Fast treatment of anterior shoulder dislocations with two sedation-free methods: The Davos self-reduction method and Arlt method.

Background: Various reduction techniques exist to treat traumatic shoulder dislocation, but best management remains unclear. Aims: To investigate the reduction rate of traumatic anteroinferior shoulder dislocations using two sedation-free techniques and success rates of subgroups. Methods: A single-center study was performed analysing shoulder dislocations in a two-year period. Adult patients with anteroinferior shoulder dislocation were included. Two sedation-free reduction techniques were used: the Davos self-reduction technique and the Arlt-chair technique. Two attempts were performed before sedation. All patients gave informed consent to study participation. Results: The investigated 106 patients (106 shoulder dislocations) had a mean age of 48 ± 18 years (74% male patients). The majority occurred during winter sports (76%). The overall success rate for both sedation-free reduction techniques was 82% (87 reduced shoulders, two attempts). A significantly increased success rate was found in patients without greater tuberosity fracture (86% without vs. 68% with fracture, p = 0.002) and for patients with repeated dislocation (93% vs. 80% for primary dislocation, p = 0.004). Time for reduction was 5 minutes (Davos technique) and 1 minute (Arlt-chair-technique). Associated injuries were mostly Hill Sachs lesions (78%). There was no major complication and no new-onset sensory deficit. Conclusion: Davos and Arlt reduction techniques allowed sedation-free and fast treatment for anteroinferior shoulder dislocation during winter sports.

Joint fluid concentrations of amphotericin B after local application with calcium sulphate-report of 2 cases.

Fungal periprosthetic joint infections (PJI) are difficult to treat, due to important biofilm formation and limited local penetration of systemically administered antifungals. Calcium sulphate (CaSO4 ) might be a promising carrier to increase local concentration of antifungals. We hypothesized that local amphotericin B release from CaSO4 is high enough to significantly contribute to treatment of fungal PJI. We report joint fluid and serum concentrations of amphotericin B after local application with CaSO4 as an implanted resorbable carrier material as adjunct to standard surgical and systemic antifungal treatment in two cases of PJI with Candida spp. Maximal joint fluid amphotericin B concentration was 14.01 mg/L 5 days after the second local administration of liposomal amphotericin in Case One and 25.77 mg/L 14 days after the second local administration in Case Two. Concentrations higher than minimal inhibitory concentrations (MIC) could be measured for 21 days and 17 days after local administration in Case One and Two, respectively. In Case Two, serum concentration of amphotericin B was <0.01 mg/L 3 days after local administration of 450 mg liposomal amphotericin B. No local or systemic adverse reaction was observed. Fungal PJI was successfully eradicated in both cases with a follow-up of 12 months in Case One and 20 months in Case Two. Application of amphotericin B-loaded CaSO4 was associated with joint fluid concentrations higher than minimal inhibitory concentrations for Candida spp. for approximately 3 weeks, with the advantage that the carrier material dissolves spontaneously and does not require secondary removal. Relapse of fungal infections did not occur in these two patients.

Reconstruction of the Anterior Acetabular Wall to Repair Symptomatic Defects Consecutive to Cup Malpositioning at Total Hip Arthroplasty.

Iliopsoas impingement (IPI) causes persistent groin pain and functional impairment after total hip arthroplasty (THA). It is caused most often by an overhang of the cup. Psoas tenotomy may successfully treat IPI in overhangs <8 mm. Cup revision usually is recommended for larger overhangs. Muscle sparing reconstruction of the anterior acetabular wall may be an alternative when malposition of the cup at THA caused a bony defect that would persist after simple cup revision. The surgical technique and results from one patient are presented. The patient rapidly became asymptomatic and remained pain free at 2-year follow-up. Any bone substance defect of the acetabulum should be considered when evaluating treatment options for IPI after THA.

Sex and age-related differences in performance in a 24-hour ultra-cycling draft-legal event - a cross-sectional data analysis.

BACKGROUND: The purpose of this study was to examine the sex and age-related differences in performance in a draft-legal ultra-cycling event. METHODS: Age-related changes in performance across years were investigated in the 24-hour draft-legal cycling event held in Schötz, Switzerland, between 2000 and 2011 using multi-level regression analyses including age, repeated participation and environmental temperatures as co-variables. RESULTS: For all finishers, the age of peak cycling performance decreased significantly (ß = -0.273, p = 0.036) from 38 ± 10 to 35 ± 6 years in females but remained unchanged (ß = -0.035, p = 0.906) at 41.0 ± 10.3 years in males. For the annual fastest females and males, the age of peak cycling performance remained unchanged at 37.3 ± 8.5 and 38.3 ± 5.4 years, respectively. For all female and male finishers, males improved significantly (ß = 7.010, p = 0.006) the cycling distance from 497.8 ± 219.6 km to 546.7 ± 205.0 km whereas females (ß = -0.085, p = 0.987) showed an unchanged performance of 593.7 ± 132.3 km. The mean cycling distance achieved by the male winners of 960.5 ± 51.9 km was significantly (p < 0.001) greater than the distance covered by the female winners with 769.7 ± 65.7 km but was not different between the sexes (p > 0.05). The sex difference in performance for the annual winners of 19.7 ± 7.8% remained unchanged across years (p > 0.05). The achieved cycling distance decreased in a curvilinear manner with advancing age. There was a significant age effect (F = 28.4, p < 0.0001) for cycling performance where the fastest cyclists were in age group 35-39 years. CONCLUSION: In this 24-h cycling draft-legal event, performance in females remained unchanged while their age of peak cycling performance decreased and performance in males improved while their age of peak cycling performance remained unchanged. The annual fastest females and males were 37.3 ± 8.5 and 38.3 ± 5.4 years old, respectively. The sex difference for the fastest finishers was ~20%. It seems that women were not able to profit from drafting to improve their ultra-cycling performance.