The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Mar 2007
Comparative StudyNecrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species.
Vibrio and Aeromonas species, which can cause necrotizing fasciitis and primary septicemia, are members of the Vibrionaceae family and thrive in aquatic environments. Because the clinical symptoms and signs of necrotizing fasciitis and sepsis caused by these two bacteria are similar, the purposes of this study were to describe the clinical characteristics of Vibrio vulnificus and Aeromonas infections, to analyze the risk factors for death, and to compare the effects of surgical treatment on the outcome. ⋯ The contact history of patients with a rapid onset of cellulitis can alert clinicians to a differential diagnosis of soft-tissue infection with Vibrio vulnificus (contact with seawater or raw seafood) or Aeromonas species (contact with fresh or brackish water, soil, or wood). Early fasciotomy and culture-directed antimicrobial therapy should be aggressively performed in those patients with hypotensive shock, leukopenia, severe hypoalbuminemia, and underlying chronic illness, especially a combination of hepatic dysfunction and diabetes mellitus.
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J Bone Joint Surg Am · Mar 2007
Occipitalization of the atlas in children. Morphologic classification, associations, and clinical relevance.
Occipitalization is defined as a congenital fusion of the atlas to the base of the occiput. We are not aware of any previous studies addressing the morphologic patterns of occipitalization or the implications of occipitalization in children. We present data on what we believe is the largest reported series of children with occipitalization studied with computed tomography and/or magnetic resonance imaging, and we provide a description of their clinical characteristics. ⋯ Occipitalization is associated with abnormalities that lead to narrowing of the space available for the spinal cord or brainstem. The risk of atlantoaxial instability developing is particularly high when there is an associated congenital C2-C3 fusion. Two-dimensional sagittal and coronal reformatted computed tomographic reconstructions and/or magnetic resonance images can help to establish the diagnosis and permit categorization of occipitalization in three zones, each of which may have a different prognostic implication.
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J Bone Joint Surg Am · Mar 2007
Dose and time-dependent effects of cyclooxygenase-2 inhibition on fracture-healing.
Fracture-healing is impaired in mice lacking a functional cyclooxygenase-2 (COX-2) gene or in rats continuously treated with COX-2 inhibitors. These observations indicate that COX-2 is a critical regulator of fracture repair. Nonsteroidal anti-inflammatory drugs are commonly used to treat pain associated with musculoskeletal trauma and disease. Nonsteroidal anti-inflammatory drugs inhibit COX-2 function and in so doing can impair fracture-healing. The goal of the present study was to determine how variations in nonsteroidal anti-inflammatory drug therapy ultimately affect fracture-healing. ⋯ COX-2-selective nonsteroidal anti-inflammatory drug therapy during the early stages of fracture repair significantly reduced fracture callus mechanical properties at later stages of healing and increased the proportion of nonunions in this animal model.
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J Bone Joint Surg Am · Mar 2007
Biography Historical ArticleRaoul Hoffmann and his external fixator.
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J Bone Joint Surg Am · Mar 2007
Randomized Controlled Trial Comparative StudyTreatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Surgical technique.
Open reduction and internal fixation is currently the accepted treatment for displaced Lisfranc joint injuries. However, even with anatomic reduction and stable internal fixation, treatment of these injuries does not have uniformly excellent outcomes. The objective of this study was to compare primary arthrodesis with open reduction and internal fixation for the treatment of primarily ligamentous Lisfranc joint injuries. ⋯ A primary stable arthrodesis of the medial two or three rays appears to have a better short and medium-term outcome than open reduction and internal fixation of ligamentous Lisfranc joint injuries.