Extensor Tenosynovitis due to Mycobacterium marseillense Infection in a Renal Transplant Recipient.

Renal transplant recipients are at an increased risk of atypical nontuberculous mycobacterial (NTM) infections. Infections caused by NTM are uncommon in the general population, rarely occurring in immunocompetent individuals. NTM infections are an uncommon cause of tenosynovitis. Mycobacterium marseillense is a rare, atypical mycobacteria that has been reported to cause pulmonary and cutaneous infections; however, no previous reports of this pathogen causing tenosynovitis exist. This case reports a 73-year-old male renal transplant recipient who presented with chronic extensor tenosynovitis of the right hand caused by M marseillense. The patient was treated with radical extensor tenosynovectomy and 6 months of antibiotic treatment. A review of literature on tenosynovitis caused by atypical mycobacteria was performed. The patient successfully responded to treatment with no complications or recurrence of infection at the 18-month follow-up. Tenosynovitis of the hand caused by atypical mycobacteria is rare. A high index of suspicion is required to prevent a delay in diagnosis, particularly in immunocompromised individuals.

Which Subspecialties Do Female Orthopaedic Surgeons Choose and Why?: Identifying the Role of Mentorship and Additional Factors in Subspecialty Choice.

Limited data exist delineating the reasons women choose subspecialties within orthopaedics. Purpose: (1) To perform a survey that determines subspecialties female orthopaedic surgeons select and (2) to analyze the motivations behind their choices. Methods: A 10-question survey was distributed via e-mail to the Ruth Jackson Orthopaedic Society (RJOS), Texas Orthopaedic Association (TOA), and to a private internet page for women in Orthopaedics, which covered the area of subspecialty practice, motivations, and demographic data. Practicing female orthopaedic surgeons, fellows, or fellowship-matched residents were included. Respondents' ranked motivations when deciding for or against a subspecialty were analyzed and comparisons made. Results: Of the 304 survey responses, 288 met inclusion criteria. The most common subspecialties were hand (24.0%), pediatrics (22.6%), and sports medicine (16.3%). A higher proportion of younger surgeons are electing to subspecialize in sports medicine, whereas a lower proportion of younger surgeons are pursuing general orthopaedics. Top-ranked reasons for selecting a subspecialty were personal satisfaction (50.8%), intellectual stimulation (42.1%), and strong mentorship (37.4%). The most common reason for not selecting a subspecialty was lack of interest (60.6%). Conclusion: Strong mentorship was the largest extrinsic/modifiable factor that affected the decision-making process. A continued focus on mentorship will be necessary to encourage future female orthopaedic surgeons to enter this field and inspire them to explore a different set of subspecialties.

Anterior locking screw plate fixation for cervical spondylosis.

Thirty consecutive patients with significant cervical spondylotic myelopathy or radiculopathy were treated with anterior decompression, autologous iliac crest graft, and titanium hollow screw plate (THSP). Eight patients had 1 previous surgery, and 1 patient had 2 previous surgeries. Satisfactory fixation was achieved intraoperatively in all instances. At time of final follow-up, graft incorporation was noted in all instances. There were 4 complications: 2 superficial infections, treated nonoperatively; 1 case of dysphagia, which resolved; and 1 case of spasmodic torticollis, which resolved. The THSP system allowed immediate stabilization of the involved cervical levels and facilitated reliable fusion.