We present a rare case of community acquired (presenting in hospital on the day of admission or within 48 h of admission) Clostridium difficile infection (CDI) with the hypervirulent (ribotype 027) strain causing toxic megacolon in a patient, diagnosed on the third postoperative day following an elective total knee replacement. The patient did not have any of the commonly reported risk factors for CDI. The source of sepsis was initially presumed to be the operated prosthetic joint, and this caused a delay in the correct diagnosis and institution of appropriate antimicrobial treatment which may have contributed to a poorer outcome. This case highlights the risk of patients arriving from the community manifesting life threatening CDI in the hospital.
The intramedullary and intra-osseous devices for arthrodesis of the hallux MTP joint achieved good outcome in terms of AOFAS score, VAS for pain, HVA, DA, bone union, and patient satisfaction.
Background:Arthrodesis of the hallux metatarsophalangeal (MTP) joint is commonly done as a primary procedure either to correct severe hallux valgus deformities or for rheumatoid arthritis, hallux rigidus, in patients with neuromuscular disorders and as a salvage procedure for failed bunion surgery or infection. Prominent metalwork frequently can cause soft tissue impingement and thus require removal. In contrast, osteosynthesis with a completely intraosseous implant has the advantage of less damage to the periosteal circulation. We describe a surgical technique and the early results of arthrodesis of the hallux metatarsophalangeal (MTP) joint using an intraosseous fixation device.Materials and Methods:Twelve consecutive patients operated with this method were retrospectively reviewed. The average age was 57 years (range 44–88 years). A retrospective review of radiographs and electronic medical notes was conducted. The patients were also asked to fill a satisfaction questionnaire.Results:Overall fusion rate was 91% with a mean hallux valgus angle of 15° (range 4–20°) and a mean dorsiflexion angle of 20° (range 7–30°). Complications included a case of failed fusion, a delayed union, and a case of persisting transfer metatarsalgia. At a mean followup of 14 months (range 5–28 months), the mean visual analog scale improved significantly from a mean of 8.4 (range 7–10) preoperatively, to a mean of 3.1 (range 0–7) postoperatively (P < 0.0001). The mean American Orthopaedic Foot and Ankle Society hallux score also significantly improved from 29.4 (range 10–54) to a mean of 73.3 (range 59–90) (P < 0.0001). The final result was satisfactory for 83% of the patients.Conclusions:The early results show intraosseous fixation to be a safe and efficient method for the fusion of the hallux MTP joint providing relief from pain and patient satisfaction.
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