Objective:
High bacterial load contributes to chronicity of wounds and is diagnosed based on assessment of clinical signs and symptoms (CSS) of infection, but these characteristics are poor predictors of bacterial burden. Point-of-care fluorescence imaging (FL) MolecuLight
i:X
can improve identification of wounds with high bacterial burden (>10
4
colony-forming unit [CFU]/g). FL detects bacteria, whether planktonic or in biofilm, but does not distinguish between the two. In this study, diagnostic accuracy of FL was compared to CSS during routine wound assessment. Postassessment, clinicians were surveyed to assess impact of FL on treatment plan.
Approach:
A prospective multicenter controlled study was conducted by 20 study clinicians from 14 outpatient advanced wound care centers across the United States. Wounds underwent assessment for CSS followed by FL. Biopsies were collected to confirm total bacterial load. Three hundred fifty patients completed the study (138 diabetic foot ulcers, 106 venous leg ulcers, 60 surgical sites, 22 pressure ulcers, and 24 others).
Results:
Around 287/350 wounds (82%) had bacterial loads >10
4
CFU/g, and CSS missed detection of 85% of these wounds. FL significantly increased detection of bacteria (>10
4
CFU/g) by fourfold, and this was consistent across wound types (
p
< 0.001). Specificity of CSS+FL remained comparably high to CSS (
p
= 1.0). FL information modified treatment plans (69% of wounds), influenced wound bed preparation (85%), and improved overall patient care (90%) as reported by study clinicians.
Innovation:
This novel noncontact, handheld FL device provides immediate, objective information on presence, location, and load of bacteria at point of care.
Conclusion:
Use of FL facilitates adherence to clinical guidelines recommending prompt detection and removal of bacterial burden to reduce wound infection and facilitate healing.
We report a case of delayed closed rupture of the tendon of extensor indicis proprius in a skeletally immature individual. This occurred following a minor greenstick fracture during use of a gymnast's wrist-finger support. To our knowledge this unusual complication has not been described previously. Keywords: Tendon rupture, fracture, gymnast's wrist support A 16-year-old male gymnast sustained an injury to the right wrist while on the high bar. The leather wrist-finger support stuck on the bar causing a hyperflexion injury. The support is placed over the fingers and held in place by a canvas strap around the forearm (Figure 1).At the time of his admission, 4 h after injury, he had no neurovascular deficit and full hand function. Radiographic examination revealed an angulated greenstick fracture of the distal radius (Figure 2), which was manipulated into an anatomical position under general anaesthesia. There was full forearm rotation with no subluxation of the distal radioulnar joint. An above-elbow plaster-of-Paris cast was applied with the forearm in supination. On discharge the following day he was pain free and had full neurovascular and tendinous function. The patient noted inability to extend his right index finger 3 days after injury. He did not seek advice until his routine follow-up appointment 1 week after injury. At this time the absence of active extension of the index finger was confirmed. He reported no pain under the cast, the radiography showed maintenance of the anatomical reduction of his fracture. The cast was removed to allow full examination of the hand and wrist. The inside of the cast was smooth and had not caused localized pressure on the skin. A tense swelling was present in the fourth extensor compartment.Surgical exploration of the fourth extensor compartment confirmed the presence of a large haematoma. The extensor indicis proprius tendon was contused and ruptured at the musculotendinous junction. The extensor communis slip to the index finger was also badly contused but found to be intact.The distal stump of the ruptured tendon was tenodesed to the intact communis slip. The patient made a satisfactory postoperative recovery. At 3 months after surgery he had full forearm and hand function, including full finger extensor power and no extensor lag (Figure 3).
Buprenorphine augmentation of standard treatment for OCD can result in clinically meaningful improvement in a proportion of refractory OCD cases. Further treatment trials are indicated.
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