[Crocodile bites].

Crocodile bites are one of the most powerful bites of any creature. Bite wounds are usually deep, with severe tissue damage, frequently contaminated with unusual microorganisms, and are difficult to treat. This case report describes the treatment of a middle-aged man admitted after a crocodile attack to the left distal end of humerus, elbow and proximal forearm. He was successfully treated with empirical broad-spectrum antibiotics and repeated wound debridement. The patient was discharged after nine days of intensive care at a level 1 trauma unit, good outcomes were seen eight months later.

MRi of the knee compared to specialized radiography for measurements of articular cartilage height in knees with osteoarthritis.

This study aims to evaluate and compare extremity-MRi with specialized radiography by measuring articular cartilage height in patients with knee osteoarthritis. A prospective study, including sixty patients. Measurements on MRi images, Rosenberg view, and coronal stress radiographs were performed. MRI was compared to specialized radiography. Measurements in the medial compartment showed negligible/weak correlation between MRi and Rosenber/varus stress. In the lateral compartment, MRi and the Rosenberg/valgus stress view were strongly correlated. We conclude that MRi cannot replace radiographs for the measurement of articular cartilage thickness. MRi should, however, be reserved for more unusual cases of atypical clinical findings.

Reliability of stress radiography in the assessment of coronal laxity following total knee arthroplasty.

BACKGROUND: Stress radiography is used in the valuation of soft tissue laxity following total knee arthroplasty (TKA). However, reliability and agreement is largely unknown. METHODS: In this prospective reliability study, we included 15 participants with prior TKA. Standardized coronal stress radiographs were obtained in both extension and flexion and with both varus and valgus stress. All radiographs were repeated (test-retest). In extension the Telos stress device was used, and flexion radiographs were obtained using the epicondylar-view. Three independent raters measured angulation between femoral and tibial component from all radiographs. Reliability was assessed by intra-class correlation coefficient (ICC) and agreement visualized with Bland-Altman plots and by mean difference and limits of agreement (LOA). RESULTS: Stress radiography in extension showed excellent reliability with ICC = 0.96 (0.95-0.98) and LOA of ±1.2°. Stress radiography at 80-90° of flexion showed good to excellent reliability when measuring medial laxity with ICC = 0.94 (0.89-0.97) and LOA of ±1.7°; however, when measuring lateral laxity the reliability was only moderate to good with ICC = 0.70 (0.51-0.84) and LOA of ±6.3°. CONCLUSION: Stress radiography is clinically applicable and the methods described in this study provide excellent reliability for measurement of laxity in extension. The reliability of measurements in flexion is good to excellent when measuring medial laxity but only moderate to good when measuring lateral laxity.

Randomized clinical trial of medial unicompartmentel versus total knee arthroplasty for anteromedial tibio-femoral osteoarthritis. The study-protocol.

BACKGROUND: In treatment of isolated medial unicondylar osteoarthritis of the knee, it is possible to choose between medial unicondylar knee arthroplasty (mUKA), or a total knee prosthesis (TKA). The demand for a blinded multicenter RCT with the comparison of mUKA and TKA has been increasing in recent years, to determine which prosthesis is better. Supporters of TKA suggest this treatment gives a more predictable and better result, whereas supporters of UKA suggest it is unnecessary to remove functional cartilage in other compartments. If the mUKA is worn or loosens, revision surgery will be relatively easy, whereas revision-surgery after a TKA can be more problematic. METHODS: A double-blinded multicenter Randomized Clinical Trial setup is the aim of the study. 6 hospitals throughout all 5 municipal regions of Denmark will be participating in the study. 350 patients will be included prospectively. Follow-up will be with PROM-questionnaires and clinical controls up to 20 years. DISCUSSION: Results will be assessed in terms of 1) PROM-questionnaires, 2) Clinical assessment of knee condition, 3) cost analysis. To avoid bias, all participants except the theatre-staff will be blinded. PROMS: OKS, KOOS, SF36, Forgotten Joint Score, EQ5D, UCLA activity scale, Copenhagen Knee ROM scale, and Anchor questions. Publications are planned at 2, 5 and 10 years after inclusion of the last patient. The development of variables over time will be analyzed by calculating the area under the curve (AUC) for the variable relative to the initial value, and comparisons of the between-group differences will be based on parametric statistics. In this study, we feel that we have designed a study that will address these concerns with a well-designed double-blinded multicentre RCT. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03396640 . Initial Release: 09/19/2017. Date of enrolment of first participant: 10/11/17.