Post-traumatic osteomyelitis due to aeromonas species.

We report a case of Aeromonas osteomyelitis due to injury in a sewage worker. He presented with cellulitis of the left foot. Radiographs showed evidence of osteomyelitis involving the head and neck of the fifth metatarsal. Aeromonas species was isolated from the tissue and swab from the foot. The head and neck of the fifth metatarsal were excised and the patient improved on 4 weeks of intravenous meropenem followed by 4 weeks of oral clindamycin and ciprofloxacin.

Placement of a palpable marker adjacent to the mid-inguinal point: assessment of a clinical method for detecting the femoral head centre during knee arthroplasty.

Localization of the centre of the femoral head is vital when using extra-medullary femoral alignment systems in knee arthroplasty. This study investigated the accuracy of a palpable marker placed in the groin for detecting the centre of the femoral head. A table tennis ball, 38 mm in diameter, was taped 2.5 cm perpendicular to the mid-inguinal point in patients having a plain radiograph of the pelvis. The mean horizontal distance between the centre of the table tennis ball and a vertical line passing through the centre of the femoral head was 8.62 mm (range 0-28.6, SD 6.76). In 100% of cases the horizontal distance between the centre of the table tennis ball and a vertical line passing through the centre of the femoral head was less than one diameter of the table tennis ball. Using a theoretical mechanical axis model our clinical method would confer an error equal to or less than 2 degrees from the weight-bearing axis of the knee in up to 98% of cases. In conclusion, our results suggest that the clinical method reported here provides a simple and reliable way of localizing the centre of the femoral head in knee arthroplasty.

Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system.

INTRODUCTION: The aim of this study was to evaluate the intra- and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs. PATIENTS AND METHODS: Fifty tibial plateau fractures were classified independently by six observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions, 8 weeks apart. RESULTS: We found that both the Schatzker and AO/OTA classifications have a high intra-observer (kappa = 0.57 and 0.53, respectively), and inter-observer (kappa = 0.41 and 0.43, respectively) variation. Classification of tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression +/- split conferred improved inter- and intra-observer variation. CONCLUSIONS: The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients' outcome. Simply classifying tibial plateau fractures into unicondylar versus bicondylar and pure splits versus articular depression +/- split may be more reliable.

Operating out of hours in acute orthopaedics: variations amongst surgeons and regions in the United Kingdom.

It is recommended that out of hours, surgery should be confined to emergency cases. What constitutes an emergency in orthopaedic surgery is not well defined. This study presents the results of a postal survey sent to orthopaedic surgeons practicing in the United Kingdom, asking them what is the time frame they would recommend operating upon, and whether they would operate out of hours for common acute orthopaedic presentations. Our results demonstrate variability both amongst individual surgeons as well as amongst different regions in the United Kingdom.

Early versus delayed surgical treatment of open tibial fractures: effect on the rates of infection and need of secondary surgical procedures to promote bone union.

The purpose of this study was to evaluate whether there was any significant difference in the rates of infection and of secondary surgical procedures to promote bone union, between early(6 h or less after arrival to hospital) and delayed(more than 6 h) surgical treatment of open tibial fractures. Three hundred and eighty-three open tibial fractures were evaluated. 184 fractures had early and 199 had delayed surgical treatment. The rates of infection and secondary surgical procedures to promote bone union of the two groups were compared with univariate and multivariate statistical methods. There was no statistically significant difference between early and delayed treatment groups with respect to overall infection (53/184 versus 51/199 infection rates, P = 0.96), deep infection (8/184 versus 8/199 infection rates, P = 1.0), and rates of secondary surgical procedures to promote bone union (24/184 versus 20/198, P = 0.77). We were unable to demonstrate any significant difference in infection rates or need of secondary procedures to promote bone union, between early and delayed surgical treatment of open tibial fractures.

Double dislocation of the proximal and distal interphalangeal joints of the little finger.

A 32-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints following a hyperextension injury. This was reduced under a digital nerve block. Neighbour finger strapping and early mobilisation achieved a full range of movements at both joints when reviewed three weeks after the initial injury.