Case Report of a Rare Cause of Reactive Arthritis: Leptospirosis.

INTRODUCTION: Leptospirosis is a zoonosis caused by infection with pathogenic Leptospira species. Leptospirosis has protean manifestations and rare, unusual presentations should be kept in mind in relevant epidemiological scenario. Reactive arthritis refers to acute non-purulent arthritis complicating an infection elsewhere in the body. It is attributed to an immune activation following certain infections; it is, therefore considered as aseptic arthritis. Very few case reports are available attributing leptospirosis as an established cause of reactive arthritis. We present a case of reactive arthritis of the hip joint due to leptospirosis. CASE REPORT: Here, we present a case of a 12-years- old female child who was admitted to our hospital with complaints of fever, headache, and pain in the right hip joint since past 5 days from admission. Subsequent elaboration revealed a past history of fever, headache, and myalgia for around 5-7 days around a week before the present complaints. There was rat infestation near her house and her father was working as sewage cleaner. Routine investigations, Ultrasonography (USG), Magnetic Resonance Imaging (MRI) of both hips and subsequently, diagnostic hip aspiration was performed. USG revealed synovitis, MRI revealed hip joint arthritis of infective or inflammatory origin. Diagnostic hip aspiration was negative for any microorganism. On 10th day of admission, patient started developing icterus with yellowish discolouration of urine. Patient was evaluated for the cause of jaundice. Screening for Leptospira was positive. Synovial biopsy of hip was performed, which showed inflammation with no specific pathology and no growth of any microorganism. In addition, Leptospira IgM MAC ELISA was done which was positive. Patient was thus confirmed to be having leptospirosis and reactive arthritis as a consequence of it. CONCLUSION: The presentation of reactive arthritis secondary to leptospirosis is rare. Leptospirosis can be an etiological factor for reactive arthritis, especially if reactive arthritis is complicated with jaundice.

Treatment of infected non-unions with segmental defects with a rail fixation system.

We conducted this study to evaluate the use of rail fixation system in infected gap non-union of femur and tibia as an alternative to the established Ilizarov circular fixator technique. Prospective study. The study was done in the Department of Orthopaedic surgery in a medical school and level I trauma center to which the authors are/were affiliated. Between June 2010 and June 2015, 40 patients with infected gap non-union of femur and tibia were treated with the rail fixation system. Patients who were willing to undergo surgery and participate in the post-operative rehabilitation were included in the study. After radical debridement, the system was applied and corticotomy done. For closure of bone gap, acute docking and distraction was done in 18 cases and segmental bone transport in 22 cases. Early mobilization of patient was done along with aggressive physiotherapy. Bone and functional results were calculated according to ASAMI scoring system, and complications were classified according to Paley classification. The mean follow-up period was 22.56 months (range 8-44). Bone union with eradication of infection was achieved in all but 1 case (97.5%). Bone results were excellent in 57.5%, good 40%, fair 0% and poor in 2.5% cases, while functional result was excellent in 32.5%, good 65%, fair 0% and poor in 2.5% cases. The rail fixation system is an excellent alternative method to treat infected gap non-union of femur and tibia. It is simple, easy to use and patient-friendly.

Kienbock's Disease treated with Interposition Arthroplasty using Ipsilateral Palmaris Longus Tendon and Muscle Belly.

INTRODUCTION: Kienbock's disease is an osteonecrosis of lunate bone (lunatomalacia) seen more commonly in males in the second to fourth decade of life. The exact etiology is unknown and symptoms include wrist pain and stiffness of wrist. Advanced stages of disease may require lunate excision and filling of the void by various substitutes like silicone implants, tendon grafts etc. We report a case of Kienbock's disease with lunate excision and filling of defect by coiled palmaris longus muscle and tendon unit. CASE REPORT: An 18 year old male student presented with progressive wrist pain and difficulty in wrist movements. Investigations revealed a diagnosis of grade 4 Kienbock's disease. Lunate excision by a palmar approach followed by interposition arthroplasty with ipsilateral coiled Palmaris longus muscle belly along with the tendon was done under regional anaesthesia. Nine months post-operatively patient is pain free and wrist movements are full and free. CONCLUSION: In advanced stages of Keinbock's disease lunate excision surgery is recommended. Post excision void can be filled with coiled Palmaris longus tendon-muscle unit together to increase the volume of the graft. This achieves snug fit, avoids the need of internal fixation, and also prevent carpal collapse. Our case shows good clinical outcome in short term with no carpal collapse by use of this procedure.