Delayed Slipped Capital Femoral Epiphysis Following Septic Arthritis of a Hip: A Case Report

Introduction: Delayed slip of the capital femoral epiphysis is a rare entity in the setting of a septic hip. Case Report: A 13-year-old male presented with an inability to walk and pain around right hip and knee region with fever. On imaging evaluation, a diagnosis of septic hip and knee arthritis was made and both the joints were drained under general anesthesia by anterior approach and an empirical antibiotic therapy was started. On the initial radiograph, there was no sign of slippage of the capital femoral epiphysis. Although the limb was kept in an immobilized position in the 1st week of the surgical debridement, yet it did not prevent the subsequent development of slipped capital femoral epiphysis (SCFE). Open reduction and screw fixation was done to stabilize the slippage. Healing took place with reduction of joint space with some restriction of the hip motion. Conclusion: SCFE is a disastrous complication in association with septic arthritis of a hip. Routine traction and immobilization may not prevent slippage. Disproportionate amount of pain on weight bearing in a post septic hip should raise the suspicion of SCFE. Prophylactic pinning may be considered in selective cases with antibiotic coverage. Keywords: Hip sepsis, septic sequelae, slipped capital femoral epiphysis.

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Primary Total Hip Replacement in a Case of Unilateral Hypo Plastic Proximal Femur – A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i04.2148 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Neetin P Mahajan ◽

Lalkar Laxman Gadod ◽

Ajay S Chandanwale ◽

Prasanna Kumar G S ◽

Mrugank Narvekar ◽

...

Keyword(s):

Case Report ◽

Femoral Head ◽

Septic Arthritis ◽

Total Hip Replacement ◽

Proximal Femur ◽

Hip Replacement ◽

Weight Bearing ◽

Harris Hip Score ◽

Femoral Canal ◽

Total Hip

Introduction: Primary total hip replacement in hypo plastic proximal femur is difficult due to the presence of a small canal, soft- tissue contracture, fragility of bone, and poor femoral cement mantle when used. Intraoperatively, there could be occurrence of fracture of the femur, inadequate fit, and fill with cement less femoral component. It is found unilaterally in cases of osteonecrosis of femoral head, post- traumatic, and in sequelae of childhood septic arthritis. Case Report: A 45-year- old male patient presented to the OPD with complaints of pain in the left hip and difficulty in walking since for 4 years. The patient had a history of fever and swelling over the left hip in childhood with no treatment taken for the same. X-ray of pelvis with both hips showed deformed femoral head, short neck, narrow femoral canal (Grade 1 Dorr), and arthritic changes in acetabulum. We managed with total hip replacement using Wagner cone stem. Postoperatively, the patient is having good range of motion and having no difficulty in walking and weight- bearing. Functional outcome is good as per Harris hip score. Conclusion: Total hip replacement in hypo plastic femur with arthritis is always a challenging problem. It requires surgical expertise and proper implant selection and pre-operative planning, which prevents intraoperative and post-operative complications. Wagner cone stem is a very good option in managing this type of patients. Keywords: Unilateral hypo plastic proximal femur, childhood septic arthritis, narrow femoral canal (Grade 1 Dorr), total hip replacement, Wagner cone stem.

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Proximal interphalangeal joint arthrodesis in a case of chronic proliferative osteoarthritis in the horse – a case report

Acta Veterinaria Brno ◽

10.2754/avb202190020155 ◽

2021 ◽

Vol 90 (2) ◽

pp. 155-158

Author(s):

Filip Koľvek ◽

Šárka Krisová ◽

Kristína Žuffová ◽

Zdeněk Žert

Keyword(s):

Case Report ◽

Weight Bearing ◽

Traumatic Injury ◽

Joint Space ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Radiographic Examination ◽

New Bone Formation ◽

Flunixin Meglumine

Proximal interphalangeal joint (PIPJ) arthrodesis is performed commonly in horses with chronic osteoarthritis of the pastern joint or in cases of acute traumatic injury to the pastern, in which the weight-bearing bony column must be restored. Chronic osteoarthritis of the pastern joint is a frequent cause of lameness in the equine athlete and is evidenced by chronic lameness which is supported radiographically by periosteal proliferation and loss of joint space. The conventional method of joint fusion involves the opening of the joint, debridement of the joint cartilage, osteostixis of the subchondral bone plate and application of either lag screws or plate. This case report describes the successful treatment of chronic proliferative ossified osteoarthritis and periarthritis of the proximal interphalangeal joint of the front limb of two mares by performing simple percutaneous drilling destruction of the articular cartilage and stabilization with the application of three lag screws. After three years of conservative treatment with local corticosteroids, the mares exhibited non-weight-bearing lameness. Radiographs revealed extensive periarticular new bone formation over the proximal interphalangeal joint. Three 4.5 mm transcortical bone screws were placed in the lag fashion. A lower limb fiberglass cast was applied in both cases for 3 days. The antibiotic and analgesic protocol included gentamicin, penicillin, and flunixin meglumine for several days. Control radiographic examination after a period of 6 and 12 months showed reduction of the periarticular bone tissue. Both of the mares in this case study successfully returned to pleasure riding after undergoing forelimb arthrodesis.

