scholarly journals Synovial fluid cell counts and its role in the diagnosis of paediatric septic arthritis

2019 ◽  
Vol 13 (4) ◽  
pp. 417-422 ◽  
Author(s):  
K. K. Obana ◽  
R. R. Murgai ◽  
M. Schur ◽  
A. M. Broom ◽  
A. Hsu ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Weight Bearing ◽  
Case Series ◽  
Antibiotic Administration ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Cell Counts ◽  
Wbc Count ◽  
Time Of Admission ◽  
Diagnosis Of Infection

PurposeClinical presentation of paediatric septic arthritis (SA) can be similar to other joint pathologies. Despite potential for infection in all major joints, most diagnostic criteria are based on values from the hip. This study identifies the best joint aspirate values in diagnosing SA in all joints.MethodsIn all, 166 patients who underwent 172 joint aspirations at the authors’ institution between 01 September 2004 and 01 September 2014 were retrospectively identified. Recorded measures included age, sex, duration of symptoms, fever history, weight-bearing status, aspiration results, serum results and antibiotic administration. Patients were placed in the following four categories: ‘culture confirmed SA’ (C-SA), ‘suspected SA’ (S-SA), ‘Other’ and ‘Other-rheumatologic’ (Other-R), a subcategory of ‘Other’.ResultsMost common sites of aspiration were the knee (55%) and hip (29%). Diagnostic grouping was as follows: C-SA = 44, S-SA = 45, Other = 83 (Other-R = 21). Fever and non-weight-bearing prior to admission were useful predictors of SA, though in C-SA patients, 21% did not have a fever and 23% could weight bear at the time of admission. Aspirate white blood cell (WBC) count was significantly greater in both C-SA (92 000 cells/hpf) and S-SA (54 000) than in Other (10 000) and Other-R (18 000) patients. The percentage of polymorphonuclear (%PMN) was also significantly greater in C-SA (81.1%) and S-SA (80.9%) than in Other (57.9%) and Other-R (63.3%).ConclusionJoint aspirate values, especially %PMN, are valuable in diagnosing SA. Additionally, antibiotics pre-aspiration did not affect %PMN, facilitating subsequent diagnosis of infection. Lastly, while aspirate WBC count was a valuable indicator of SA, this finding is not as definitive as previous research suggests.Level of EvidenceIV Case Series

Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

2009 ◽  
Vol 30 (9) ◽  
pp. 873-876 ◽  
Author(s):  
J. Thaddeus Leaseburg ◽  
James K. DeOrio ◽  
Shane A. Shapiro
Keyword(s):  
Weight Bearing ◽  
Proximal Phalanx ◽  
Case Series ◽  
Statistical Correlation ◽  
Titanium Plate ◽  
Care Needs ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lower Correlation ◽  
Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

scholarly journals Pseudo paralysis of the shoulder and increased C-reactive protein are predictive factors for septic shoulder in children superior to other clinical symptoms: a retrospective case series of 25 patients

2020 ◽  
Vol 14 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Cezara Danilov ◽  
Christoph Ihle ◽  
Francisco F. Fernandez ◽  
Gunnar Blumenstock ◽  
Thomas Wirth ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Clinical Symptoms ◽  
Case Series ◽  
Diagnostic Procedures ◽  
White Blood Count ◽  
C Reactive Protein ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Shoulder Arthritis

Purpose The aim of the study was to evaluate predictable parameters with the highest sensitivity used in the diagnosis of children septic shoulder arthritis. Methods All children treated in our paediatric orthopaedic hospital between 2000 and 2017 with intraoperative verified septic arthritis of the shoulder were included in this retrospective study. Diagnostic procedures e.g. ultrasound, MRI, radiograph or blood samples as well as typical clinical symptoms were evaluated as predictable parameters for septic shoulder arthritis in paediatric patients. Descriptive statistics as well as sensitivity analysis were performed. Results In all, 25 children, 20 boys and five girls, aged from eight days to 15 years, were included for further statistical analysis. All parameters included were tested for sensitivity with binomial confidence intervals (Cis) of 95%. Predictive parameters with highest sensitivity were pseudo paralysis (100%, CI 0.86 to 1.00) and C-reactive protein (CRP) (96%, CI 0.79 to 0.99) superior to temperature (52%, CI 0.3 to 0.73), white blood count (11%, CI 0.01 to 0.34), radiograph (21%, CI 0.04 to 0.50), ultrasound (71%, CI 0.47 to 0.88) or MRI (100%, CI 0.78 to 1.00). Conclusion The diagnosis of a septic arthritis of the shoulder in children can be challenging for the clinician and especially for the resident doctor. Clinical symptoms such as pseudo paralysis and increased CRP level must be considered as predictive markers not to delay further diagnostics and treatment. Level of Evidence IV

