scholarly journals Pediatric septic arthritis of the hip: the benefit of hip arthroscopy by extracapsular (outside-in) approach

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0001
Author(s):  
Nicolas Jan ◽  
Julien Pietrzak ◽  
Matthieu Baudoux ◽  
Arnaud Kaba
Keyword(s):  
Septic Arthritis ◽  
Hip Arthroscopy ◽  
Weight Bearing ◽  
Needle Aspiration ◽  
High Rate ◽  
Peripheral Compartment ◽  
X Rays ◽  
Quick Method ◽  
Emergency Situations ◽  
Tensor Fasciae Latae

Background: Pediatric septic arthritis of the hip is a surgical emergency. Facing a hip flexum and fever, surgeons can use comparative ultrasound to confirm the diagnosis and to establish the surgical indication. While needle aspiration-irrigation is a simple and quick method, it gives rise to a high rate of recurrence. The purpose of our study was to demonstrate that hip arthroscopy by extracapsular approach is an effective and accessible alternative applicable in emergency situations. Methods: This is a report of 2 cases (7 years-135 cm; 13 years-143 cm) of needle aspiration-irrigation failure subsequently treated by hip arthroscopy. The X-ray and arthroscopy-assisted extracapsular technique was performed on a conventional orthopedic table, using a 30 degree arthroscope and a 3.5mm diameter motorized knife. Minimally invasive anterior longitudinal capsulotomy was performed by 2 anterolateral approaches via the proximal and distal tensor Fasciae Latae muscle, without dedicated instrumentation, followed by sampling, irrigation, removal of false membranes, synovial biopsies, partial synovectomy, cartilage assessment of the central then peripheral compartment and placement of a drainage. Results: In both cases, effusion completely disappeared and the inflammatory process gradually normalized with antibiotic therapy without any repeat procedure or complications related to the approach. Weight bearing was resumed in 3 weeks. Postoperatively, in 6 months and 15 months respectively, after resumption of sports activities hip examination was painless and no damage was noted on x-rays in either case. Conclusion: In our experience, hip arthroscopy by extracapsular approach can effectively address cases of failed needle aspiration-irrigation in pediatric septic arthritis of the hip. It could be provided as first-line emergency treatment in the event of purulent septic arthritis or late management, as a replacement for arthrotomy.

Arthroscopic treatment of psoas abscess concurrent with septic arthritis of the hip joint

2017 ◽  
Vol 28 (3) ◽  
pp. 336-340 ◽  
Author(s):  
Chul-Ho Kim ◽  
Kekatpure Aditya ◽  
Soong-Joon Lee ◽  
Hyo-June Kim ◽  
Kang-Sup Yoon ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Psoas Abscess ◽  
Positive Culture ◽  
Peripheral Compartment ◽  
Drain Tube ◽  
Arthroscopic Debridement ◽  
Suction Drain ◽  
Anterior Capsulotomy

Purpose: To describe the outcomes of 7 cases of psoas abscess concurrent with septic arthritis of the hip treated by hip arthroscopy alone. Methods: We retrospectively collected the data of patients who underwent arthroscopic drainage of psoas abscess concurrent with septic arthritis of the hip. Arthroscopic debridement was performed in both the central and peripheral hip joint compartments. In all cases, the iliopsoas compartment was accessed from the peripheral compartment through an anterior capsulotomy without limb traction. After debridement and drainage of the iliopsoas compartment, a suction drain tube was placed in the iliopsoas compartment through an enlarged anterior capsulotomy and another tube in the peripheral compartment. Postoperative intravenous antibiotics were administered on the basis of culture results; in cases with no positive culture, empirical antibiotics were administered for 4 to 6 weeks after surgery. Results: 7 patients underwent arthroscopic debridement and drainage for a psoas abscess concurrent with hip joint septic arthritis. Laboratory tests were normalized within 4 weeks after hip arthroscopy in all patients. At a median follow-up of 16 months (range, 13-30 months) after surgery, infection recurrence was absent in all patients. Conclusions: Arthroscopic debridement alone could be an effective treatment alternative to open surgery for psoas abscess concurrent with hip joint septic arthritis.

