Orthopaedic review
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Septic arthritis of the hip and knee is very common in children and adolescents. Sixteen consecutive patients were treated for septic arthritis of the kee with arthroscopic lavage and debridement. ⋯ The mean immobilization period was 1 1/2 days and the time to full and painless range of motion averaged 2.8 weeks. All patients resumed normal activities by 3 weeks, no infections recurred, and postoperative morbidity was minimal.
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Shoulder arthroscopy has become a popular therapeutic and diagnostic procedure during the past decade. As with all new procedures, complications can occur. The highest complication rate (3.2%) was noted with staple capsulorrhaphy, and recurrence is more likely than with open repairs. ⋯ Careful positioning of the patient and the extremity lessens the potential of pressure and traction neuropraxias. Electrosurgical instruments plus adequate distension pressure help minimize intraoperative bleeding, thus improving visualization. Infection rates have been low, ranging from .04% to 3.4%.
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Case Reports
Pseudonotch of the atlas vertebra simulating fracture with computed tomographic diagnosis. A case report.
Pseudonotch of the atlas represents a normal variation of the atlas related to a notched protuberance of the medial surface of its lateral masses. A case is presented in which cervical spine roentgenography revealed a prominent pseudonotch that mimicked a fracture of the lateral masses of the atlas. Minimal rotation of C-1 on C-2 was present without apophyseal joint subluxation. Computed tomography imaging provided an accurate diagnosis.
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Parenteral antibiotic therapy for acute bone infections, soft-tissue infections, and osteomyelitis may result in high serum concentrations associated with nephrotoxic, ototoxic, and allergic complications. Conversely, the local release of antibiotics into the wound with the use of antibiotic-impregnated cement or antibiotic-impregnated polymethylmethacrylate beads has been found effective and does not induce negative effects or result in systemic concentrations of clinical significance. The antibiotic-impregnated cement beads are fabricated on a surgical steel wire, and they have bimodal elution properties. ⋯ Compared with systemic antibiotic therapy, the incidence of nephrotoxic, ototoxic, and hypersensitivity reactions is significantly diminished. The beads release 5% of the antibiotic within the first 24 hours. The sustained elution then progressively diminishes to undetectable levels within a few weeks or months.