Pharmacokinetics in plasma and alveolar regions of a healthy calf intramuscularly administered a single dose of orbifloxacin.

This study analyzed the pharmacokinetics of orbifloxacin (OBFX) in plasma, and its migration and retention in epithelial lining fluid (ELF) and alveolar cells within the bronchoalveolar lavage fluid (BALF). Four healthy calves received a single dose of OBFX (5.0 mg/kg) intramuscularly. Post-administration OBFX dynamics were in accordance with a non-compartment model, including the absorption phase. The maximum concentration (Cmax) of plasma OBFX was 2.2 ± 0.1 µg/ml at 2.3 ± 0.5 hr post administration and gradually decreased to 0.3 ± 0.2 µg/ml at 24 hr following administration. The Cmax of ELF OBFX was 9.3 ± 0.4 µg/ml at 3.0 ± 2.0 hr post administration and gradually decreased to 1.2 ± 0.1 µg/ml at 24 hr following administration. The Cmax of alveolar cells OBFX was 9.3 ± 2.9 µg/ml at 4.0 hr post administration and gradually decreased to 1.1 ± 0.2 µg/ml at 24 hr following administration. The half-life of OBFX in plasma, ELF, and alveolar cells were 6.9 ± 2.2, 7.0 ± 0.6, and 7.8 ± 1.6 hr, respectively. The Cmax and the area under the concentration-time curve for 0-24 hr with OBFX were significantly higher in ELF and alveolar cells than in plasma (P<0.05). These results suggest that OBFX is distributed and retained at high concentrations in ELF and alveolar cells at 24 hr following administration. Hence, a single intramuscular dose of OBFX (5.0 mg/kg) may be an effective therapeutic agent against pneumonia.

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures.

Surgical treatment for humeral shaft fractures has been reported to yield satisfactory results; however, there may be complications, such as delayed bone union, nonunion, iatrogenic radial nerve injury, and infection. The risk factors for postoperative complications remain largely unknown. This study aimed to investigate the influence of timing of surgery on the incidence of postoperative complications of acute humeral shaft fractures. We retrospectively reviewed 43 patients who underwent osteosynthesis for acute humeral shaft fractures between 2006 and 2020. The patients were divided into early (21 patients) and delayed (22 patients) treatment groups based on the timing of the surgical intervention (within or after four days). Outcomes were the incidences of complications (delayed union, nonunion, iatrogenic radial nerve injury, and infection) and postoperative fracture gaps. We evaluated the outcomes using plain radiographs and clinical notes. In addition, we performed subgroup analyses on outcomes in a subgroup of patients who underwent intramedullary nailing and one who underwent plate fixation. The frequency of delayed union was significantly higher in the delayed group (P=0.046), and the postoperative fracture gap size was also significantly greater in the delayed group (P=0.007). The subgroup analyses demonstrated a significant association between the increased incidence of delayed union and delayed surgical interventions only in the intramedullary nailing subgroup (P=0.017). This study suggests that performing surgery within four days after acute humeral shaft fracture is recommended to reduce the occurrence of delayed union, particularly in cases requiring intramedullary nailing fixation.

Surgical Repair Using Suture Bridge Technique for Triceps Tendon Avulsion.

Triceps tendon avulsion is a rarely occurring tendinous injury. Various surgical procedures, such as repair using sutures through the transosseous tunnel or suture anchors, have been reported for treating triceps tendon avulsion. However, standard surgical treatment has not yet been established. Here, we present a case of triceps tendon avulsion treated using the suture bridge technique. A 58-year-old man who fell on his left elbow from standing height presented to our hospital. Plain radiography revealed an avulsion fracture of the left olecranon process, suggesting triceps tendon avulsion. We performed surgical repair of the avulsed bone fragments and ruptured triceps tendon. We inserted suture anchors into the ulna, proximal to the fracture site, and passed the sutures through the full thickness of the triceps. Subsequently, fracture fragments were reduced and fixed by pulling them together with the triceps. We inserted knotless anchors into the ulna distal to the fracture site and fixed the avulsed bone fragments and triceps tendon using the suture bridge technique. The patient recovered well in five months and reported no elbow pain or limited range of motion. This suture bridge technique is advantageous as it prevents iatrogenic fracture and knot irritation, and it would be indicated in cases with poor bone quality or thin skin soft tissue of the olecranon.

Risk factors for failure of reduction of anterior glenohumeral dislocation without sedation.

BACKGROUND: Although anterior glenohumeral dislocations are common, the reduction procedure is often difficult, requiring sedation or anesthesia. To date, the risk factors for reduction failure without sedation have not been fully investigated. This study aimed to clarify the predictive factors that render the reduction of anterior glenohumeral dislocation without sedation difficult by use of multivariate analyses. METHODS: We retrospectively reviewed 156 patients who underwent attempted reduction of anterior glenohumeral dislocation between 2006 and 2019. Patients were included based on the following criteria: traumatic dislocation, undergoing attempted reduction using the traction-countertraction method, and acute dislocation in which reduction was attempted within 2 days of the injury. The dependent variable was set as an irreducible glenohumeral dislocation without sedation, which was defined as a reduction failure in this study. Explanatory variables included age, sex, side of injury, recurrent dislocation, axillary nerve injury, time from dislocation to attempted reduction, greater tuberosity fracture, humeral neck fracture, glenoid rim fracture, and glenohumeral osteoarthritis. We evaluated these outcomes from radiographs and clinical notes. Univariate and multivariate analyses were performed. Baseline variables, which were observed to be significant in the univariate analysis, were included in multivariate models, which used logistic regression to identify independent predictors of reduction failure. RESULTS: Of the 156 patients, 25 (16.0%) experienced reduction failure. Multivariate analyses showed that older age (≥55 years) (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-10.4; P = .036), greater tuberosity fractures (OR, 3.6; 95% CI, 1.1-12.2; P = .033), and glenoid rim fractures (OR, 11.5; 95% CI, 1.5-87.7; P = .018) were risk factors for reduction failure. CONCLUSIONS: Our results demonstrated that multiple factors were associated with unsuccessful reduction of anterior glenohumeral dislocation without sedation. In elderly patients or patients with concurrent greater tuberosity fractures and glenoid rim fractures, reduction failure could occur in the absence of sedation; thus, the administration of sedatives or anesthesia should be considered.

