purpose. To measure C-reactive protein (CRP) and interleukin-6 (IL-6) levels in 30 patients with open fractures and correlate the levels with infection. Methods. 29 men and one woman aged 9 to 70 (mean, 37) years presented with open fractures of the upper or lower extremity within 12 hours of injury and underwent debridement and external fixation 3 to 40 (mean, 16) hours after injury. Serum CRP and IL-6 concentrations were measured preoperatively and on postoperative days 2 and 4. CRP was measured using latex agglutination and nephelometry, and IL-6 by enzyme-linked immunosorbent assay. The mean CRP and IL-6 levels in infected and non-infected patients were compared. The trend of CRP and IL-6 levels within the infected group was analysed. Correlations between CRP and infection, and between IL-6 and infection were analysed. results. 11 of the 30 patients developed wound infection. The day-2 CRP levels of 30 patients were positive (range, 7-28 µg/ml). In 27 patients, the CRP C-reactive protein and interleukin-6 levels in the early detection of infection after open fractures levels were higher on day 2 than preoperation. On day 4, CRP levels declined sharply in patients without infection (mean, 8 µg/ml) but were persistently elevated in patients with infection (mean, 17 μg/ml). The sensitivity and specificity of the CRP test were 100% and 42%, respectively. In the 11 patients with infection, the IL-6 concentrations were elevated at day 2 (mean, 689 pg/ml) and decreased progressively at day 4 (mean, 175 pg/ml). The sensitivity and specificity of the IL-6 test were 90% and 100%, respectively. Infection correlated with CRP and IL-6 levels. conclusions. Serial serum measurements of IL-6 and CRP levels help in the early diagnosis of infections after open fractures before they are clinically evident.
Osteomyelitis variolosa is an infection of bone and joints by smallpox virus variola major, most commonly in the elbows, wrists, ankles, hands, and feet. We report one such case in a 70-year-old woman who presented with deformities of the right knee, both elbows and ankles, and the left hand, and a history of childhood fever with rashes. Her lateral femoral condyle of the right knee was hypoplastic with patella baja. Her right elbow was ankylosed and her left elbow was dislocated with multidirectional instability. Her third and fourth metacarpals on the left hand were shortened. Both ankles were stiff with valgus deformity; both taluses were destroyed.
Primary plating of displaced mid third clavicle fractures with superiorly placed locking plate avoids complications of non-operative management and leads to early return to pre injury activities.
Introduction Monoarticular presentation of rheumatoid arthritis is infrequent and it usually occurs in the hip and knee joints. We report such a case in a 70-year-old male with monoarticular rheumatoid arthritis of the left wrist. Case report A 70-year-old male patient presented with pain and restriction of movements of his left wrist. Radiographs showed lytic lesions in distal radius and carpal bones, concentric reduction of wrist joint space and periarticular osteoporosis. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor was negative. Uric acid levels were normal. Joint aspirate culture was negative. Anti-citrullinated cyclic peptide was strongly positive. Following treatment using diseasemodifying anti-rheumatic drugs, patient improved signi icantly. Conclusion Our case did not have the classical features of rheumatoid arthritis. Monoarticular presentation of rheumatoid arthritis is rare, of which isolated wrist involvement is even rarer. Rheumatoid arthritis should be considered in the differential diagnoses of monoarticular arthritis, and anticitrullinated cyclic peptide should be used more frequently to diagnose rheumatoid arthritis in doubtful cases.
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