Pyoderma gangrenosum after hip hemiarthroplasty; a case report.

Pyoderma gangrenosum is a severe and rare neutrophilic disorder that can present as a complication following any kind of surgery, usually after breast and abdominal surgery. This condition mimics infection, delaying prompt diagnosis and appropriate treatment with high dose of corticosteroids. We describe a case of pyoderma gangrenosum after hip hemiarthroplasty, in an 86-year-old woman, who sustained a neck of femur fracture after a simple fall. The patient was diagnosed 2 weeks postoperatively with pyoderma gangrenosum through a biopsy with clinical manifestations from other systems such as seizures and atrial fibrillation.

Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study.

This study is a randomized prospective study comparing two fracture fixation implants, the extramedullary sliding hip screw (SHS) and the dual lag screw cephalomedullary nail, in the treatment of intertrochanteric femoral fractures in the elderly. One hundred and sixty-five patients with low-energy intertrochanteric fractures, classified as AO/OTA 31A, were prospectively included during a 2-year period (2005-2006). Patients were randomized into two groups: group A included 79 hip fractures managed with sliding hip screws and group B included 86 fractures treated with cephalomedullary nails. Delay to surgery, duration of surgery, time of fluoroscopy, total hospital stay, implant-related complications, transfusion requirements, re-operation details, functional recovery, and mortality were recorded. The mean follow-up was 36 months (24-56 months). The mean surgical time was statistically significantly shorter and fluoroscopy time longer for the group B. No intraoperative femoral shaft fractures occurred. There was no statistically significant difference in the functional recovery score, reoperation, and mortality rates between the 2 groups. A new type of complication, the so-called Z-effect phenomenon, was noticed in the cephalomedullary nail group. There are no statistically significant differences between the two techniques in terms of type and rate of complications, functional outcome, reoperation and mortality rates when comparing the SHS and the cephalomedullary nail for low-energy AO/OTA 31A intertrochanteric fractures. Our data do not support recommendations for the use of one implant over the other.

Colour Doppler ultrasonography of the ophthalmic artery: flow parameters in normal subjects. The significance of the resistance index.

BACKGROUND: The aim of this study was to assess the flow characteristics in ophthalmic arteries and to detect their possible relationships to those in the common and internal carotid arteries. METHODS: Sixty healthy subjects (age range 20-74 years) with normal vascular findings, stratified by age and sex were recruited to the study. A colour Doppler ultrasound examination of the neck arteries was performed, followed by a colour Doppler ultrasound examination of the 120 ophthalmic arteries included. Peak systolic velocity, end diastolic velocity and resistance index (RI) of the common carotid, internal carotid and ophthalmic arteries, as well as the insonation depth of the ophthalmic arteries were measured. RESULTS: The mean values (standard deviation) of the measured parameters for the ophthalmic arteries were: insonation depth: 38.38 mm (2.60 mm), peak systolic velocity: 34.71 cm/sec (6.38 cm/sec), end diastolic velocity: 7.95 cm/sec (1.70 cm/sec), resistive index: 0.77 (0.04). The resistance index of the ophthalmic arteries was, in all cases, greater than that of the ipsilateral common carotid artery which in turn, was greater than that of the internal carotid. The value of the index in the ophthalmic arteries, when the circulation is normal in the extra- and intracranial arteries is rarely lower than 0.70. CONCLUSIONS: When an inversion of the ratio between the resistance index of the ophthalmic artery and that of the common carotid or an index value lower than 0.70 in the ophthalmic artery is observed, further investigation is needed as this situation cannot be considered normal. The resistance index seems to be the most reliable parameter for the estimation of normal circulation in ophthalmic arteries.

Screening school children for scoliosis on the island of Crete.

The present study is the first that reports the prevalence of scoliotic changes in the island of Crete. We examined 21,220 children (10,942 boys and 10,278 girls), which corresponds to 87.8% of the 6-12-year-old children living in the Iraklion district (city and rural areas). Of the examined population, 9.6% were referred for radiological examination; 1.7% of the screened children were found to have spine deformities with angular values > 10 degrees. The prevalence of severe abnormalities (> 20 degrees) requiring conservative treatment was 0.06%. Thirty percent of the scoliotic deformities involved the thoracolumbar region, whereas 48 and 22% of curves were confined to the thoracic or lumbar area, respectively. The cost of the screening per child during the 1st year was estimated to be $10 (U.S.), but it was reduced by 42% during the 2nd year. The screening program is continuing to include all four districts of the island of Crete and assess the impact of scoliosis screening programs and of conservative treatment on the natural history of the disease. Scoliometers are used for the selection of children who should be referred for radiological evaluation (> 7 degrees). The screening includes children older than 8 years of age.

Broadband ultrasound attenuation of the os calcis in female postmenopausal patients with cervical and trochanteric fracture.

The broadband ultrasound attenuation (BUA) of the right calcaneus was measured in 78 women with hip fracture (45 trochanteric and 33 cervical) and in 85 normal women (mean age 78 years and 63 years, respectively). All cases were postmenopausal and the hip fractures had resulted from a fall from standing position or less. The women with hip fracture had lower BUA (41 dB/MHz) than normals (67 dB/MHz), but about 10 dB/MHz of this difference was associated with age. There was no significant difference in BUA between cases with trochanteric (41 dB/MHz) and those with cervical fracture (39 dB/MHz). It is worth noting that 35.5% of the women with trochanteric fracture were suffering from osteoarthrosis of the knees but only 15% of the women with cervical fractures had the same problem. Over 90% of the cases with hip fracture had BUA lower than 61 dB/MHz and 80% had lower than 51 dB/MHz.