Early surgery for limb preservation in Group A Streptococcus-induced necrotizing soft tissue infection and subsequent soft tissue infection: A case report.

BACKGROUND: Group A Streptococcus pyogenes (GAS) causes necrotizing soft tissue infections (NSTIs) necessitating exploration, surgical debridement, and possibly limb amputation. CASE PRESENTATION: A 45-year-old man presented with traumatic injury of the left carpal region, vomiting, and diarrhea. The swelling and pain in the left forearm worsened with sensorimotor deficits, and his skin color deteriorated. Emergent exploration was performed for limb preservation; GAS was detected in an exudate, and debridement was performed on postoperative day 2 for streptococcal toxic shock syndrome. He recovered uneventfully and was discharged; however, he returned after 2 months with GAS-induced STI at the same site and received antimicrobial treatment. CONCLUSION: Exploration and subsequent debridement are crucial for effective treatment of NSTI.

Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases.

BACKGROUND: Plate fixation is an established method for treating unstable distal clavicle fractures. However, the appropriate timing of surgery for acute distal clavicle fractures remains unclear. The present study aimed to evaluate the clinical outcomes of osteosynthesis using a Scorpion plate and to assess the influence of surgery timing on the surgical outcomes for acute unstable distal clavicle fractures. METHODS: We retrospectively reviewed 105 patients who underwent fixation for acute unstable distal clavicle fractures (Neer type II and V) using the Scorpion plate between 2008 and 2018. Patients were divided into early (45 patients) and delayed (60 patients) treatment groups based on the timing of the surgical intervention (within or after 7 days). The outcomes were postoperative complications (nonunion, peri-implant fracture, plate loosening, plate-related pain, and stiffness). We evaluated the outcomes from X-ray radiographs and clinical notes. RESULTS: Among the 105 patients, nonunion, plate loosening, plate-related pain, and stiffness were observed in six patients (5.7%), four patients (3.8%), seven patients (6.7%), and one patient (1.0%), respectively. The nonunion rate was significantly higher in the delayed treatment group than that in the early treatment group (P = 0.036). Although the difference was not significant, plate loosening and stiffness were only observed in the delayed treatment group. CONCLUSION: Our results demonstrated that osteosynthesis using Scorpion plates achieved satisfactory surgical outcomes for unstable distal clavicle fractures. In addition, this study suggested that performing surgery within 6 days after injury is recommended to reduce postoperative complications.

Acute progressive bilateral carpal tunnel syndrome associated with remitting seronegative symmetrical synovitis with pitting edema syndrome: A case report.

The association between carpal tunnel syndrome (CTS) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, an elderly onset rheumatic disease, is not fully understood. Here, we describe a case of acute CTS caused by RS3PE syndrome. An 84-year-old man visited the hospital with sudden onset of severe neuralgia in the median nerve and pitting edema in both hands. Computed tomography showed low-density areas around the flexor tendons and median nerve compression in the carpal tunnel. Rapidly progressing intolerable neuralgia and paralysis required urgent carpal tunnel release in the left hand. After surgery, we considered the possibility of RS3PE syndrome and started the administration of prednisolone. The pitting edema and neuralgia improved. In this case, imaging and intraoperative findings suggest that the effusion generated from flexor tenosynovitis associated with RS3PE syndrome increased the internal pressure in the carpal tunnel rapidly, which led to acute CTS and urgent surgery.

Clavicle fracture at the suture hole after acromioclavicular joint reconstruction using a suture-button: a case report.

BACKGROUND: Intraosseous suture-button devices have been used for acromioclavicular joint reconstruction due to its relative simplicity compared with other procedures. However, the complications of acromioclavicular joint reconstruction using a suture-button are not fully understood. Here, we describe a case of a clavicle fracture at the suture hole following acromioclavicular joint reconstruction using a suture-button and hook plate. CASE PRESENTATION: A 28-year-old man presented at our hospital after a fall from his bicycle. The patient had a history of acromioclavicular joint reconstruction with a suture-button and a hook plate for right acromioclavicular joint dislocation, seven months ago at another hospital. The hook plate had been removed four months ago, while X-ray radiography before removal had shown the widening of a suture hole. In the current fall from the bicycle, X-ray radiography revealed a clavicle fracture through the previous drill hole for suture-button. We removed the suture-button and performed an open reduction and internal fixation for the clavicle fracture. CONCLUSION: The present case indicated that a clavicle fracture at the suture hole, although rare, is one of the complications after an acromioclavicular joint reconstruction using a suture-button. This case suggested that drilling to the necessary minimum when making suture holes and paying attention to the widening of suture holes are important to prevent a postoperative clavicle fracture.