Avulsion fracture of the tibial attachment of the posterior cruciate ligament. Indications and results of delayed repair

In a series of delayed repair in 8 instances of avulsion fracture of the tibial attachment of the posterior cruciate ligament, 6 were isolated avulsion fractures of the tibial attachment of the posterior cruciate ligament and 2 were associated with the fractures of the tibial condyle. Staple fixation was used exclusively. The detachment of the posterior horn of the meniscus was observed in 6 of 8 cases. Four cases, in which the surgery had been carried out within 7 weeks after the injuries, had excellent results. The other cases in which the surgery had been carried out more than 11 weeks after the injuries, had less than satisfactory results. Pain on motion or synovial effusion disappeared but residual anteroposterior instability remained. Repair of the avulsion fracture of the posterior cruciate ligament is recommended in cases of delayed or non-union with symptoms.     

Serial MRI findings of acute flaccid myelitis during an outbreak of enterovirus D68 infection in Japan

Objecive

To clarify the neuroimaging findings of children with acute flaccid myelitis during an outbreak of EV-D68 infection.

Risk of Rebleeding in Patients with Small Bowel Vascular Lesions

Objective With recent advances in endoscopic modalities, small bowel vascular lesions (SBVLs) are often now detected in patients with gastrointestinal bleeding. Given the high invasiveness of endoscopic treatment, it is important to select patients at high risk for bleeding. To assess the risk of rebleeding in patients with SBVLs as a systemic disease rather than a gastrointestinal disease in relation to their general health. Methods We retrospectively analyzed the clinical data of 55 patients with SBVLs among patients with obscure gastrointestinal bleeding. The possible association between the clinical findings and the updated Charlson comorbidity index with rebleeding was evaluated. Results Gastrointestinal rebleeding occurred in 20 patients (36.4%) during the follow-up period. The presence of multiple comorbidities as indicated by an updated Charlson comorbidity index of ≥4 was a risk factor for rebleeding (hazard ratio, 3.64; p=0.004). Other risk factors were arteriosclerosis of the superior mesenteric artery and multiple SBVLs. Endoscopic hemostasis and the discontinuation of antithrombotic medications were not significantly associated with rebleeding. Patients with a high updated Charlson comorbidity index had a high risk of death of causes other than gastrointestinal rebleeding. Conclusion Gastrointestinal rebleeding is not a rare condition among patients with SBVLs. Patients with poor general health may therefore have a higher risk of rebleeding.     

Subchondral Insufficiency Fracture of the Femoral Head may be Associated with Hip Dysplasia: A Pilot Study

Background  

Subchondral insufficiency fracture of the femoral head occurs mainly in elderly patients with osteoporosis. Spontaneous resolution is observed after nonoperative treatment in some patients whereas other show progressive joint destruction requiring THA. Several studies report the occurrence of subchondral insufficiency fracture of the femoral head in dysplastic hips.