Distal radius fractures are among the most common pediatric fractures. In unstable fractures, treatment methods include closed or open reduction and percutaneous pinning with Kirschner wire (K-wire). This report presents a 13-year-old boy with an unstable distal radius and ulnar fractures, following an accident, who was treated with open reduction and K-wire fixation. He had pain and limited wrist range of motion for 6 months. Conventional radiography revealed a lytic lesion with evident sclerotic margin. Chronic osteomyelitis and Brodie's abscess were also indicated. A complete curettage and antibiotic therapy for 3 months was successful. Culturing results showed that Staphylococcus aureus and pathologic findings were in favor of chronic osteomyelitis. Subacute osteomyelitis and Brodie's abscess are rare retarded complications in percutaneous pinning of distal radius pediatric fractures. The curettage of the lesion and antibiotic therapy for at least 3 months would be successful and could result in good prognosis among children.
Management of proximal tibial fractures is a challenging issue in patients with rheumatoid arthritis (RA). In the present study, we aimed to describe our experience of acute total knee replacement in RA patients.This case series included 11 RA patients with simultaneous insufficiency fractures of the proximal tibia, who were treated by acute total knee replacement. Midterm functional results, severity of pain, Hospital for Special Surgery (HSS), and Knee Society Score (KSS) parameters were evaluated in this study. The patients were followed up for 24 months.Eleven women with proximal tibial fractures and history of RA (mean age: 54.3 ± 4.7 years) were enrolled in this study. The mean score of Tegner activity scale was 2.2 ± 1.4 preoperatively, which significantly improved to 4.3 ± 1.4 postoperatively (p < 0.001). The two sections of KSS (knee and function section) averaged 88.7 ± 5.4 and 59.4 ± 8.2, respectively. There wasn't poor outcome and excellent result was in knee section 54.5% and function section 36.3% based on KSS. The mean score of pain severity during normal activity before fracture was 65.2 ± 12.3, which significantly reduced to 35.5 ± 11.3 in the final follow-up (p = 0.02). The score of HSS scale improved from 42 (range: 16–58) in the preoperative stage to 78 (range: 72–91) after surgery (p < 0.001). In the 6-month follow-up, deep vein thrombosis was reported in two patients. The time required to return to normal activity was 5.5 ± 2.3 months.Based on the findings, total knee replacement therapy in patients with RA and proximal tibial fractures produced excellent clinical outcomes, which led to rapid return to normal activity. This is a Level IV, therapeutic study.
Introduction: Skeletal involvements are less reported in tuberculosis and even less likely observed in fingers. Fingers are rarely involved in adults and it often has been reported in children under 5 years old. Most likely, a recent condition in adult patients is required to provoke reactivation of bacilli lodged in the bone during the original mycobacteremia of primary infection. Case Presentation: In this report, a 31-year-old female patient, suffered from detached extensor tendon due to the fourth finger trauma, was diagnosed as a Mallet finger and treated by closed percutaneous pining is introduced. The patient had chronic swelling and progressive pain in the same finger for six months after treatment. The common anti-inflammatory and antibiotic therapy was not successful. Radiographic images of the ring finger demonstrated erosion and irregularity of the articular surfaces around the distal interphalangeal join (DIP). She expressed a history of untreated cough and exposure to people with tuberculosis. A positive tuberculosis (TB) skin test was determined with more than 10mm induration. Treatment with anti-tuberculosis medication regimen was successful and continued for 12 months. Conclusions: Skeletal tuberculosis should always be considered by physicians in endemic areas. A slow progression of the disease in skeletal involvement and lack of clinical suspicion can lead to misdiagnosis. Using anti-tuberclusis medications for an appropriate period is effective in the disease control and treatment of patients.
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