Recurrent Fusobacterium pyogenic myositis of the rotator cuff A case report of recurrent Fusobacterium pyogenic myositis of the rotator cuff

Pyogenic myositis is uncommon. It normally affects the large muscle groups in the lower limb or trunk and the most common causative organism is Staphylococcus aureus. We present a case of an immunocompetent man who, unusually, had a recurring form of the disease in subscapularis and teres minor. The causative organism was also highly unusual (Fusobacterium).     

Mid-term outcome of GSB-III total elbow arthroplasty in patients with rheumatoid arthritis and patients with post-traumatic arthritis

Introduction  

We reviewed the mid-term outcome of GSB-III semi-constrained total elbow arthroplasty (TEA) and compared the results of patients with rheumatoid arthritis (RA) and those suffering from post-traumatic arthritis (PTA).     

The effect of bone porosity on the shear strength of the bone–cement interface

This study investigated the relationship of bone porosity and bone–cement interface shear strength. One hundred forty-six samples were taken from the distal metaphysis of 20 bovine femora. After cementation, the shear strength of the bone–cement interface was tested. According to the porosity, the samples were divided into four groups. Group I (porosity <80%) had a median interface shear strength of 4.03 MPa, group II (80% ≤porosity <85%) 7.06 MPa, group III (85% ≤porosity <90%) 9.44 MPa, and group IV (porosity ≥90%) 14.85 MPa. The differences between the four groups were statistically significant. Greater porosity yielded a stronger bone–cement interface shear strength under the identical cementation technique. The optimum porosity of cancellous bone is more than 90% which can be found by reaming or drilling to deeper bone in cemented acetabular fixation.

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Résumé  L’objet de cette étude est d’apprécier les relations entre la porosité osseuse et l’interface ciment-os. 146 échantillons osseux prélevés sur la métaphyse distale de 20 fémurs bovins ont permis de tester l’interface ciment-os après cimentation. suivant leur degré de porosité, les échantillons ont été divisés en 4 groupes. Groupe I porosité < 80% avec des forces, au niveau de l’interface de 4,03 MPa, groupe II porosité comprise entre 80 et 85% (7,06 MPa), groupe III porosité comprise entre 85 et 90% (9,44 MPa) et groupe IV porosité inférieure à 90% (14,85 MPa). Les différences entre ces 4 groupes sont statistiquement significatives. une plus grande porosité permet l’application de forces plus importantes au niveau de l’interface ciment-os après cimentation. La porosité optimum au niveau de l’os spongieux doit être supérieur à 90% et cette porosité peut être augmentée par l’alésage et les trous d’ancrages au niveau de la zone de fixation acétabulaire.

     

Newcastle approach to the elbow,a cadaveric study

Aim  

The aim of the current study was to assess the amount of the distal humerus articular surface exposed through the Newcastle approach, a posterior triceps preserving exposure of the elbow joint.     

Allograft-prosthesis composite reconstruction for the management of failed elbow replacement with massive structural bone loss: a medium-term follow-up

We studied, ten patients (11 elbows) who had undergone 14 allograft-prosthesis composite reconstructions following failure of a previous total elbow replacement with massive structural bone loss. There were nine women and one man with a mean age of 64 years (40?to 84), who were reviewed at a mean of 75 months (24 to 213). One patient developed a deep infection after 26 months and had the allograft-prosthesis composite removed, and two patients had mild pain. The median flexion-extension arc was 100° (95% confidence interval (CI) 76° to 124°). With the exception of the patient who had the infected failure, all the patients could use their elbows comfortably without splints or braces for activities of daily living. The mean Mayo Elbow Performance Index improved from 9.5 (95% CI 4.4 to 14.7) pre-operatively to 74 (95% CI 62.4 to 84.9) at final review. Radiologically, the rate of partial resorption was similar in the humeral and ulnar allografts (three of six and four of eight, respectively; p > 0.999). The patterns of resorption, however, were different. Union at the host-bone-allograft junction was also different between the humeral and ulnar allografts (one of six and seven of eight showing union, respectively; p = 0.03). At medium-term follow-up, allograft-prosthesis composite reconstruction appears to be a useful salvage technique for failed elbow replacements with massive bone loss. The effects of allograft resorption and host-bone-allograft junctional union on the longevity of allograft-prosthesis composite reconstruction, however, remain unknown, and it is our view that these patients should remain under long-term regular review.     

The functional outcome of the fractured clavicle

Background  

The severity of symptoms, rate and completeness of recovery after closed treatment of the fractured clavicle has not been fully explored.     

Primary Total Knee Replacement: Is Suction a Portal of Infection?

INTRODUCTION

Pulsed lavage during a total knee replacement usually leaves a pool of fluid on the surgical drapes. It is common practice to suck away this fluid using the same suction device used intra-operatively. This could be a cause of direct wound contamination. We hypothesised that bacteria contaminate fluid that collects around the foot in total knee replacement surgery and that suction equipment could be a portal of contamination. We also hypothesised that bacterial count in the fluid is lower if chlorhexidine, rather than saline, is used in the pulsed lavage.

PATIENTS AND METHODS

Forty patients undergoing primary total knee replacement were divided into two groups. The first group had pulsed lavage with normal saline and the second with 0.05% chlorhexidine.

RESULTS

At the end of the operation, 20 ml of fluid, pooled on the surgical drapes was aspirated and cultured for bacterial growth. None of the fluid samples showed bacterial growth.

CONCLUSIONS

Suction device used peri-operatively during knee replacement is unlikely to be a cause of wound contamination. Pulsed lavage with normal saline is as effective as lavage with chlorhexidine.     

Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up

We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21?patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001). The CPT stem continues to provide excellent radiological and clinical outcomes at 15?years following implantation. Its results are consistent with other polished tapered stem designs.     

Clinical tests for carpal tunnel syndrome in contemporary practice

Introduction  

A study conducted to establish the most accurate combination of questionnaire and physical signs for the diagnosis of carpal tunnel syndrome.     

The role of physiotherapy in the treatment of whiplash associated disorders: a prospective study

Objectives  Prospective longitudinal study to evaluate the effect of physiotherapy on whiplash associated disorders (WAD). Materials and methods  A total of 141 patients suffering from grades I–III WAD after a road traffic accident were employed. Validated neck Bournemouth Questionnaire was used in order to look at the effect of treatment on the symptoms. Results  The mean age was 40 (±14) years. The mean length of the treatment was 6 (±3.4) weeks. The mean individual effect size was 0.97 (95% CI 0.8–1.2). A total of 67% of the patients who started their treatment in the first 3 months post-injury improved compared to 48% in those who started physiotherapy after 3 months (P = 0.025). In both groups the applied treatment almost halved the number of patients taken sick leave. Conclusion  Physiotherapy is effective in the treatment of whiplash injury, especially in order to get the patients fit to go back to their previous employment.