made based upon the type of surgical intervention or fracture. Swiss legislation is equally approached so as to better define the decision

Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience

Purpose: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. Methods: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. Results: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eightweeks (range, 4-14weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of twoyears. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to threeweeks (0.2, 0.1-1.9) or ≥ 3weeks (0.3, 0.1-2.4). More than sixweeks of total antibiotic treatment equalled ≤ six weeks (0.8, 0.1-5.2). Conclusions: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observatio

Third order dielectric susceptibility in a model quantum paraelectric

In the context of perovskite quantum paraelectrics, we study the effects of a quadrupolar interaction $J_q$, in addition to the standard dipolar one $J_d$. We concentrate here on the nonlinear dielectric response $\chi_{P}^{(3)}$, as the main response function sensitive to quadrupolar (in our case antiquadrupolar) interactions. We employ a 3D quantum four-state lattice model and mean-field theory. The results show that inclusion of quadrupolar coupling of moderate strength ($J_q \sim {{1}\over{4}} J_d$) is clearly accompanied by a double change of sign of $\chi_{P}^{(3)}$ from negative to positive, near the quantum temperature $T_Q$ where the quantum paraelectric behaviour sets in. We fit our $\chi_{P}^{(3)}$ to recent experimental data for SrTiO$_3$, where the sign change is identified close to $T_Q \sim 37 K$.Comment: 22 page

Fatal Cases of Influenza A(H3N2) in Children: Insights from Whole Genome Sequence Analysis

During the Northern Hemisphere winter of 2003–2004 the emergence of a novel influenza antigenic variant, A/Fujian/411/2002-like(H3N2), was associated with an unusually high number of fatalities in children. Seventeen fatal cases in the UK were laboratory confirmed for Fujian/411-like viruses. To look for phylogenetic patterns and genetic markers that might be associated with increased virulence, sequencing and phylogenetic analysis of the whole genomes of 63 viruses isolated from fatal cases and non fatal “control” cases was undertaken. The analysis revealed the circulation of two main genetic groups, I and II, both of which contained viruses from fatal cases. No associated amino acid substitutions could be linked with an exclusive or higher occurrence in fatal cases. The Fujian/411-like viruses in genetic groups I and II completely displaced other A(H3N2) viruses, but they disappeared after 2004. This study shows that two A(H3N2) virus genotypes circulated exclusively during the winter of 2003–2004 in the UK and caused an unusually high number of deaths in children. Host factors related to immune state and differences in genetic background between patients may also play important roles in determining the outcome of an influenza infection

Classification des fractures des os longs : concepts et utilité

Le traitement des fractures des os longs fait partie intégrante des tâches quotidiennes d'un service d'orthopédie et peut représenter une part importante de son activité. Le choix de la stratégie thérapeutique est influencé par de nombreux facteurs plus ou moins objectifs allant de l'expérience de l'opérateur aux recommandations basées sur des preuves scientifiques, en incluant des facteurs liés au patient et aux ressources du service. Cependant, la décision part toujours initialement de la fracture, qui est décrite, puis catégorisée et incluse dans une classification. L'objectif de ce travail est de développer le concept de classification des fractures en soi, d'en identifier les caractéristiques, l'utilité et les limitations, et d'évoquer les pistes de développements futurs qui devraient permettre d'améliorer la prise en charge des patients victimes de fracture

Prise en charge orthopédique des métastases des os longs

The recent progress in oncologic management of patients with metastatic disease has permitted a significant improvement of their life expectancy. Many of these patients will suffer from complications related to bone metastasis. Unfortunately an orthopaedic treatment is seldom offered to them, mainly because of the misconception that this would not bring them any benefice. However these patients are often good candidates for an orthopaedic management, which objectives are to relieve pain and to re-establish their quality of life. The available surgical techniques are well described and the management protocols are clearly defined, as are the expectable complications and the errors that must not be done

Prise en charge des tumeurs osseuses malignes autour du genou

Primary bone tumors arise mostly around the knee. A treatment strategy issued from a multidisciplinary team is the key factor for an optimal management of such patients. Many durable options for reconstructing a functional limb are available, as an alternative to amputation, without lowering patients' survival. Nevertheless complications are frequent and any decision for one technique or the other should be made with the patient, appreciating the specificity of each single case. We discuss here the different techniques with their advantages and drawbacks, including long term results