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Primary Hyperparathyroidism From Ectopic Parathyroid Adenoma in a Patient With Bilateral Slipped Capital Femoral Epiphysis

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.434 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A213-A214

Author(s):

Rebecca J Vitale ◽

Hester Shieh ◽

Biren P Modi ◽

Rebecca J Gordon

Keyword(s):

Vitamin D ◽

Case Report ◽

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Pediatric Patients ◽

Weight Bearing ◽

Slipped Capital Femoral Epiphysis ◽

Autism Spectrum ◽

Ectopic Parathyroid Adenoma ◽

Ectopic Parathyroid

Abstract Background: Primary hyperparathyroidism has been reported in 13 pediatric patients presenting with slipped capital femoral epiphysis (SCFE), but never in patients with ectopic parathyroid adenoma [1]. Case report: A 12-year-old boy with obesity (BMI 99th percentile) and autism spectrum disorder presented with a limp and was found to have bilateral SCFE. Calcium was elevated to 12.3 mg/dL (reference range 8.0–10.5) with phosphorus of 3.2 mg/dL (3.0–5.7), alkaline phosphatase 775 units/L (40–360), tubular reabsorption of phosphorus 89% (&gt 95%), 25OH-vitamin D 12.1 ng/mL (30–80), 1,25OH-vitamin D 246.6 pg/mL (19.9–79.3), and PTH 1191 pg/mL (10–65). He had significant neuropsychiatric agitation but denied constipation, polyuria, and other symptoms of hypercalcemia. He had in situ pinning of the SCFE bilaterally and was hyperhydrated with minimal improvement in his calcium level. Neck ultrasound revealed no parathyroid adenoma. He was discharged on cholecalciferol 1000 IU daily with plans for outpatient Tc-99m Sestamibi scintigraphy. Following discharge, he developed significant nausea, did not tolerate the cholecalciferol, and was non-weight bearing. Repeat labs and imaging 5 days later demonstrated calcium had risen to 16.7 mg/dL with phosphorus of 2.2 mg/dL. He was admitted and calcium improved transiently to less than 12 mg/dL with intranasal calcitonin therapy. Sestamibi and subsequent CT scan revealed a 2.7x1.6x1.9 cm ectopic parathyroid adenoma in the upper anterior mediastinum. He had thoracoscopic resection of the mass, which was revealed to be intrathymic, and PTH levels fell from 1613 pg/mL pre-operatively to 76 pg/mL 30 minutes post-resection. Post-operatively, he developed hungry bone syndrome with a calcium nadir of 7.6 mg/dL and phosphorus nadir of 1.6 mg/dL, which required oral calcium and calcitriol for 10 days. With normalization of his calcium, his neuropsychiatric symptoms improved. Pathology revealed a parathyroid adenoma. Conclusion: Primary hyperparathyroidism can be associated with SCFE and should be considered even in patients with traditional risk factors for SCFE, especially with bilateral disease. Pediatric patients with primary hyperparathyroidism and negative neck imaging should be further evaluated for ectopic parathyroid adenomas. References: 1. George, G.S., Raizada, N., Jabbar, P.K., Chellamma, J., Nair, A. Slipped Capital Femoral Epiphysis in Primary Hyperparathyroidism - Case Report with Literature Review. Indian J Endocrinol Metab. 2019 Jul-Aug;23(4):491–494.

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Radiographic Study of Haematogenous Septic Arthritis in Dairy Calves

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1641732 ◽

2018 ◽

Vol 31 (04) ◽

pp. 252-260

Author(s):

Isabelle Masseau ◽

Marie Babkine ◽

Sylvain Nichols ◽

David Francoz ◽

Gilles Fecteau ◽

...

Keyword(s):

Septic Arthritis ◽

Subchondral Bone ◽

Weight Bearing ◽

Clinical Signs ◽

Joint Space ◽

Dairy Calves ◽

Long Term Outcome ◽

Radiographic Findings ◽

Bone Lysis

Objectives (1) To develop an evaluation grid to provide a systematic interpretation of calves' articular radiographs, (2) to describe radiographic lesions of septic arthritis in dairy calves less than 6 months of age, (3) to investigate potential associations between demographic data or synovial bacteriological culture results and radiographic lesions (4) to determine whether an association is present between radiographic lesions, their severity and the long-term outcome. Methods Medical records of 54 calves less than 180 days old treated for septic arthritis between 2009 and 2014 with radiographic images performed in the first 2 days after admission were reviewed. Results Most common radiographic findings were increased articular joint space height (n = 49), irregularity of the articular surfaces (n = 24) and subchondral bone lysis (n = 24). The number of lesions observed and their severity were associated with older calves (p = 0.02), increased time between onset of clinical signs and admission (p = 0.0001) and the culture of Trueperella pyogenes within the joint (p = 0.02). The radiographic lesions associated with negative long-term prognosis were reduction in the joint space height (p = 0.01) and subchondral bone lysis on weight-bearing surfaces (p = 0.02). Clinical Significance An evaluation grid designed for veterinarians can facilitate systematic reading of articular radiographs and can be used for dairy calves with a presumptive diagnosis of septic arthritis. This diagnostic tool may aid in establishing a prognosis and decision-making process in terms of treatment.

