Case Report of an Unusual Differential Diagnosis of a Red and Atraumatic Swollen Foot Charcot Arthropathy in Rheumatoid Arthritis.

Introduction: Neuropathic osteoarthropathy of the foot and ankle (Charcot foot) is a disease that can lead to progressive malpositioning and deformation up to complete collapse of the foot. In most cases, diabetic polyneuropathy is the underlying disease, but polyneuropathy of any cause can lead to neuropathic osteoarthropathy. Pathogenesis is still not completely understood. Due to the non-specific clinical presentation, the symptoms of Charcot arthropathy are generally easily misdiagnosed and proper therapy is delayed, especially in patients with an underlying disease other than diabetes mellitus. To date, published literature on patients with rheumatoid arthritis who develop neuropathic osteoarthropathy of the foot is scarce. Case Report: We present a rare case of a 61-year-old patient with Charcot foot and rheumatoid arthritis. The patient presented with an extreme foot deformity after a failed conservative treatment. The surgical procedures, complications, and outcome are described. The pitfalls in this special patient group are highlighted. Conclusion: If necessary, a variety of surgical options are available to maintain ambulation and prevent infection from open ulcers and amputation. For surgical management of patients with rheumatoid arthritis, the overall statics of the lower extremity and the influence of antirheumatic drugs must be considered.

The Use of Mobile Applications for the Diagnosis and Treatment of Tumors in Orthopaedic Oncology - a Systematic Review.

The use of smartphone apps is an essential part of everyday life. Mobile applications offer enormous opportunities for dealing with challenges in public health, and their number increases every day. This paper aims to review the existing literature on mobile applications in orthopaedic oncology and to summarize the current mobile applications for musculoskeletal tumors. A systematic literature review was conducted regarding articles on mobile applications in orthopaedic and trauma surgery. The focus was on identifying mobile applications that can be used in the treatment of patients with musculoskeletal tumors. Two reviewers independently assessed study eligibility, extracted data, and appraised methodological quality. In addition, the Apple App Store and Google Play Store were searched for suitable mobile applications. Ninety-one articles describing a mobile application in orthopaedic and trauma surgery were identified. Three articles focused on a mobile application for musculoskeletal tumors. Additionally, seven mobile applications were available in the App/Play Stores dealing with bone or soft tissue tumors in orthopaedic oncology without corresponding scientific articles. Increasing numbers of mobile applications are being developed in orthopaedic and trauma surgery. Currently, only three scientific articles on mobile applications in orthopaedic oncology are present, yet several more applications are available without scientific medical evaluation. Since mobile applications can facilitate the everyday life of orthopaedic and trauma surgeons, it is worthwhile to be aware of new developments in this field. A regular scientific evaluation of the subject is important in order to classify the significance of these applications.

Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data.

PURPOSE: Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. PATIENTS AND METHODS: Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher - 1, n = 26) was compared with a group with impaired bone density (T-score lower - 1, n = 24). RESULTS: A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. CONCLUSIONS: HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. LEVEL OF EVIDENCE: III. These slides can be retrieved under Electronic Supplementary Material.

Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study.

INTRODUCTION: Establishing a systematic multidisciplinary approach in the treatment of prosthetic joint infections (PJI) of the hip and analyzing its effect on clinical decision-making. PATIENTS AND METHODS: Forty-six patients diagnosed with PJI of the hip were included in the retrospective study. The treatment plan was either established by a single-discipline approach (n = 20) or by a weekly multidisciplinary infections conference (n = 26) consisting of at least an orthopedic surgeon, microbiologist and pathologist. Recorded data included the length of hospital stay, number and type of surgeries, medical complications, recovered organisms as well as the number of applied antibiotics. RESULTS: Patients discussed in the multidisciplinary infections conference showed a significantly shorter in-hospital stay (29 vs 62 days; p < 0.05), a significant reduction in surgeries (1.8 vs 5.1; p < 0.05) and a smaller number of antibiotics required (2.8 vs 4.2; p < 0.05). No significant difference could be found comparing inpatient complications between the two groups. Staphylococcus aureus and coagulase-negative staphylococci were the most frequently recovered organisms in both patient groups. CONCLUSION: This study demonstrates the successful implementation of a weekly infections conference as an instrument to introduce a multidisciplinary approach to PJI of the hip. Implementation of these conferences significantly improves the treatment plan compared to a single-discipline approach, which we therefore highly recommend for other institutions. Multidiscipline may even affect clinical outcome which needs to be further investigated.