Tuberculous arthritis of the knee with Staphylococcus superinfection.

We describe a case of septic arthritis of the knee in which the diagnosis of tuberculosis was masked by an initial culture growth of Staphylococcus aureus. This led to a delay in diagnosis and an adverse outcome. In the appropriate clinical setting, we suggest that the index of suspicion for skeletal tuberculosis be raised in developed countries in order to avoid diagnostic delay, by requesting cultures for acid-fast bacilli and synovial biopsies at arthroscopy. Moreover, antituberculosis therapy should be started whilst awaiting the results of culture if the clinical history and biopsies are strongly suggestive of the diagnosis.

Local bone mineral response to brief exercise that stresses the skeleton.

OBJECTIVE: To compare grip strength and bone mineral content in the forearm in women and to test the effects on bone mineral content of short periods of exercise that stresses the skeleton. DESIGN: Assessment of both wrists in 69 volunteers and of the non-fractured wrist in 30 patients followed by an exercise regimen entailing squeezing a tennis ball as hard as possible for 30 seconds each day for six weeks. SETTING: Old people's homes and outpatient departments of Hammersmith and Northampton general hospitals. PATIENTS: 99 Women, of whom 69 were volunteers and 30 had a fractured forearm. MAIN OUTCOME MEASURE: Grip strength and bone mineral content after six weeks and at six months after the exercises had stopped. RESULTS: The bone mineral content of the women's forearms was measured with a densitometer and the grip strength with a semi-inflated bag connected to an anaeroid barometer. Measurements before exercise showed that the two variables correlated closely, irrespective of age, and that there were significant differences in both between the dominant and non-dominant arms of the volunteers. After six weeks of exercise there was a mean increase in grip strength of 14.5% (95% confidence interval 9.9 to 19.2%) and in bone mineral content of 3.4% (1.4 to 5.3%) in the stressed forearms of the 77 women who attended for examination. After six months without exercise the improvements in the 33 women who attended for follow up had reversed. Women who had had a fractured forearm (n = 13), however, had continued to gain grip strength and bone mineral content in the arm that had not been injured. CONCLUSIONS: Grip strength in the forearm is a good indicator of bone mineral content. Both variables may be increased by brief periods of stressful exercise. If this principle can be applied to the whole skeleton it may provide a means of reversing osteoporosis.

Radiolucent plastic in gunshot wounds.

We present two patients who suffered a total of three close-range gunshot wounds. In each injury plastic shot-retaining wadding had been carried deep into the tissues but this was not apparent on the initial radiographs. The presence of such plastic wadding must be considered in all such wounds.

Load cell analysis following silastic arthroplasty of the hallux.

The first metatarsophalangeal joint was replaced by a flexible silastic hinge prosthesis in 33 joints of 25 patients. Most patients were pleased with the operation but one third had some discomfort under the second and third metatarsal heads. We used a computer linked load cell matrix to analyse the forces under these feet during normal walking. After silastic arthroplasty there was a rise of 65% in peak load under the second and third metatarsal heads compared with that found in the opposite feet which had not undergone operation (P less than 0.001). This was associated with a fall in peak load under the hallux of 43% (P less than 0.03) compared to normal and a less significant fall averaging 23% in the peak pressure experienced under the first metatarsal head. There was a rise in peak heel loading and a reduction in the normal pronation which occurs during the stance phase of walking.

Anterior interosseous nerve palsy and dislocation of the elbow.

A case is presented of an isolated anterior interosseous nerve palsy following posterior dislocation of the elbow. This has not previously been described. Full recovery occurred without operation. We have reviewed the literature and suggest a mechanism for this injury. The classification and treatment of the condition are discussed.