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

2019 ◽  
Vol 13 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Derek Stenquist ◽  
Brian T. Velasco ◽  
Patrick K. Cronin ◽  
Jorge Briceño ◽  
Christopher P. Miller ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Break Point ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Retrospective Case Series ◽  
Screw Breakage ◽  
Tissue Stabilization

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

2019 ◽  
Vol 40 (7) ◽  
pp. 803-807 ◽  
Author(s):  
Abdel-Salam Abdel-Aleem Ahmed ◽  
Mahmoud Ibrahim Kandil ◽  
Eslam Abdelshafi Tabl
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Deformity Correction ◽  
Functional Results ◽  
The Body ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

Lumbar Spondylolysis in Pediatric and Adolescent Soccer Players

2005 ◽  
Vol 33 (11) ◽  
pp. 1688-1693 ◽  
Author(s):  
Georges El Rassi ◽  
Masakazu Takemitsu ◽  
Patarawan Woratanarat ◽  
Suken A. Shah
Keyword(s):  
Back Pain ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Soccer Players ◽  
Fisher Exact Test ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Exact Test ◽  
Lumbar Spondylolysis ◽  
Pain Duration

Background Lumbar spondylolysis in young soccer players has not been studied extensively. Purpose The purpose of this study was to review lumbar spondylolysis in young soccer players, describe the causes, and report the results of nonoperative treatment emphasizing the cessation of activity for 3 months. Study Design Case series; Level of evidence, 4. Methods The authors reviewed 57 child and adolescent soccer players (35 boys and 22 girls) with lumbar spondylolysis who came to their outpatient clinic for back pain evaluation. These patients received different modalities of nonoperative treatment, including cessation of sports and wearing a thoracolumbosacral orthosis. Soccer skills, field position, side of dominant leg, age, initiating event of low back pain, duration of symptoms, and nonoperative treatment were reviewed. Clinical outcome of treatment was assessed by the Steiner-Micheli criteria at the most recent follow-up (minimum 2 years). The Fisher exact test was used to compare all the data. Results Of the patients, 43% noticed that pain started after a high-velocity kick. Thirty-three (58%) of 57 patients had excellent results with no pain during sports, 20 (35%) good, 3 (5%) fair, and 1 (2%) poor. Subjects who ceased playing soccer for 3 months had better results than those who did not comply with this restriction. Conclusion The authors recommend stopping sports for at least 3 months in cases of lumbar spondylolysis in young soccer players who hope to return to their previous level of play without back pain.

The Development of a Neuropathic Ankle following Successful Correction of Non-Plantigrade Charcot Foot Deformity

2012 ◽  
Vol 33 (8) ◽  
pp. 644-646 ◽  
Author(s):  
Michael S. Pinzur
Keyword(s):  
External Fixator ◽  
Weight Bearing ◽  
Case Series ◽  
Disease Process ◽  
Circular Ring ◽  
Surgical Correction ◽  
Charcot Foot ◽  
Foot Deformity ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of Charcot foot arthropathy has traditionally involved immobilization during the acute phase followed by longitudinal management with accommodative bracing. In response to the perceived poor outcomes associated with nonoperative accommodative treatment, many experts now advise surgical correction of the deformity, especially when the affected foot is not clinically plantigrade. The significant rate of surgical and medical-associated morbidity accompanying this form of treatment has led surgeons to look for improved methods of surgical stabilization, including the use of the circular ring external fixation. Methods: Over a 7-year period, a single surgeon performed surgical correction of non-plantigrade Charcot foot deformity on 171 feet in 164 patients with a statically applied circular external fixator. Following successful correction, five patients developed a neuropathic deformity of the ipsilateral ankle after removal of the external fixator and subsequent weight bearing total contact cast. Results: Three of the five patients progressed to successful healing of the neuropathic (Charcot) ankle arthropathy following treatment with a series of weightbearing total contact casts. Two underwent successful ankle fusion with retrograde locked intramedullary nailing. Discussion: This unusual clinical scenario likely represents either a progression of the disease process in the foot or a complication associated with surgical correction of the original neuropathic foot deformity. A better understanding of this observation will likely become apparent as we acquire more experience with this disorder. Level of Evidence: IV, Retrospective Case Series

scholarly journals Interprosthetic Femoral Fractures Surgical Treatment in Geriatric Patients

