Musculoskeletal infections associated with Citrobacter koseri.

Introduction Citrobacter koseri is a well known cause of central nervous system infections in the paediatric setting. Musculoskeletal infections caused by C koseri are rare, with only 14 previously reported cases. We present the first recorded case of C koseri induced septic arthritis of the knee along with a review of the literature. Methods A search of the PubMed, Embase(®) and Google Scholar™ databases was undertaken. Only complete or near complete cases were reviewed. Findings Fourteen musculoskeletal infections were identified. Of these, five were associated with an operative procedure and five involved a septic joint. Surgical treatment was required in the majority of cases and cure was achieved in all cases following prolonged antibiotic use. Conclusions C koseri associated musculoskeletal infections may complicate primary orthopaedic procedures. The organism can present aggressively and can be difficult to identify microbiologically. It is sensitive to newer generation beta-lactams, cephalosporin-based antibiotics and timely surgery.

Wrist and scaphoid fractures: a 17-year review of NHSLA litigation data.

Wrist and scaphoid fractures are common injuries seen and treated in everyday orthopaedic practice. The purpose of the study was to assess the trends and reasons for litigation related to wrist and scaphoid fractures within the NHS. Under a freedom of information (FOI) request, data from 1995 to 2012 were provided by the National Health Service Litigation Authority (NHSLA) on all litigation claims made as a result of wrist and scaphoid fractures. A total of 1354 claims relating to the hand and wrist were identified. Wrist and scaphoid fractures accounted for 492 (36.3%) of these claims, and 365 of these claims were settled, representing 74.2% of all wrist and scaphoid fracture claims. Overall, the most common reason for lost claims was due to incorrect, missed or delayed diagnosis (43.5%). Alleged mismanagement (29.5%), poor care (10.1%) and incompetent surgery (8.0%) were other common causes for litigation. This paper augments previous work published in this area and explores litigation trends specific to wrist and scaphoid fractures. We discuss the trends and reasons for litigation in this area, suggesting areas for improvement that may aid health-care professionals who deal with these injuries and potentially help reduce future litigation.

Treatment of osteoporosis: missed opportunities in the hospital fracture clinic.

AIM: To identify what proportion of patients who, having sustained an initial distal radial fragility fracture and a subsequent femoral neck fracture, had had their osteoporosis addressed in the interval between the two events. PATIENTS AND METHODS: The hospital electronic information system was used to identify all patients aged over 50 years treated for a distal radial fracture, in our fracture clinic, between 1995-2000. In addition all patients admitted to our hospital, during the same time period, with a femoral neck fracture were identified. RESULTS: A study cohort of 74 patients were identified. The proportion of patients who received investigation of, or treatment for, osteoporosis between their wrist and femoral neck fracture was 8% whereas 84% did not. CONCLUSIONS: Current mechanisms for identifying patients with osteoporosis before they sustain a femoral neck fracture are inadequate.

A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow.

We conducted a prospective, randomised, controlled trial of 45 patients (47 elbows), with tennis elbow, who underwent either a formal open release or a percutaneous tenotomy. All patients had pre- and post-operative assessment using the Disability of Arm, Shoulder and Hand (DASH) scoring system. Both groups were followed up for a minimum of 12 months. Statistical analyses using the Mann-Whitney U test and repeated measured ANOVA showed significant improvements for patient satisfaction (p = 0.012), time to return to work (p = 0.0001), improvements in DASH score (p = 0.001) and improvement in sporting activities (p = 0.046) in the percutaneous group. Those patients undergoing a percutaneous release returned to work on average three weeks earlier and improved significantly more quickly than those undergoing an open procedure. The percutaneous procedure is a quicker and simpler procedure to undertake and produces significantly better results.

"Life" above the neck: brain tumour presenting as carpal tunnel syndrome.

Carpal tunnel syndrome is a common condition with many aetiologies. We present a case report of a glioblastoma which presented as carpal tunnel syndrome, and highlights that the most proximal site for pathology is not the spinal cord.