Nosocomial post-traumatic Rhizomucor soft tissue and bone infection treated with liposomial amphotericin B: case report.

Mucornycosis is a rare fungal infection most commonly occuring in patients with severe immunocompromise, diabetes, uremia or trauma. Only a few cases of non axial skeletal bone osteomyelitis have been reported. We report a case of nosocomial cellulitis and osteomyelitis complicating a posttraumatic bacterial infection, successfully treated with liposomial amphotericin B and surgical debridement. Traumatized patients with extensive tissue loss, receiving broad-spectrum antibiotics, can develop impaired immune responses and are at risk for fungal infections.

An evaluation of the results of two non-surgical methods in the treatment of fractures of the odontoid process.

The authors illustrate the results of a series of 47 fractures of the odontoid process all treated according to two non-surgical methods, among the most diffused and accepted: Minerva plaster and halo-plaster. The various elements used to classify odontoid fractures are examined, as is their importance for prognosis. The conclusions refer to two essential points: 1) fractures with a higher risk of nonunion are Anderson type II, with posterior shifting, in elderly patients; 2) reduction and immobilization with a halo-plaster may be considered the first choice of a method for most of these fractures, in consideration of the limited risk of nonunion involved.

[The results of a resection intervention in isolated fractures of the radial head]. / Risultati dell'intervento di resezione nelle fratture isolate del capitello radiale.

The results of radial head excision were studied in 33 patients with isolated fracture of the radial head. The follow-up period ranged from 1 to 19 years (mean 9.5 years). Overall results were excellent or good in 25 patients (76%) and fair or poor in 8 patients (24%) with functional limitation of the elbow. Range of motion was greatly limited in those patients who had a myositis ossificans or a radio-ulnar synostosis. Periarticular ossifications were observed in 17 elbows (54%) and subluxation of the inferior radio-ulnar joint in 20 wrists (60%). Excision of the radial head is the treatment of choice for comminuted isolated fractures of the radial head, even if in some patients limited elbow function should be expected.

Resection of the radial capitellum. Long-term results.

The results of 39 resections of the radial capitellum reviewed after an average of 12 years were excellent or good in 59% of the cases and fair or poor in 41%. The results were better in isolated fractures of the capitellum (excellent or good, 71%) compared with those with associated lesions in the same limb (excellent or good, 44%). A reduction of movement was frequently observed, particularly in pronation and supination, which was limited in 28% of the cases and abolished in 15%. In 4 patients there was a significant increase in cubitus valgus. Arthrosis was present in 45% and periarticular calcification in 74% of the cases. There were 5 cases of radioulnar synostosis and 4 cases of myositis ossificans. Subluxation of the distal radioulnar joint was observed in 26 wrists, 4 of which were painful. The results of resection of isolated fractures may be considered acceptable, while the prognosis of fractures with associated lesions is more unfavourable.

Long-term results of conservative treatment of fractures of the distal radius.

The long-term results of the conservative treatment of wrist fractures were observed in a follow-up study of 297 cases over a period of one and one-half years to six years. The evaluation of the results was based on clinical parameters, both subjective and objective, as well as radiological features. The results were: excellent in 38% of cases, good in 49%, fair in 11.5%, and poor in 1.5%; considerably worse were the subjective results (20% fair to poor). No statistically significant relation could be found between results and type of fracture. Clinical deformities and pain in the area of the distal radioulnar joint were frequent. Decrease in grip strength was observed in 17.8% of cases. A limitation of wrist movement was not frequent. Numerous compressive neuropathies were found (41 in 35 patients), especially of the median nerve. The values relative to the three radiographic parameters under investigation (that is, radial deviation, volar tilt, and radioulnar index) were often found to be out of the normal range. The comparative study of postreduction and follow-up radiograms show the loss of reduction to be frequent, especially as far as the volar tilt is concerned. The frequent radiologic deformities are associated with significantly bad results only in cases of extremely abnormal values. However, fractures of the distal radius are not to be underestimated. Long-term results following conservative treatment may not be as acceptable as is generally assumed.