Radiological assessment of irreducible posterolateral knee subluxation after dislocation due to interposition of the vastus medialis: a case report.

Knee dislocation is a serious and relatively uncommon traumatism that every emergency room is supposed to diagnose and treat rapidly. Most of the time these dislocations reduce spontaneously or with closed reduction. If a subluxation persists, an incarceration of soft tissue in the joint must be suspected. Irreducible knee subluxations after dislocation are rare entities better described in the orthopaedic than in the radiological literature. However, the initial radiological assessment is an important tool to obtain the correct diagnosis, to detect neurovascular complications, and to plan the most suitable treatment. In cases of delayed diagnosis, the functional prognosis of the joint and even the limb may be seriously compromised primarily because of vascular lesions. Thereby, vascular imaging is essential in cases of dislocation of the knee, and we will discuss the role of angiography and the more recent use of computed tomography angiography or magnetic resonance angiography. Our patient presented with an irreducible knee subluxation due to interposition of the vastus medialis, and we will review the classical clinical presentation and 'do not miss' imaging findings on conventional radiography, computed tomography angiography, and magnetic resonance imaging. Finally, we will also report the classical imaging pathway indicated in knee dislocation, with a special emphasis on the irreducible form.

[The infected diabetic foot: diagnosis and management]. / Pied diabétique infecté: du diagnostic a la prise en charge.

Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management.

Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

PURPOSE: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. METHODS: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. RESULTS: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of ten days. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was three days and the median delay between trauma and surgery was one day. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. CONCLUSION: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.

[Lower limb amputation: indication, preoperative workup and complications]. / Amputations du membre inférieur: indications, bitan et complications.

The main causes of lower limb amputations are peripheral artery disease (92% of the cases) and trauma (7%). The selection of the amputation level aims at optimizing the chances of healing and the functionality of the involved limb. Foot preserving amputations offer the best functional outcome but the healing process is frequently slow and difficult. After a below-knee amputation, 60% of the patients are capable of ambulating again, whereas only 20% of the patients undergoing an above-knee amputation ambulate autonomously. Complications after amputations are frequent, can occur a long time after surgery and must be managed by a highly specialized team.

Is there a significant seasonality in the occurrence of osteoarticular infections?

Clinical experience suggests fluctuation in the occurrence of osteoarticular infections. We performed a single-centre study during 2004-2012, dividing each year into the four seasons according to the Gregorian calendar. A total of 455 episodes of osteoarticular infections were retrieved. There were 91 prosthetic joint infections (45 of haematogenous origin) and 159 cases of septic arthritis. The median period between early symptoms and diagnosis of infection was 27 days. The overall number of infections per season, cumulated over the 8-year study period, was 119 in spring, 129 in summer, 95 in fall, and 112 in winter, which did not reflect any significant seasonal fluctuation. None of the different subgroups of infections, namely arthroplasties (p for trend = 0.755), haematogenous arthroplasty infections (p = 0.493), gram-negative episodes or arthritis (p = 0.290), showed any season-related fluctuation. We conclude that osteoarticular infections, including haematogenous prosthetic joint infections, do not show any significant seasonality.