Contaminated osteochondral plugs: effect of different sterilizing solutions: an experimental study in the rabbit.

BACKGROUND: To determine the efficacy of different antiseptic solutions (Control group (I), Antibiotic solution (II), Chlorhexidine 0.4% (III), and povidone - iodine 10% (IV)) in sterilizing contaminated osteochondral plugs. METHODS: Under sterile conditions, the femoral head and condyles of 20 rabbits were removed and cut into equal osteochondral pieces. A total of 200 osteochondral specimens were obtained. All 200 specimens were dropped on the operating room floor for fifteen seconds and assigned to one of four experimental groups. Group I samples were cultured after washing with normal saline solution (Control group). In other three groups, prior to culturing process, samples were placed in an antibiotic solution after washing with normal saline (Neomycin & Polymyxin) (group II), Chlorhexidine 0.4% (group III), and povidone - iodine 10% (group IV), respectively. RESULTS: In group I, 25 of 50 specimens had positive cultures. Of 50 specimens of group II, III and IV, no positive cultures were found after 10 days. CONCLUSION: All three agents including antibiotic solution, povidone-iodine 10% and chlorhexidine 0.4% seem effective in sterilizing the contaminated osteochondral samples. According to the literature, povidone-iodine has no negative effect on the cartilage metabolism and seems to be a proper choice of decontaminating solution for osteochondral plugs.To the best of the authors' knowledge, such a study on the contaminated osteochondral specimen has not been previously reported in the literature.

Effect of three different sterilizing solutions on the contaminated bone: an experimental study in the rabbit.

BACKGROUND: To determine the efficacy of three different antiseptic solutions (Control group (I), Antibiotic solution - Neomycin and polymyxin (II), Chlorhexidine 0.4% (III), and povidone - iodine 10% (IV)) in disinfecting contaminated bone fragments. METHODS: Under sterile conditions, the femora of 12 rabbits were removed and cut into six millimeter pieces. A total of 200 bone specimens were obtained. All 200 specimens were dropped on the operating room floor for fifteen seconds and assigned to one of four experimental groups. Group I samples were cultured after immersion in normal saline solution (Control group). In other three groups, prior to culture the samples, they were washed with normal saline for ninety seconds and placed in an antibiotic solution (Neomycin & Polymyxin) (group II), Chlorhexidine 0.4% (group III), and povidone-iodine 10% (group IV) respectively. RESULTS: In group I, 22 of 50 specimens had positive cultures. Of 50 specimens of group II and IV, positive cultures were found in 3 and 2 grafts respectively after 10 days whereas no positive cultures were detected in any samples of group III. CONCLUSION: Chlorhexidine 0.4% seems to be the best antiseptic solution for discontaminating the contaminated bone samples although it did not have any significant difference with povidone-iodine and other antibiotic solution.

Comparison of Pediatric and General Orthopedic Surgeons' Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus.

Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher's exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist's report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.

Multifocal tuberculosis of long bones in an immunocompetent child.

Although tuberculosis (TB) is prevalent in many parts of the world, multifocal TB involvement of bones is rare. It is believed that less than 5% of skeletal TB is multifocal. We report a case of multifocal TB of long bones in an immunocompetent child. We describe the radiological and diagnostic features of TB osteomyelitis and outline its therapy and prognosis. To the best of the authors' knowledge, such a case with multiple long bone involvement without articular sequel and visceral involvement/constitutional symptoms has not been reported previously in the literature.

Modified Ponseti method of treatment for correction of neglected clubfoot in older children and adolescents--a preliminary report.

Congenital talipes equinovarus may be the most common congenital orthopedic condition requiring treatment. Nonoperative treatment including different methods is generally accepted as the first step in the deformity correction. Ignacio Ponseti introduced his nonsurgical approach to the treatment of clubfoot in the early 1940s. The method is reportedly successful in treating clubfoot in patients up to 9 years of age. However, whether age at the beginning of treatment affects the rate of effective correction and relapse is unknown. We have applied the Ponseti method successfully with some modifications for 11 patients with a mean age of 11.2 years (range, 6 to 19 years) with neglected and untreated clubbed feet. The mean follow-up was 15 months (12 to 36 months). Correction was achieved with a mean of nine casts (six to 13). Clinically, 17 out of 18 feet (94.4%) were considered to achieve a good result with no need for further surgery. The application of this method of treatment is very simple and also cheap in developing countries with limited financial and social resources for health service. To the best of the authors' knowledge, such a modified method as a correction method for clubfoot in older children and adolescents has not been applied previously for neglected clubfeet in older children in the literature.

Giant Solitary Synovial Chondromatosis Mimicking Chondrosarcoma: Report of a Rare Histologic Presentation and Literature Review.

Synovial chondromatosis is a benign lesion of the synovium, and giant solitary synovial chondromatosis (GSSCM) is a rare presentation of it. In this article, we describe clinical, imaging, and pathologic features of a hip GSSCM with an unusual histologic presentation.

Fulminant spread of a femur anaerobic osteomyelitis to abdomen in a 17-year-old boy.

To our knowledge, distant spread of infection in anaerobic osteomyelitis has not been described before. In this article, we report a case of anaerobic osteomyelitis of femur with fulminant spread of infection to the abdomen in a 17-year-old boy with no predisposing medical factors and minimal bone involvement.

An unusual location of ossified intramuscular lipoma: a case report.

Lipoma is the most common soft tissue tumor but the presence of osseous component within the tumor is quite rare. Some studies show that less than 1% of lipomas were ossified. We describe the histological, radiological and diagnostic features of an ossified intramuscular lipoma. To the best of the authors' knowledge, a symptomatic ossified intramuscular lipoma without any cortical erosion and hyperostosis has not been previously reported in the literature.