2021 ◽  
Vol 12 ◽  
pp. 215145932110137
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Nico Safa Akhavan ◽  
Patrick Fries ◽  
Michael Dietrich
Keyword(s):  
Surgical Treatment ◽  
Geriatric Patients ◽  
Standard Procedure ◽  
Weight Bearing ◽  
Case Series ◽  
Femoral Fractures ◽  
Full Weight Bearing ◽  
Level Of Evidence ◽  
Type Iv ◽  
Case Series Study

Background: Total hip (THA) and total knee arthroplasty (TKA) are becoming an increasingly standard procedure in the whole world. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic, and interprosthetic fractures is of great interest to orthopedic surgeons. This study aims to report the clinical and radiographic outcomes, complications and reoperations of IFFs in geriatric patients. Methods: A retrospective single-institution case series study was conducted. Between 2011 and 2019, 83 patients underwent surgical treatment for periprosthetic femoral fractures. Thirteen fractures were identified as IFFs. Patient demographics and comorbidities were collected preoperatively, and fractures were classified with the Vancouver and AO unified classification system (AO-UCS). Results: We included 12 patients (13 hips) with IFFs (AO-UCS type IV.3 B (2/13) type IV.3 C (3/13), type IV.3 D (8/13)). The average patient age was 86.54 (range, 79-89) years. There were 10 females and 2 males. Perioperative morbidity has been identified in 10 of the 12 patients, and the 3-month and 1-year mortality were reported in 2 and 3 patients, respectively. Cerclage cables were used in 9 of 12 patients. One of 12 patients showed a local complication, with no documented implant failure or revision. Patients achieved complete union and returned to their preoperative ambulatory status, and full weight-bearing at an average of 5 (range, 2 to 7) months later. Conclusion: Management of IFF can be challenging because these fractures require extensive surgical expertise. Locking plate seems to be a valuable treatment option for geriatric patients with IFFs. Despite the complexity of this type of fracture, the overall complication and revision rate, as well as the radiographic outcome are good to excellent. Level of Evidence: Level III, Therapeutic study.

scholarly journals 1158. Pediatric Group A Streptococcal Peritonitis: A Single-Center Eleven Patient Case Series

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S670-S671
Author(s):  
Nicole L Pershing ◽  
Scott Eldredge ◽  
Jack E Burgeson ◽  
David Dansie ◽  
Katie Russell ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Appendicitis ◽  
Peritoneal Fluid ◽  
Clinical Signs ◽  
Case Series ◽  
Streptococcal Toxic Shock Syndrome ◽  
Antibiotic Administration ◽  
Duration Of Symptoms ◽  
Group A ◽  
Appendiceal Inflammation

Abstract Background Pediatric group A streptococcal peritonitis (GASP) is a rare but serious infection, with few cases reported in the literature. Utah has an unusually high incidence of invasive GAS (iGAS) disease, but the frequency and characteristics of pediatric GASP are unknown. Methods We performed a retrospective chart review to identify GASP in Utah children from 2000-2019. GASP was defined as isolation of GAS from peritoneal fluid or blood and clinical signs of peritonitis. Results : Eleven children with GASP were identified, with slight female predominance (n=6). Median age was 6 years; males were significantly younger than females (1.4 versus 7.2 years, p=0.01). GAS was isolated from 4 of 8 blood and 8 of 11 peritoneal cultures obtained. Peritoneal fluid PCR was positive for GAS in one patient. Ten patients underwent laparotomy. Peri-appendiceal inflammation prompted appendectomy in 7 patients; only one had pathologic findings of acute appendicitis. Four patients developed streptococcal toxic shock syndrome and 7 required intensive care. Non-white race (n=4) and lack of appendectomy (n=5) were associated with more severe outcomes. Median antibiotic duration was 27 days. Median hospitalization was 8 days. All patients survived. Figure 1. Schematic representation of GAS peritonitis patient clinical course. Each patient is represented by a single line. Duration of symptoms prior to hospitalization, as well as duration of hospitalization (day 0 representing admission), intensive care, antibiotic administration, and timing of procedural interventions are noted. Duration of antibiotics after discharge for patient 3 was unable to be verified, as indicated by a question mark. Hospitalization, general pediatric hospital care. PICU, pediatric intensive care unit. IR, interventional radiology. Conclusion We present the largest pediatric case series of GASP to date. Diagnostic hallmarks included gastrointestinal symptoms, fever, systemic inflammation, and peritoneal enhancement without an abdominal source. Peri-appendiceal inflammation was common, although acute appendicitis was rare, and appendectomy was associated with a less severe course. GASP should be considered in patients with acute abdominal processes given increasing incidence of iGAS infections. Disclosures All Authors: No reported disclosures

scholarly journals Safety and Efficacy of Mesenchymal Stromal Cells and Platelet-Rich Plasma for the Treatment of Moderately Advanced Post-Traumatic Arthritis of the Ankle

