Acta Orthop Belg
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Case Reports
Epidural abscess T5T8 due to methicillin-resistent staphylococcus aureus in an immunocompetent patient.
A 28-year-old man was admitted with severe thoracic pain, a body temperature of 37.20, paraplegia and sphincter disturbances. MRI revealed an epidural abscess T5T8. A decompressive laminectomy T5T8 was performed and the abscess was removed. ⋯ MRI is the first choice diagnostic tool. Laminectomy, drainage and intravenous antibiotics constitute the basic treatment. Antibiotics alone can be sufficient in case of whole spine involvement, lumbosacral localization without neurological symptoms, fixed neurological deficit, complete paralysis for more than 72 hours, or severe concomitant medical problems.
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An ageing population and greater number of hip and knee replacements performed have led to an increasing number of patients with ipsilateral hip and knee replacements in situ. This often physiologically suboptimal population is at risk for periprosthetic fracture. An interprosthetic femoral fracture represents a unique challenge to the surgeon and requires a detailed multidisciplinary management strategy involving both fracture fixation and often complex revision. ⋯ We believe this fracture pattern presents to the general orthopaedic surgeon a unique challenge, which bridges the expertise of the trauma and revision surgical spectrum. It is obvious that this will become an increasing issue with the median age of the population increasing. This case series highlights the need for ready availability of biological, arthroplasty and trauma systems to address such.
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The aim of this study was to determine the functional outcome and radiological results after open and arthroscopic stabilization of the acromioclavicular joint using a double-button fixation system. We reviewed 16 patients that were surgically treated for acromioclavicular dislocation using a double-button fixation system. An arthroscopic technique was used in 9 patients for acute injuries and an open technique in 7 patients for subacute or chronic lesions. ⋯ Only one patient experienced a redislocation after new trauma and needed revision surgery. Operative treatment of grade 3 and 4 acromioclavicular dislocations, using a double button coracoclavicular fixation system, yielded good functional results with full return to work and recreational activities. Arthroscopic coracoclavicular fixation without CA ligament transfer should be reserved for acute injuries within 2 weeks after the trauma.
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The objective of this prospective consecutive cohort study was to investigate the effect of sagittal cervical profile, gender and age on the thoracic kyphosis in 228 subjects, mainly adults, free of spinal complaints and with a thoracic kyphosis of less than 500. The subjects, who were actually treated for lower extremity problems, were divided into two groups: the 68 subjects in group 1 (30%) had loss of cervical lordosis, while the 160 subjects in group 2 (70%) had a physiological cervical lordosis. In group 1 (loss of cervical lordosis) the mean angles of the upper (T1T6), lower (T7T12), and whole (T1T12) thoracic kyphosis were 8 degrees +/- 2 (range: 3-28 degrees), 15 degrees +/- 4 (range: 6-400), and 24 degrees +/- 6 (range: 10-46 degrees), respectively. ⋯ Also age had no influence, neither in group 1 nor in group 2 as a whole, but in group 2 advanced age (> 50 years) was correlated with a significant increase in the lower (T7T12) (p = 0.009) and whole (T1T12) thoracic kyphosis (p = 0.007). This study yields standards for reference for the normal curvatures of the spine in the sagittal plane. The literature is quite controversial on this matter.
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Local antibiotic delivery with antibiotic loaded acrylic bone cement has been used extensively in the management of chronic osteomyelitis and implant related infections. Though newer drug delivery vehicles are being investigated, it remains the most widely used local antibiotic delivery vehicle in orthopaedic surgery. Self-made antibiotic loaded bone cement beads, which are cheaper and antibiotic specific, have been shown to elute less effectively than commercial antibiotic loaded cement beads. We offer several tips for increasing the elution and effectiveness of antibiotic loaded bone cement in clinical practice.