Fracture Dislocation C6 to C7: Importance of Adequate Radiographs

<p>[West J Emerg Med. 2011;12(4):577–578.]</p

Rheumatoid nodule mimicking an olecranon bursitis as the primary manifestation of rheumatoid arthritis

Olecranon bursitis is a relatively common condition, being most of the cases idiopathic. Less commonly it is caused by infection, by a systemic inflammatory process or by a crystal-deposition disease such as gout or pseudogout. We present a case that was referred as olecranon bursitis, in which the diagnose of rheumatoid nodule was stablished after histological study of the resected tissue

Minimally invasive bone grafting of simple cyst of the femoral head in femoroacetabular impingement

Femoral head and neck cysts are a common finding among patients with femoroacetabular impingement. However, their exact role in this pathology has not been yet clarified. We report herein the case of a 45-year-old male presenting with femoroacetabular impingement in which the treatment of a femoral simple bone cyst resolved the symptomatology

Long-term functional outcomes of the terrible triad of the elbow

Introduction: The published literature regarding the terrible triad of the elbow has historically shown a high rate of unacceptable outcomes. The objective of the present study was to evaluate the long-term functional outcomes and repercussions in patients who suffered the terrible triad of the elbow. Material and methods: A retrospective analysis of a prospectively-recruited consecutive series of cases registered from August 2005 to August 2009, involving 27 patients from which 16 complied with inclusion criteria for the study. The mean follow-up period was 8.6 years (range: 6.9 to 10.6). Two different final quality of life evaluation questionnaires were performed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient answered questionnaire portion of the Liverpool Elbow Score (PAQ-LES). Results: Fifteen (93.7%) patients were intervened surgically whereas only 1 case was treated conservatively. EQ-5D-rated outcome averaged 0.87 (range: 0.36 to 1) and the PAQ-LES averaged 33.5 (range: 17 to 36). Five (31.2%) presented pain or discomfort, 4 (25.0%) had some kind of difficulties in their daily activity and 3 (18.7%) founded some limitations with their personal hygiene. Only 6 cases (37.5%) declared to be fully asymptomatic. Conclusion: The terrible triad of the elbow remains a challenging injury that entails the presence of chronic pain and discomfort in almost one third of the cases at a long-term follow-up

Can the intra-operative measurement of the diameter of the femoral head help surgeons to choose the best size of the acetabular cup?

Purpose: We hypothesized that the intra-operative measurement of the femoral head may increase the accuracy of the acetabular cup size optimal selection in total hip arthroplasty (THA). The purpose of this clinical research was to analyze the correlation between the estimated cup size from intra-operative measurement of the femoral head and the pre-operative templated cup size. Methods: A prospective observational single-center study was conducted from June 2019 to January 2020 including primary THA (n = 100). All cases were pre-operatively templated. The measurement of the anterior-posterior diameter of the femoral head was routinely intra-operatively performed. Any definitive implanted cup was considered as 'oversized' when the size was > 4 mm than the diameter of the native head. Results: The median (interquartile range) size of the implanted cup, pre-operative planned cup size, and diameter of the femoral head were measured 52 (50-54) mm, 50 (48-54) mm and 49 (45-51) mm, respectively. Pre-operative planned size cup accurately predicted the implanted cup or differed in only one size (2 mm) in 77 (78%) cases. Otherwise, intra-operative femoral head measurement method accurately predicted the implanted or differed in only one size (2 mm) in 51 (87%) cases (p = 0.097). Conclusion: The intra-operative femoral head measurement is a simple and reliable tool to help the surgeons choose the best size of the acetabular cup and is as reliable as the pre-operative templating in order to avoid cup oversizing in THA. Utmost caution is warranted whenever the cup reamer is > 4 mm than the anterior-posterior diameter of the native head

Intraoperative Transfusion of Red Blood Cell Units Stored >14 Days is Associated with an Increased Risk of Prosthetic Joint Infection.

Background: The aim of the present study was to evaluate the association between prosthetic joint infection (PJI) after joint arthroplasty and the length of red blood cell (RBC) storage, timing of RBC transfusion, and the number of RBC units transfused. Study design and Methods: All patients who underwent a primary or revision joint artrhoplasty between January 2000 and December 2012 were retrospectively reviewed. For this study, only patients who received RBC transfusions during the day of the surgery (early transfusion group) or within the first 4 days after surgery (late transfusion group) were included. Results: A total of 9906 patients were reviewed. In the early transfusion group (n=1153, 11.6%), patients receiving 1 or 2 RBC units (3.5% vs 6.3%, P=0.041), 3 or 4 RBC (1.3% vs 13.3%, P=0.004) or ≥5 RBC units (5.0% vs 37.5%, P=0.026) had a higher PJI rate only when >50% of RBC units transfused had been stored >14 days. In the late transfusion group (n=920, 9.3%) these differences were not significant. Early transfusion of RBCs stored >14 days was an independent variable associated with an increased risk of PJI (OR:2.50, 95%CI:1.44-4.33) Conclusion: Transfusion of RBC within the first 6h after joint arthroplasty was an independent variable associated with PJI risk when RBC units are stored >14 days. The rate of PJI increased with the number of old RBC units transfused within this critical period

Functional Discharge Criteria In Total Hip Arthroplasty. What Makes The Difference For Overnight Hospital Stay In Our Center?

