Streptococcus pneumoniae Osteomyelitis in a 25-Year-Old Man as the Initial Presentation of Multiple Myeloma: A Case Report.

CASE: We report the case of a 25-year-old man with femoral Streptococcus pneumoniae pyomyositis as well as hypercalcemia, mild anemia, and elevated inflammatory markers; he subsequently was diagnosed with immunoglobulin G (IgG) kappa multiple myeloma. CONCLUSION: Multiple myeloma most commonly affects patients who are >60 years of age, and causes clinical symptoms from anemia, lytic bone lesions, hypercalcemia, and renal failure. These findings and a monoclonal protein spike serve as initial diagnostic and treatment criteria. Multiple myeloma is associated with susceptibility to bacterial infections, especially encapsulated organisms; however, this is rarely the initial presentation. Additionally, it is unusual for myeloma to be diagnosed in a young person (<40 years of age).

Correlation between distal radial cortical thickness and bone mineral density.

PURPOSE: To determine interobserver reliability in measuring the cortical thickness of distal radiuses on posteroanterior radiographs obtained at the time of injury and to determine whether there is a correlation between distal radius cortical thickness and hip and lumbar spine scores on dual-energy x-ray absorptiometry (DXA). METHODS: Four orthopedic surgeons at 2 academic institutions who were blinded to the study protocol reviewed standard posteroanterior wrist radiographs of 80 women over age 50 years with distal radius fractures with DXA data obtained within the past 2 years. Radial bicortical widths were measured at 50 and 70 mm proximal to the distal ulnar articular surface, and mean bicortical thickness was calculated from radiographs of the injured wrist. Average bicortical width was compared with each patient's femoral and lumbar spine bone density measures. Data were analyzed using Pearson correlation coefficients and simple linear regression. Inter-rater reliability was evaluated using intra-class correlation coefficients. RESULTS: The inter-rater reliability for average bicortical thickness had a high intra-class correlation coefficient value of 0.91. Average bicortical thickness showed a statistically significant positive relationship with femoral bone density. Average bicortical thickness was statistically correlated with femoral bone density values, with a 1-mm increase in average bicortical thickness associated with a 0.05 g/cm(2)-increase in femoral density. Average bicortical thickness was not associated with lumbar bone density. CONCLUSIONS: Bicortical thickness of the distal radius was positively correlated with femoral bone density but not with lumbar spine density. This may reflect similarity in quality and loading properties of the femur and radius as appendicular bones, compared with the axial spine. Identification of thinned distal radial cortices in association with distal radius fracture is a simple qualitative observation that should prompt further evaluation with DXA and medical management of bone insufficiency. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Rate of adverse reactions to more than 1 series of viscosupplementation.

Viscosupplementation, hyaluronic acid treatment, is an ancillary method for treating patients with symptomatic stage I or II osteoarthritis. Previous studies reported that local reactions occurred more frequently in patients receiving >1 course of treatment compared with patients receiving their first course of treatment. One (2%) of 42 first series patients and 4 (21%) of 19 of repeated series patients had adverse reactions severe enough to seek unscheduled care.This study was performed to determine whether patients receiving >1 series of viscosupplementation had an increased adverse reaction rate. A retrospective chart review was performed on all patients who received >1 series of viscosupplementation during the study. A local adverse reaction was defined as acute swelling and pain in the knee, with no injury or trauma within 72 hours after hyaluronic acid injection.Twenty-eight knees received >1 series of viscosupplementation. The adverse reaction rate to second series injections was 1.28% (3.57% of knees). The adverse reaction rate to ≥3 series was 0.9% (6.67% of knees). This adverse reaction rate was significantly less than the 21% reported in previous studies for multiple series injections (z=-1.90; P<.05) and is not significantly different than the 2% rate of adverse reactions reported for first series injections. No significant difference existed in the adverse reaction rates between 2 series and ≥3 series of viscosupplementation.The current study suggests that the rate of adverse reaction was low at 1.28% of second series viscosupplementation.