Should scintigraphy be completely excluded from the diagnosis of periprosthetic joint infection?

AIM: To analyse the diagnostic performance of bone and leukocyte scintigraphy for periprosthetic joint infection before excluding the test from routine practice, and to analyse the possible benefit of bone marrow scintigraphy in inconclusive cases. MATERIALS AND METHODS: From 2012 to 2018, all patients with a total hip or knee arthroplasty who had a bone and leukocyte scintigraphy performed and underwent revision surgery were included. Bone marrow scintigraphy was indicated only in cases in which bone and leukocyte scintigraphy were inconclusive. Diagnosis of periprosthetic joint infection was confirmed by positive intraoperative cultures after revision surgery. RESULTS: A total of 105 patients were included. Eighteen patients had total hip arthroplasties (18.1%) and 86 had total knee arthroplasties (81.9%). Mean age was 74 years. Nineteen cases were diagnosed with a periprosthetic joint infection. Bone and leukocyte scintigraphy had 64% sensitivity and 97% specificity. Bone marrow scintigraphy increased sensitivity and specificity to 88% and 100%, respectively. CONCLUSION: Bone and leukocyte scintigraphy possesses high sensitivity and specificity for the diagnosis of chronic periprosthetic joint infection. The additional use of bone marrow scintigraphy significantly increases diagnostic performance. For these reasons, bone scintigraphy is reserved for inconclusive cases of chronic periprosthetic joint infection.

Double plating as treatment for supracondylar humeral fractures. / Tratamiento de fracturas supracondíleas de húmero mediante osteosíntesis con doble placa.

INTRODUCTION AND OBJECTIVES: Supracondylar humeral fractures represent only about 0.5-1% of all fractures in adults. The objective of this study is to evaluate functional outcome and quality of life in patients treated with open reduction and internal fixation using double plates. MATERIAL AND METHODS: We designed a retrospective descriptive study including 27 supracondylar humeral fractures treated with open reduction and internal fixation using two anatomic plates from January 2005 to September 2012. Mean age was 56 ± 22.9 years including 14 female and 13 male. All fractures were classified using the AO classification. Average follow-up was of 41 ± 23.9 months. Fracture union was evaluated with x-ray exams and functional outcome using the Mayo Elbow Performance Score (MEPS). Quality of life was evaluated using the Short Form-36 survey. RESULTS: Union at 6 months was achieved in 96% of all fractures. Average range of motion was 102° (70°-140°) and average MEPS 86 points (60-100). Mean score on SF-36 was 54.87 (8.66-89.22) the older patients had lower scores. Sixty percent of patients (15 of 25) were able to return to previous activity. No infection was reported. Two patients required surgical treatment due to a stiff elbow. CONCLUSIONS: Open reduction and internal fixation using double plates in supracondylar humeral fractures obtains a high union rate allowing excellent functional and radiological outcomes.