scholarly journals Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Urso R ◽  
◽  
Milani L ◽  
Ortolan A ◽  
Martucci A ◽  
...  
Keyword(s):  
External Rotation ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
The Elderly ◽  
Gamma Nail ◽  
Trauma Centre ◽  
High Rate ◽  
Full Weight Bearing ◽  
Coxa Vara ◽  
X Rays

Cephalomedullary nailing is considered the treatment of choice for trochanteric and subtrochanteric femoral fractures. The aim of this study was to report postoperative outcomes of one of the widely used trochanteric nail device, the Gamma 3 long nail. We retrospectively assessed 405 patients treated with Gamma 3 long nail in a single Level One Trauma Centre between 2010 and 2018. We finally included 261 ambulant patients with 65 years or older, a lowenergy trauma and a closed trochanteric or subtrochanteric femoral fracture. Clinical outcomes were evaluated using the Hip Fracture Functional Recovery Score (FRS), while radiological complications and failures were assessed on postoperative x-rays. More than two-thirds of patients had completed fracture consolidation within 4 months after surgery. Immediate full weight bearing was allowed postoperatively in 64.0% of patients. We reported a mortality of 24.5% at one year postoperatively. The leading clinical postoperative complication was anemia (69.3%), followed by deep venous thrombosis (7.7%). Coxa vara was observed in 73 patients (28%), followed by malreduction in flexion-external rotation of the proximal femoral fragment (26.8%). No case of lag screw cutout was reported. Our study indicated that last generation of Long Gamma nail is a reliable implant for trochanteric and subtrochanteric femoral fractures in the elderly patients, leading to high rate of bone union and reduced incidence of related complications. An excellent fracture reduction and prevention of postoperative varus malalignment are the main factors that can avoid the major postoperative complications and failures after Gamma 3 long nailing.

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

Complications with the Zurich Canine Total Hip Replacement System in an Initial Series of Cases Performed by a Single Surgeon

2021 ◽  
Author(s):  
Samuel P. Franklin ◽  
Nathan A. Miller ◽  
Todd Riecks
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Weight Bearing ◽  
Normal Function ◽  
High Rate ◽  
Total Hip ◽  
Initial Series ◽  
Major Complications ◽  
Hip Replacements ◽  
Replacement System

Abstract Objective The aim of this study was to quantify the complications using the Zurich total hip replacement system in an initial series of cases performed by a single surgeon who had experience with other total hip replacement systems. Materials and Methods This was a retrospective study in which complications were classified as major if any treatment was needed or if the outcome was less than near-normal function. Complications that did not warrant treatment and that did not result in function that was inferior to near-normal were considered minor. Outcomes were assessed by radiographic review, physical examination, subjective gait evaluation or, in one case, by objective gait analysis. Bilateral total hip replacements were considered separate procedures. Results The first 21 procedures in 19 dogs performed by a single surgeon were included. The mean time to follow-up was 48 weeks (range: 8–120 weeks; standard deviation: 36 weeks). Two cases (of 21) experienced major complications including one dog with excess internal femoral rotation during weight bearing and one dog having luxation. One case (of 21) had a minor complication; femoral fracture in the presence of an intact bone plate that maintained alignment and healed without treatment. Clinical Significance A high rate of successful outcomes with few major complications can be obtained in the initial cases treated using the Zurich total hip replacement system for surgeons with prior experience with other total hip replacement systems.

scholarly journals Hematologic emergencies

2012 ◽  
pp. 238-248
Author(s):  
Daniele Vallisa ◽  
Carlo F. Moroni
Keyword(s):  
New England ◽  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Hematologic Malignancies ◽  
Cord Compression ◽  
High Rate ◽  
Cochrane Library ◽  
Drug Induced ◽  
Hematologic Diseases ◽  
Emergency Situations

