Isolated traumatic posterior dislocation of the radial head in an adult, a rare injury: New case report.

Isolated radial head dislocations are rare in adults with only 23 cases published in 45 years. The diagnosis may be easily missed on radiographs and a CT-scan is often required. If managed promptly patient can restore normal range of motion and elbow function. Authors report a new case of a 67-year-old female presenting a posttraumatic isolated posterior dislocation of the radial head. Treatment consisted of closed reduction followed by immobilization for four weeks in a plaster cast with the elbow flexed at 90°, followed by active mobilization and physiotherapy. At 18 months of follow-up, functional outcome is excellent with no differences between both sides.

Long-term results of total knee arthroplasty in hemophilic arthropathy.

PURPOSE: Knee arthropathy is a frequent complication affecting hemophilic patients, which can cause severe pain and disability. When conservative measures fail, total knee arthroplasty (TKA) may be performed. METHODS: Eighteen TKA were performed in 15 patients with hemophilia during a 24-year period in a Hemophilia Comprehensive Care Center. All patients were evaluated by a multidisciplinary team constituted by a hematologist, an orthopedic surgeon, and a physical medicine and rehabilitation physician. Mean follow-up was 11.3 years. RESULTS: Ten-year survival rate with prosthesis removal as end point was 94.3%. At last, follow-up visual analog pain scale score was 3.2 points, knee osteoarthritis outcome scale was 86.7 points, and mean range of motion was 88°. Only two patients required perioperative transfusion. Complication rate was 27.8% and included two infections, two prosthesis stiffness, and one case of recurrent hemarthrosis. CONCLUSION: After appropriate medical optimization and with prompt rehabilitation, TKA can be performed in hemophilic patients with good clinical results and survivor rates comparable to nonhemophilic patients.

Empirical antibiotic therapy in prosthetic joint infections.

When dealing with prosthetic joint infections (PJI) there is often the need to start antibiotic therapy without having identified the underlying pathogen. Under these circumstances there is no consensus regarding which antibiotic to use. We aimed to produce local recommendations for empirical antibiotic treatment of PJI by describing the microbiological spectrum involved and respective antibiotic susceptibility profile. We examined the records of 75 consecutive patients that underwent surgery for prosthetic joint infection from July 2001 to December 2008. There were 49 women and 26 men with an average age of 63 years. Ninety culture results were available from 41 hips and 34 knee replacements. Staphylococcus sp. was present in most infections (72.8%) regardless of surgical site or classification. The prevalence of methicillin-resistance among staphylococci was 64.2% with no relevant difference between sub-groups. Vancomycin is 100% effective against most commonly isolated Gram positives. Gram negative pathogens were present in about 15% of all cases, especially in haematogenous and chronic infections. Carbapenems and aminoglycosides are the most effective antibiotics against these pathogens. Our results suggest that in acute post-operative infections, treatment should start with vancomycin. In chronic and haematogeneous infections, vancomycin in combination with carbapenems appears to be an effective regimen. Treatment should be adjusted as soon as preliminary or definitive microbiology results are available.

LONG-TERM RESULTS OF BODY AND NECK TALUS FRACTURES.

OBJECTIVES: Talar neck and body fractures are unusual fractures. The purpose of this study is to determine the prevalence of long term results. MATERIAL AND METHODS: A retrospective analysis was carried out including 11 patients that underwent surgical treatment for body or neck talus fractures between January 1997 and December 2005. Final follow-up examination included a clinical evaluation (AOFAS score) and standard radiographs. RESULTS: The mean follow-up time was 58.5 months. The prevalence of associated fractures was 60% (6/10). Overall AOFAS score averaged 72 [19-100]. Avascular necrosis and post-traumatic arthritis were present in half of the patients. Quality of surgical reduction, body fractures and absence of degenerative changes were correlated with better functional results. Neck fractures, osteonecrosis and posttraumatic arthritis led to inferior results. CONCLUSION: There is a great potential for long term functional impairment due to posttraumatic arthritis and chronic pain in this kind of fracture. Anatomic surgical reduction is the best chance to avoid them but it is not infallible. The avascular necrosis rate correlates with initial fracture displacement, but its occurrence in each specific case is unpredictable.