Granulicatella adiacens prosthetic hip joint infection after dental treatment.

INTRODUCTION: Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. CASE PRESENTATION: We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. CONCLUSION: Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors.

Technical tip: tightrope fixation of neer type II distal clavicle fracture supported by a case series.

BACKGROUND: We present a case series of 3 patients who underwent a novel technique of tight rope fixation for Neer type II distal clavicle fracture. MATERIAL AND METHODS: 2-3 cm incision was made lateral to the fracture site moving inferomedially. Part of the distal end of clavicle was exposed close to fracture site and further dissection was carried out to reveal the coracoid process. Tight rope fixation of the distal ends of clavicle and coracoid was performed to achieve satisfactory fracture reduction on x-ray. RESULTS: 4 weeks of sling with gentle pendulum movement were followed by active shoulder movement exercises. Radiographic union was reached at 6 weeks' time, while the patients achieved proper shoulder functionality 3 months following the operation. CONCLUSIONS: Neer type II distal clavicle fractures are characterized by disruption of the coracoclavicular ligament with wide proximal fragment displacement. Overall, type II distal clavicle fractures have a 20-30% nonunion rate if treated non-surgically. Various techniques have been described for the treatment of these fractures, including hook plate and nailing. Tight rope fixation provides proper apposition of the fracture fragments for union by maintaining a reduced coracoclavicular interval.

Entwinement of sciatic nerve around a total hip prosthesis following closed reduction of dislocated total hip replacement.

The usual causes of injury to sciatic nerve during total hip replacement are intraoperative direct nerve injury, significant leg lengthening, improper retractor placement, cement extravasation, cement-related thermal damage, patient positioning, manipulation and postoperative hematoma. We present a case of early sciatic nerve injury with entrapment of sciatic nerve around the prosthetic femoral neck following repeated manipulation of dislocated total hip replacement. This case emphasises the importance of soft tissue in dealing with orthopedic problem. Limited number of attempts at closed reduction should be made as prolonged manipulation may place surrounding soft-tissue structures particularly nerve at risk of injury. If a closed reduction with the patient under general anesthesia is difficult, there should be a low threshold for open exploration and reduction. Documentation of neurovascular status before and after manipulation is essential.

Femoral neuropraxia after vaccination in a 3-month-old infant: a case report.

We report an incidence of a 3-month-old infant who developed femoral neuropraxia after vaccination (diphtheria, tetanus and acellular pertussis/inactivated poliovirus/haemophilus influenzae type B vaccine) in the thigh. To the best of our knowledge, femoral nerve injury after vaccination has not been reported in the literature before. However, this baby made good neurological recovery within 8 weeks after vaccination.

Quality of consent form completion in orthopaedics: are we just going through the motions?

Consent plays a vital role in every aspect of medicine and surgery, facilitating the patient in making informed decisions about their treatment. The recently published Reference Guide to Consent, by the Department of Health (DH), notes that, although not a legal requirement, the completion of consent forms is good practice, particularly in interventions such as surgery. In addition, the Parliamentary and Health Service Ombudsman noted that a significant number of complaints about consent involved the complainant feeling that they did not fully understand what was going to happen. It was often found that there was no documentation to clarify what the patient was told, when and by whom. We have performed an audit of 71 randomly selected consent forms, elective and trauma cases within our district general hospital orthopaedics department. Our data demonstrate that a significant number of consent forms were incorrectly or insufficiently completed. This could not only leave the patient confused about their procedure but also leaves the doctor open to litigation, with little in the way of documentation support. Minor changes in consenting methods and more precise documentation could significantly improve patient experience and satisfaction.