In recent years, the surprising progress made in other areas of hematology (advances in the understanding of leukemogenesis, improved transplant techniques) has been conspicuously absent in the management of hematologic emergencies. And yet, every step toward greater knowledge, every new treatment option will be of little value unless we are able to manage the acute complications of hematologic diseases. These complications are better defined as hematologic emergencies, and they are characterized by a high rate of mortality. This review is based on a search of the literature that was initially confined to articles published in the journal Hematology from 2000 to 2009. The search was then extended to the Cochrane Library and to Pub Med in February 2010 with the following Keywords emergencies; urgencies; hematology. The same key words were employed in a search of the archives of Blood and the New England Journal of Medicine from 2000 to 2010. The results confirm that hematologic emergencies can be caused by hematologic malignancies as well as by non-neoplastic hematologic diseases. Within the former category; this review examines the causes; manifestations; treatment and prevention of disseminated intravascular coagulation; superior vena caval syndrome; spinal cord compression; tumor lysis syndrome; hyperleukocytosis; and hypercalcemia. We also review emergency situations associated with non-neoplatic haematological diseases; such as thrombotic thrombocytopenic purpura; drug-induced hemolytic anemia; and acute sickle-cell crisis.

scholarly journals In situ damage assessment using synchrotron X-rays in materials loaded by a Hopkinson bar

2014 ◽  
Vol 372 (2015) ◽  
pp. 20130191 ◽  
Author(s):  
Weinong W. Chen ◽  
Matthew C. Hudspeth ◽  
Ben Claus ◽  
Niranjan D. Parab ◽  
John T. Black ◽  
...  
Keyword(s):  
High Speed ◽  
Particle Interaction ◽  
Tensile Failure ◽  
High Rate ◽  
X Rays ◽  
Contrast Imaging ◽  
X Ray ◽  
Damage Initiation ◽  
Dynamic Experiments

Split Hopkinson or Kolsky bars are common high-rate characterization tools for dynamic mechanical behaviour of materials. Stress–strain responses averaged over specimen volume are obtained as a function of strain rate. Specimen deformation histories can be monitored by high-speed imaging on the surface. It has not been possible to track the damage initiation and evolution during the dynamic deformation inside specimens except for a few transparent materials. In this study, we integrated Hopkinson compression/tension bars with high-speed X-ray imaging capabilities. The damage history in a dynamically deforming specimen was monitored in situ using synchrotron radiation via X-ray phase contrast imaging. The effectiveness of the novel union between these two powerful techniques, which opens a new angle for data acquisition in dynamic experiments, is demonstrated by a series of dynamic experiments on a variety of material systems, including particle interaction in granular materials, glass impact cracking, single crystal silicon tensile failure and ligament–bone junction damage.

Hip Arthroscopy: The Peripheral Compartment

2013 ◽  
pp. 169-175
Author(s):  
Emmanuel Illical ◽  
Paul E. Beaulé
Keyword(s):  
Hip Arthroscopy ◽  
Peripheral Compartment

Labyrinthectomy decreases bone mineral density in the femoral metaphysis in rats

2004 ◽  
Vol 14 (5) ◽  
pp. 361-365
Author(s):  
Régis Levasseur ◽  
Jean Pierre Sabatier ◽  
Olivier Etard ◽  
Pierre Denise ◽  
Annie Reber
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Weight Bearing ◽  
Whole Body ◽  
X Rays ◽  
Mineral Density ◽  
Femoral Metaphysis ◽  
Significant Difference ◽  
Distal Femoral Metaphysis ◽  
Vestibular Influence

To determine whether the vestibular system could influence bone remodeling in rats, we measured bone mineral density with dual energy X-rays absorptiometry before and 30 days after bilateral labyrinthectomy. Comparatively to intact control rats, labyrinthectomized animals showed a reduced bone mineral density in distal femoral metaphysis (p = 0.007): the variations between D0 and D30 were +3.0% for controls and -13.9% for labyrinthectomized rats. No significant difference between the 2 groups was observed in the whole body mineral density. These results suggest that the peripheral vestibular apparatus is a modulator of bone mass and more specifically in weight bearing bone. We discuss possible mechanisms of this vestibular influence probably mediated by the sympathetic nervous system.

