• 期刊
• OpenAccess

Latent spondylodiscitis following elbow cellulitis: A case report and literature review

Spondylodiscitis is usually caused by hematogenous spread, and recently there have been only a few published reports citing the soft tissue as the hematogenous source. We present an unusual case of pyogenic spondylodiscitis following elbow cellulitis. In addition to white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values, we checked the procalcitonin (PCT) level to confirm if the infection was in acute phase. Although the patient’s fever subsided after administration of antibiotics, the neurologic claudication worsened, and we performed an anterior debridement and interbody fusion combined with posterior instrumentation. The direct lateral retroperitoneal approach, which we adapted, has the advantage of excellent exposure for irrigation, debridement, and reconstruction without requiring blood vessel mobilization or manipulation of the peritoneal contents. After surgery, intravenous antibiotics were administered for 6 weeks, followed by oral antibiotics until the CRP normalized and the ESR was decreasing. The patient made an uneventful recovery, with no significant neurologic sequelae reported at outpatient follow-up evaluations. The purpose of this case report is to inform clinicians of the potentially severe complication of spondylodiscitis following cellulitis and describe a modified approach to surgical treatment.

• 期刊
• OpenAccess

Unusual extra-articular gouty tophi mimicking Pellegrini-Stieda disease: A rare case report

Gouty arthritis is a form of inflammatory arthritis, most prevalent among middle-aged to elderly men and postmenopausal women as well. The radiograph of extra-articular gouty tophi presented with calcification at medial collateral ligament (MCL) of knee is uncommon. We describe a case of the 68-year-old woman with intermittent left knee pain for one year who had extra-articular calcification. After the failure of conservative treatment, she received excision under the impression of Pellegrini-Stieda disease according to the calcification location and size near the MCL of left knee. However, the postoperative pathological examination showed tophaceous gout, which was not compatible with our preoperative diagnosis. Back to preoperative survey, ultrasonography or dual-energy computed tomography may help us to make correct diagnosis. Thus, the patient may need not excision, but medical treatment. In addition, we also discuss the differential diagnosis of extra-articular calcification in this article.

• 期刊
• OpenAccess

Stress fractures of metatarsal after subtalar arthroereisis in an adolescent with symptomatic pes valgus: A case report

The incidence of complications of subtalar arthroereisis has been reported to be wide ranging. We describe a rare case of stress fracture of the lesser metatarsus after subtalar arthroereisis. Conservative treatment with short leg casting and non-weight bearing was performed for four weeks. The fracture united uneventfully. Post-operative gait training, including avoiding persistent hindfoot inversion, should be mentioned to the patient before surgery.

• 期刊
• OpenAccess

Late shedding of uncemented cup-Retrieval analysis and postulate the mechanism of failure

Uncemented modular acetabulum components demonstrate a lower rate of radiographic loosening. However, most of late failure was caused by the osteolysis, inducing bone destruction and loss of fixation. Loosening of the well-fixed cup caused by late shedding of the ingrowth surface of uncemented cup is a rare complication. We report of three cases, and through retrieval analysis of the cup we postulate the possible mechanism of late shedding of well-fixed cup. We found that improper position of the cup and eccentric polyethylene (PE) wear may cause impingement of the cup by neck and increase tensile and shear forces which may cause late shedding of good bone-ingrowth cup. Early revision of the eccentric wear PE is indicated for prevention of this complication.

