The present study demonstrated that IL-6 has been found to be the most accurate laboratory marker for diagnosing PJI when compared to ESR, CRP, and WCC. IL-6 above 10.4 pg/ml and CRP level above 18 mg/L will identify all patients with PJI and the combination of CRP + IL-6 is an excellent screening test to identify all such patients (sensitivity 100%, NPV 100%).
In our study, only one patient developed non-union and no patients had avascular necrosis of the femoral head. Closed reduction, fibular strut grafts, and DHS fixation is a reliable procedure for femoral neck fractures with posterior comminution in young adults.
PurposeTo evaluate the clinical and radiological outcomes of using fibular strut grafts as a fixation device for non-united femoral neck fractures in children with or without subtrochanteric valgus osteotomy.MethodsA total of 12 children with non-united femoral neck fractures (nine males and three females) with an average age of 8.2 years (5 to 12) were managed, and functional results evaluated, between July 2013 and July 2015. The mechanisms of injury were fall from a height in ten patients and road traffic accident in two cases. Nine cases of femoral neck nonunion followed failed internal fixation and three cases were neglected fractures. Six cases were treated by fibular strut graft and subtrochanteric valgus osteotomy with contoured plate and six cases were treated by fibular strut graft and hip spica.ResultsThe mean follow-up period was 20.4 months (12 to 36). Union was achieved in all 12 cases by a mean of 3.5 months (2.5 to 6). All patients were satisfied at five months. For final analysis of clinical and radiographic results, the Ratliff’s classification was used. We classed 11 cases as good results and one case as fair.ConclusionsFibular strut grafts are a reliable option for treatment of pseudo-arthrosis in femoral neck fracture nonunion in children. It is successful in restoration of femoral neck length in children with non-united femoral neck fractures.
Anterior shoulder dislocations are common in young athletes. The mechanism for the first or primary shoulder dislocation may involve a collision or a fall typically with the arm in an abducted and externally rotated position. The aim of this study was to design a physical rehabilitation program using the elastic band and resistive exercise to improve joint strength and range of motion in individuals diagnosed with a first-time shoulder dislocation. Twelve physically active males with a first-time acute shoulder dislocation were asked to volunteer. Participants began a physical rehabilitation program 2 weeks after the shoulder dislocation, which was confirmed by a referring physician. The rehabilitation program was 6 weeks in duration and required the participants to engage in progressive resistive loads/duration using elastic bands and weights 5 days per week. Pretest and posttest measures included shoulder strength and range of motion. All outcome measures were compared between the injured and uninjured shoulder, which served as the control condition in this study. There were statistically significant differences between the injured and uninjured shoulder for measures of strength and range of motion during pretests (P<0.01) but not post-tests (P<0.53). Finally, there were no differences between shoulders in regards to the volume measure suggesting that any changes in muscle atrophy or swelling were not detected. The physical rehabilitation program proposed in this study was effective at improving strength and range of motion in the injured shoulder as evidenced by the similarity in posttest values between the injured and uninjured shoulder.
PurposeThe “bean-shaped foot” exhibits forefoot adduction and midfoot supination, which interfere with function because of poor foot placement. The purpose of the study is a retrospective evaluation of patients who underwent a combined double tarsal wedge osteotomy and transcuneiform osteotomy to correct such a deformity.MethodsTwenty-seven children with 35 idiopathic clubfeet were treated surgically by combined double tarsal wedge osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) and transcuneiform osteotomy between 2008 and 2012. The age of children at surgery ranged from 4 to 9 years. There were 19 boys and 8 girls. Pre- and postoperative X-rays were used, considering: on the AP radiograph, the calcaneo-fifth metatarsal angle and the talo-first metatarsal angle (indicators of forefoot adduction); on the lateral radiograph, the talo-first metatarsal angle (an indication of supination deformity) and calcaneo-first metatarsal angles (an indication of cavus deformity). These radiological parameters were compared with the clinical results.ResultsFollow-up was conducted for 24–79 months following surgery. Clinical and radiographic improvements in forefoot position were achieved in all cases. An average improvement in the anteroposterior talo-first metatarsal angle of 21°, calcaneo-fifth metatarsal angle of 14°, lateral talo-first metatarsal angle of 10°, and lateral calcaneo-first metatarsal of 12° confirmed the clinically satisfactory correction in all feet. One patient had a wound infection postoperatively, which resolved with removal of the wires and administration of oral antibiotics. Eight patients followed up for more than 5 years had no deterioration of results.ConclusionsCombined double tarsal wedge osteotomy as well as transcuneiform osteotomy is an effective and safe procedure for lasting correction of the bean-shaped foot.
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