Pathology of thyroid cancer

2011 ◽  
pp. 609-615
Author(s):  
Yolanda C. Oertel
Keyword(s):  
Fine Needle Aspiration ◽  
Armed Forces ◽  
Medullary Carcinoma ◽  
Needle Aspiration ◽  
High Rate ◽  
Follicular Epithelium ◽  
Thyroid Cancers ◽  
Fine Needle ◽  
Thyroid Fine Needle Aspiration ◽  
Well Differentiated

The majority of thyroid cancers arise from the follicular epithelium, are usually well differentiated, and thus many have a follicular architecture with varying amounts of colloid present. Medullary carcinoma constitutes a minority of thyroid cancers and arises from the C cells. Fine-needle aspiration (FNA) biopsy is the accepted diagnostic test to determine whether a thyroid nodule is benign or malignant (1, 2). The role of the cytopathologist in the interpretation of smears has been considered crucial, and I believe this is partially valid. Based upon 30 years of experience as an ‘interventional pathologist’ who performs and interprets many aspirates, I emphasize that the quality of the sample is the crucial factor. The pathologist’s interpretation is only as good as the sample he/she obtains or receives, and not enough attention has been paid to the technique of aspiration. I have trained numerous physicians to perform FNAs in a skilful fashion in a short period of time, and I refer the reader to my previous publications (3–5). The high rate of ‘unsatisfactory specimens’ reported in the literature is concerning. This was discussed at the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference in October 2007 (6) and it was recommended that ‘at the end of training and for re-credentialing 90% diagnostic samples should be documented’. Please note that FNA biopsy should not be confused with needle biopsies (e.g. Tru-cut, Vim-Silverman, etc.) that yield tissue fragments that are processed for histological diagnosis. The usual classification of thyroid cancers is founded on their histological and cytological features, many of which have been correlated with the clinical behaviour of the tumours. In addition, the age of the patients and the extent of the tumours are particularly important to determine the prognosis. The classification I follow is that of the WHO (7) with some of the modifications by the Armed Forces Institute of Pathology (AFIP) (8). My discussion will be focused largely on the most common types (see Box 3.5.5.1). Prolonged follow-up of the patients and extensive modern studies of the tumours indicate that papillary carcinomas and follicular carcinomas have histological similarities and are usually of a low grade of malignancy, but they also have a variety of inherent differences.

scholarly journals Stress vs. Non-Stress Radiographs in Subtle Syndesmotic Injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Nicola Krähenbühl ◽  
Travis Bailey ◽  
Nathan Davidson ◽  
Heath Henninger ◽  
Charles Saltzman ◽  
...  
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Paired Comparison ◽  
Weight Bearing ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
X Rays ◽  
Syndesmotic Injury ◽  
Stress Radiographs ◽  
Clear Space

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. The purpose of this study was to investigate whether syndesmotic injury was more easily diagnosed with stress vs. non-stress radiographs.radiographs.sed with stress vs. non-stress radiographs. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb, w/ and w/o 10 Nm static external rotation torque). Digitally reconstructed radiographs (DRRs), which are comparable to conventional radiographs, were reconstructed from the 3D CT data. The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Condition 3 was defined as acute syndesmotic injury. Using antero-posterior (AP) views, the tibio-fibular clear space (TFCS), tibiofibular overlap (TFO) and medial clear space (MCS) were assessed. Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding the TFCS, Native vs. Condition 3 in 10 Nm stress radiographs was significantly different in the deltoid group (p=0.021). Using TFO in stress and non-stressed radiographs, Native vs. Condition 2 and 3 was significantly different for the deltoid group (p=0.043), and Native vs. Condition 3 in the syndesmotic group (p=0.027). Regarding the MCS in non-stress radiographs, Native vs. Condition 3 was significantly different in the deltoid group (p=0.007), while in stress views, Native vs. Condition 2 was significant different in the syndesmotic (p=0.026) and Native vs. Condition 3 in the deltoid group (p=0.030). No differences were found comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: The TFCS cannot be used to assess subtle or acute syndesmotic injuries in stress and non-stress radiographs. The TFO can be used to assess a combined injury to the AITFL and deltoid ligament in stress and non-stress radiographs. The MCS can be used to assess acute syndesmotic injuries in stress and non-stress radiographs. Radiographs (stress or non-stress) cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Therefore, stress and non-stress radiographs are not useful in assessment of subtle syndesmotic injuries. Stress-radiographs are not superior compared to non-stress radiographs in assessment of acute syndesmotic injuries.

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