Overnight total hip arthroplasty is becoming common in our center. Despite all the patients are under the same protocol, which includes a funcional discharge criteria, not all the patients leave the hospital the day after the surgical procedure. We conducted a study evaluating a group of patients who stayed one night, compared to a matched pair regarding age, body mass index and sex. Group 1 mean age was 61.4 years-old (SD 9.3), Group 2 was 60.8 years-old (SD 9.6); 10 women and 20 men each group, BMI was 28.1 (SD 3.7) and 27.8 (SD 3.6) for Groups 1 and 2 respectively. Patients who stayed only 1 night after THA were found to have higher levels of preoperative hemoglobin, had uncommonly 2 or more major comorbidities, and the operation was predominantly performed by anterior approach

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip

Utilitat de la membrana periprotètica en el diagnòstic de la infecció en el recanvi d’una artroplàstia de maluc

[cat] La infecció és una de les complicacions més greus que poden aparèixer després de la implantació d'una artroplàstia total de maluc. Fer un recanvi en un terreny infectat comporta un major risc d'infecció de la nova pròtesi. No existeix cap prova que tingui suficient sensibilitat i especificitat com per determinar si l'afluixament protètic és degut a una causa sèptica o mecànica. Aquesta tesi està dedicada a l'estudi de la utilitat de la membrana periprotètica per al diagnòstic d'infecció durant el recanvi d'una pròtesi de maluc. El primer objectiu d'aquesta tesi ha estat avaluar si el rendiment de la membrana periprotètica com a mostra per a l'estudi histològic peroperatori d'infecció en un recanvi d'una artroplàstia de maluc és superior al de la mostra de pseudocàpsula. Els resultats han demostrat que el percentatge de la histologia positiva de la membrana en pacients amb infecció de pròtesi és significativament més gran que el percentatge de la histologia positiva de pseudocàpsula. D'aquesta manera se suggereix que la membrana és millor com a mostra histològica. El segon objectiu ha estat determinar si el rendiment de la membrana periprotètica com a mostra sòlida per al cultiu convencional és superior al de la mostra de pseudocàpsula per al diagnòstic d'infecció en un recanvi d'una artroplàstia de maluc. Els resultats han demostrat que no existeixen diferències significatives entre tots dos tipus de mostra. El tercer objectiu ha estat avaluar la utilitat de la histologia fent servir la membrana periprotètica per al diagnòstic de la infecció durant un recanvi d'una artroplàstia de maluc per una fractura periprotètica. Els resultats han demostrat que la utilització de la histologia en casos de fractura està associada a una elevada taxa de falsos positius (baixa especificitat).[eng] Prosthetic infection is one of the most severe complications that can appear after a total hip arthroplasty. To perform the replacement in a septic environment entails a significantly higher risk of prosthesis infection. Currently, there are no preoperative or perioperative reliable tests able to determine whether the prosthesis loosening is caused by septic or mechanical reasons. This thesis is devoted to study the usefulness of the periprosthetic membrane for predicting infection during a total hip replacement. The first objective of this thesis has been to evaluate if the usefulness of the periprosthetic membrane as a histologic sample is more accurate than the pseudocapsule. The results have confirmed that the percentage of positive histology of the membrane is significantly higher than the pseudocapsule, suggesting that periprosthetic membrane is the best specimen for the histological diagnosis of prosthetic joint infection. The second objective has been to assess whether conventional cultures from the periprosthetic membrane are superior to pseudocapsule samples in the diagnosis of infection in hip revision arthroplasty. The results allow to concluding that the membrane sample for a conventional culture is not superior to the pseudocapsule sample in detecting microorganisms. The third objective has been to analyze the usefulness of the histology for the diagnosis of infection during a hip prosthesis replacement for the treatment of a periprosthetic fracture. The results have demonstrated that periprosthetic fractures are a cause of false-positive histology results for the diagnosis of infection during revision of a hip prosthesis for the treatment of a periprosthetic fracture when conventional cultures are used for diagnosis of infection

Pulsed electric fields reduce bacterial attachment to stainless steel plates

The purpose of this study was to evaluate the capacity of pulsed bilateral electric fields to control bacterial attachment on stainless steel plates. Previously sterilized circular metal plates of stainless steel were submerged in a liquid medium with a known concentration of Staphylococcus epidermidis and incubated for 1 hour at 36ºC while a 200 Hz pulsed electric field of 18 V/cm was applied for 2.5 µseg and then sonicated for 5 minutes in 10 ml of saline.  Three different models were cultured and compared: 1) negatively-charged plate, 2) positively-charged plate, and 3) control plate without electric current. A total of 39 metal plates were processed. The median adherence in the control group and the electric field group was 312 CFU/mm2 and 16,2 CFU/mm2 respectively (p&lt; 0.001, reduction of 95% of bacterial attachment).  Bilateral pulsed electric field is able to reduce bacterial attachment on stainless steel plates in in vitro conditions