• 期刊
• OpenAccess

Middle term result of two-stage total knee arthroplasty for prosthetic knee joint infection

Introduction: The treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a challengeable task. Two-stage exchange arthroplasty is a commonly used treatment for chronic PJI. Purpose: The aim of this study was to investigate the successful rate and possible failure risk factors in patients undergoing a planned two-stage exchange arthroplasty for treatment of knee PJI. Methods: From March 2004 to February 2015, we retrospectively reviewed 35 patients have more than 36 months clinical follow-up with periprosthetic knee joint infections. The clinical outcomes were recorded to define the successful or fail treatment for the periprosthetic knee joint infections. Multiple factors such as obesity, comorbidities, diabetes, were recorded and analyzed to evaluate the risk factors of poor outcome. Results: Five patients were unable to receive second stage surgery with cement spacer retained due to variable reasons. Three patients ended with amputation due to uncontrolled infectious process. Overall 27 patients received two-stage exchange arthroplasty to treat knee PJI were analyzed in this study. However, two patients were loss follow-up during the period between 1st and 2nd time surgery. Two patients were treated with static cement spacer due to poor soft tissue condition. These 4 patients were excluded and overall 23 patients were included and analyzed. Overall success rate is 78.26%. 4 patients with recurrent infection were treated with additional surgical debridement. One patient with recurrent infection was treated with the second time two-stage arthroplasty. All of these patients were successful treated without further recurrent infection. Conclusion: We found that failure rate is increasing when considerate the failure between first stage and second stage surgery. In addition, patients without more than 36 months follow-up may have infection free due to honeymoon period but still in risk of reinfection.

• 期刊
• OpenAccess

Hip arthroscopy for the intra-articular sequelae after Thompson-Epstein type I-II traumatic hip dislocation: A 2-year minimal follow-up

Background: Traumatic hip dislocation is a usually high-energy injury and often leads to serious intra-articular pathologies. Hip arthroscopy is an increasingly popular minimally invasive procedure for intra-articular conditions. Purpose: This study was designed to review the arthroscopic diagnosis and treatment for mechanic hip symptoms after traumatic hip dislocation and evaluate clinical outcomes. Methods: Seven consecutive patients treated with arthroscopy for mechanical hip symptoms after traumatic hip dislocation between 2005 and 2014 were enrolled in the study. We use Tonnis classification for evaluation of hip osteoarthritis by preoperative and the last follow-up plain radiography. Visual analogue scale (VAS), modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item short-form (SF-12) were obtained for clinical outcome assessment. All patients were followed up for a minimum of 2 years. Results: The average age of the patients when undergoing hip arthroscopy was 32.7 years. The interval from injury to arthroscopy ranged from 3 days to 2 years, with a mean of 353 days. The mean operative time was 165 mins. Loose bodies were found in 6 patients. Four patients had labral tears, five had ligamentum teres lesions and six had chondral injuries at the femoral head or acetabulum. All preoperative clinical functional scores improved at last follow-up. The mean length of postoperative hospital stay was 2.6 days. No patients had surgery-related complication. Conclusion: Hip arthroscopy is a powerful tool to detect loose bodies or intra-articular fragments after traumatic hip dislocation and provides good-to-excellent clinical outcomes. For patients with mechanic hip symptoms after traumatic hip dislocation, early referral for hip arthroscopy surgeon is recommended.

• 期刊
• OpenAccess

External locked plating as the definitive treatment for open proximal tibial fractures-A biomechanical feasibility study

Background: Open proximal tibial fractures are associated with significant morbidity due to increased risks of infection, nonunion, malunion, knee stiffness, and possible amputation. Several authors demonstrated the benefits of bridging external fixation followed by definitive internal fixation once the soft-tissue envelope had sufficiently healed. We recently demonstrated the benefits of external locked plating followed by definitive internal fixation. Purpose: The purpose of this study was to evaluate the biomechanical feasibility of definitive external locked plating for open proximal tibial fractures. Methods: Two types of constructs were tested: (1) internal locked plate fixation (ILPF) and (2) external locked plate fixation (ELPF). Specimens were evaluated under static or dynamic axial loading to assess construct stiffness, strength, durability and failure mode. Results: The mean of construct strength of the ILPF and ELPF groups was 2147.4 ± 460.56 N and 793.2 ± 96.78 N, respectively. The mean of construct stiffness of the ILPF and ELPF groups was 384.01 ± 40.37 N/mm and 87.35 ± 7.40 N/mm, respectively. Conclusion: In this study, external locked plating showed biomechanical flexibility and could reduce construct stiffness to promote fracture healing by callus formation. However, ELPF constructs were not as strong as standard locked plating constructs. If we want to use ELPF constructs as definitive treatment, further biomechanical study to improve construct strength is warranted.