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Intra-articular Placement of an Intraosseous Catheter

Prehospital and Disaster Medicine ◽

10.1017/s1049023x14001290 ◽

2014 ◽

Vol 30 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Zachary Grabel ◽

J. Mason DePasse ◽

Craig R. Lareau ◽

Christopher T. Born ◽

Alan H. Daniels

Keyword(s):

Emergency Medicine ◽

Case Report ◽

Knee Joint ◽

Septic Arthritis ◽

Vascular Access ◽

Critically Ill Patients ◽

Joint Space ◽

Potential Complication ◽

Publication Type ◽

Line Placement

AbstractGaining vascular access is essential in the resuscitation of critically ill patients. Intraosseous (IO) placement is a fundamentally important alternative to intravenous (IV) access in conditions where IV access delays resuscitation or is not possible. This case report presents a previously unreported example of prehospital misplacement of an IO catheter into the intra-articular space of the knee joint. This report serves to inform civilian and military first responders, as well as emergency medicine physicians, of intra-articular IO line placement as a potential complication of IO vascular access. Infusion of large amounts of fluid into the joint space could damage the joint and be catastrophic to a patient who needs immediate IV fluids or medications. In addition, intra-articular IO placement could result in septic arthritis of the knee.GrabelZ, DePasseJM, LareauCR, BornCT, DanielsAH. Intra-articular placement of an intraosseous catheter. Prehosp Disaster Med. 2015;30(1):1-4.

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Case report: A rare progression of Necrotising Otitis Externa resulting in septic arthritis of the TMJ, a pressing matter

Advances in Oral and Maxillofacial Surgery ◽

10.1016/j.adoms.2021.100060 ◽

2021 ◽

Vol 2 ◽

pp. 100060

Author(s):

Daanesh Zakai ◽

Ravir Singh Bhatti ◽

Daya Singh Gahir ◽

Richard Gareth Rowlands ◽

Jooly Joseph

Keyword(s):

Case Report ◽

Septic Arthritis ◽

Otitis Externa

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Septic arthritis caused by Desulfovibrio desulfuricans: A case report and review of the literature

Anaerobe ◽

10.1016/j.anaerobe.2021.102407 ◽

2021 ◽

pp. 102407

Author(s):

Timothy J. Marquis ◽

Vincent J. Williams ◽

David B. Banach

Keyword(s):

Case Report ◽

Septic Arthritis ◽

Desulfovibrio Desulfuricans ◽

Review Of The Literature

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High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: the MOST study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.099531 ◽

2009 ◽

Vol 69 (01) ◽

pp. 163-168 ◽

Cited By ~ 68

Author(s):

M C Nevitt ◽

Y Zhang ◽

M K Javaid ◽

T Neogi ◽

J R Curtis ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Joint Space Narrowing ◽

Weight Bearing ◽

Joint Space ◽

Whole Body ◽

Mineral Density ◽

Knee Oa ◽

Increased Risk

Objectives:Previous studies suggest that high systemic bone mineral density (BMD) is associated with incident knee osteoarthritis (OA) defined by osteophytes but not with joint space narrowing (JSN), and are inconsistent regarding BMD and progression of existing OA. The association of BMD with incident and progressive tibiofemoral OA was tested in a large prospective study of men and women aged 50–79 years with or at risk for knee OA.Methods:Baseline and 30-month weight-bearing posteroanterior and lateral knee radiographs were scored for Kellgren-Lawrence (K-L) grade, JSN and osteophytes. Incident OA was defined as the development of K-L grade ⩾2 at follow-up. All knees were classified for increases in grade of JSN and osteophytes from baseline. The association of gender-specific quartiles of baseline BMD with risk of incident and progressive OA was analysed using logistic regression, adjusting for covariates.Results:The mean (SD) age of 1754 subjects was 63.2 (7.8) years and body mass index was 29.9 (5.4) kg/m2. In knees without baseline OA, higher femoral neck and whole body BMD were associated with an increased risk of incident OA and increases in grade of JSN and osteophytes (p<0.01 for trends); adjusted odds were 2.3–2.9-fold greater in the highest compared with the lowest BMD quartiles. In knees with existing OA, progression was not significantly related to BMD.Conclusions:In knees without OA, higher systemic BMD was associated with a greater risk of the onset of JSN and K-L grade ⩾2. The role of systemic BMD in early knee OA pathogenesis warrants further investigation.

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