2021 ◽  
Vol 3 (1) ◽  
pp. e9-e18
Author(s):  
Henry Stiene
Keyword(s):  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Platelet Rich Plasma ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Retrospective Case ◽  
Duration Of Symptoms ◽  
Cell Counts ◽  
Post Traumatic

Background: Orthobiologics such as mesenchymal stromal cells and platelet-rich plasma are intensely being investigated as treatment options for osteoarthritis. The purpose of this retrospective case series is to evaluate the safety, adverse events, long-term outcomes, and efficacy of bone marrow concentrate (BMC) combined with platelet-rich plasma (PRP) to treat moderate to advanced Kellgren-Lawrence (KL3-4) post-traumatic ankle osteoarthritis.Methods: Study population at final follow-up included 19 patients with 22 treated ankles with post-traumatic ankle osteoarthritis with a mean duration of symptoms of 56 months before treatment with ultrasound-guided intra-articular injection of BMC and PRP. Patients were followed prospectively from the time of treatment for a mean of 2.6 years at final follow-up. Pre and post Foot and Ankle Disability (FADI) scores were tabulated to assess outcomes, and 7 patients also completed the FADI sports module. Total nucleated cell counts were obtained on all treated patients and Mishra Type 3A PRP was utilized.Results: A total of 19 of 22 ankles treated showed improvement in their FADI scores. Thirteen of the 19 who had improved FADI scores patients reached MCID (P = .17). Three of the six patients who did not reach MCID eventually underwent ankle arthrodesis. The average patient age was 56 years old. There was no correlation between the history of previous surgery, KL grade, sex, or age in terms of outcomes. Seven patients completed the sports module of the FADI, and none reached MCID. Patients with a shorter duration of symptoms had higher post-FADI scores reaching MCID (P < .001). The three patients who underwent arthrodesis had the longest duration of symptoms of 84, 84, and 120 months. No adverse effects were reported in the study group. Total nucleated cell count (TNCC) did not correlate with outcomes in this group, and there was no correlation of TNCC based on age and sex.Conclusion: BMC combined with PRP is a safe treatment option for patients with moderate to advanced ankle arthritis and can provide functional pain relief for a sustained period and delay or possibly obviate the need for future ankle arthrodesis. A shorter duration of symptoms may lead to improved outcomes.  

Posterior Ankle Scope Approach to Symptomatic Os Trigonum Removal

2021 ◽  
pp. 193864002098430
Author(s):  
John M. Thompson ◽  
Travis M. Langan ◽  
Christopher F. Hyer
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Wound Complication ◽  
Full Weight Bearing ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Os Trigonum ◽  
Average Return ◽  
Surgical Options

Introduction Os trigonum can become symptomatic following acute or chronic repetitive compression of the posterior ankle. Following conservative treatment failure, removal is often warranted. Current surgical options include traditional open resection and endoscopic removal. The purpose of this article is to review a population of patients who underwent endoscopic excision of symptomatic accessory os trigonum through a posterior approach and evaluate the outcomes of the procedure. Methods From May 2009 to September 2018, all patients who underwent excision of a symptomatic os trigonum were reviewed. Outcomes of interest were major and minor complications and time to return to full weight-bearing activities. Postoperative protocol included 5 to 7 days non–weight-bearing and 1 to 2 weeks of protected weight-bearing followed by full release to weight-bearing activities. Results Twelve patients who met the inclusion criteria were studied. Mean follow-up was 10.2 (±7.4) months with no major complications and 1 minor wound complication. Average advancement to protected weight-bearing was 7.1 days. Average return to full weight-bearing activities without restriction was 24.4 days. Conclusion The current study describes the technique and results to minimally invasive os trigonum removal with favorable postoperative outcomes. Results demonstrated minimal complications and postoperative pain, also quick return to weight-bearing and full activity. Level of Evidence: Therapeutic, Level IV: Case series

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