• 期刊
• OpenAccess

Modified knee extension training for treatment of patellar malalignment

Background: Patients with patellar malalignment (PM) are common in orthopedic clinics. Conservative treatment first for PM is generally supported. Generally, reinforcing vastus medialis obliquus (VMO) strength is most convincing. Knee extension had been reported to be able to initiate VMO activities in electromyogram (EMG). Also, goosestep training had been reported to be able to upraise VMO/vatus lateralis (VL) ratio in EMG. Purpose: The purpose of this prospective study was to investigate clinical effects of modified knee extension training on treating lateral patellar tilt or subluxation. Methods: Thirty-seven consecutive adult patients (average: 52 years) were treated with modified knee extension training. It was performed once each day and each time needed 50 times (about one minute). Plain knee radiographs of anteroposterior, lateral, and Merchant's axial views were taken before treatment. Exclusion criteria were trochlear dysplasia (＞ 144° of sulcus angle), patellar alta or dislocation, symmetrical mediolateral patellofemoral (P-F) joint space (P-F index = 1), and snapping hips clinically. Ten weeks later, clinical outcome using modified Kujala score (5 items with 40 points) and Merchant's axial radiograph (congruence angle, lateral P-F angle, and P-F index) were compared statistically. Results: All 37 patients with 68 knees (32 bilaterally and 4 unilaterally) were followed at the outpatients' department (OPD) at 10-12 weeks. Before treatment, none of patients were satisfactory (average knee score: 27.2 points). At the latest follow-up, 89% of patients (33/37) were satisfactory (p ＜ 0.001) with an average knee score of 33.1 (p = 0.01). Only the P-F index was statistically significant before and after treatment (3.6 vs. 2.1, p ＜ 0.001) on Merchant's axial radiographs. Conclusion: The described technique may be one of excellent techniques for conservative treatment of PM. The technique is simple and an 89% success rate is relatively acceptable. The P-F index may be practical for follow-up of treatment effect.

• 期刊
• OpenAccess

Slipped capital femoral epiphysis due to pituitary hypoplasia related panhypopituitarism: Case report and review of literature

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents, and it has a prevalence of 10.8 cases per 100,000 children. SCFE in adults is uncommon, with only 22 cases reported in the literature, and only 10 of them were related to panhypopituitarism. This article presents a 26-year-old man with panhypopituitarism who developed pain in the left hip and knee that proved to be a slipped femoral capital epiphysis, he was treated by in situ pinning and hormone replacement therapy. Most patients with congenital hypopituitarism present at young age when short stature is noted during childhood. This case with normal body height and had no medical care until the presentation of SCFE, which is unusual for hypopituitarism.

• 期刊
• OpenAccess

The spinal cord ischemia detected by evoked potentials: The first pediatric scoliosis surgical case report in Taiwan

While iatrogenic neurologic deficits peri-operatively are possible in pediatric scoliosis correction, postoperative deficits are relatively more common in adolescents with early onset scoliosis (EOS) under maximal correction. For early prevention of the spinal cord at risk during surgery, the neurophysiologic intraoperative monitoring (NIOM) plays a critical role. This article will present a case about spinal cord ischemia injury detected by NIOM of a twelve-year-old girl with EOS. The application of NIOM and monitoring the spinal cord ischemia in pediatric scoliosis surgery should be considered essential for surgical quality and patient's safety via early detection of neurophysiologic signals change. In sum, the profession of NIOM should be introduced and promoted into the clinical practice in Taiwan in the future.