RESUMEN
Treatment of osteonecrosis of the femoral head appears to be effective when the disease is identified and treated early. Forty-one patients were evaluated with prospective laboratory assessment, anteroposterior and frog-lateral roentgenograms of both hips, intraosseous pressure measurements (IOP), magnetic resonance imaging (MRI), and 99mTc methylene diphosphonate planar and single-photon emission computerized tomographic (SPECT) bone imaging. Pathologic specimens were obtained in most patients. Preradiographic disease was identified in 26 hips and 11 of these were asymptomatic. Fifteen clinically symptomatic hips had normal plain roentgenograms, but abnormal protocol studies. Evaluation of sensitivity, specificity, and predictive value (positive and negative), respectively, in diagnosing osteonecrosis of the femoral head revealed the following percentages: 83%, 83%, 96%, and 48% for planar bone scanning; 91%, 78%, 94%, and 70% for SPECT; 87%, 83%, 96%, and 55% for MRI; 80%, 60%, 95%, and 25% for IOP; and 88%, 100%, 100%, and 25% for core biopsy. (There were few true negatives, thus specificity values are approximations.) The identification of preradiographic stages is possible, but difficult. MRI appears appealing at present, particularly in identifying disease in asymptomatic hips. However, there is no definitive method for noninvasive diagnosis. Pathologic confirmation in early stages is difficult.
Asunto(s)
Diagnóstico por Imagen , Necrosis de la Cabeza Femoral/diagnóstico , Adolescente , Adulto , Anciano , Huesos/patología , Femenino , Articulación de la Cadera/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Presión , Radiografía , Medronato de Tecnecio Tc 99m , Tomografía Computarizada de EmisiónRESUMEN
To review infectious morbidity in extremity fractures, 265 patients with 280 open fractures and 573 patients with closed fractures requiring open reduction and internal fixation (ORIF) were reviewed. Among open fractures, 32 (11%) became infected. Significantly fewer infections occurred in open fractures secondary to gunshot wounds (p less than 0.01) and in the upper extremity regardless of cause (p less than 0.05). Preventive preoperative antibiotics did not appear to affect infection rates. Open fracture infections were consistently with hospital-acquired organisms, and these were consistently resistant to the preventive antibiotic employed. Closed fractures had only 18 (3%) infections after ORIF. Preoperative antibiotics did reduce infection rates compared to rates in patients with no preoperative systemic antibiotics (p less than 0.05). Pathogens in ORIF patients showed a greater preponderance of Staphylococci. In conclusion, preventive antibiotics were only effective in the prevention of infection in the ORIF patients. Open fracture patients consistently develop infections with hospital-acquired pathogens, suggesting that contamination after hospitalization rather than at the time of injury is a major factor.
Asunto(s)
Antibacterianos/uso terapéutico , Fracturas Óseas/cirugía , Infección de la Herida Quirúrgica/prevención & control , Humanos , Estudios RetrospectivosRESUMEN
This is a case report of a fifty-nine-year-old rheumatoid arthritic woman who developed lack in finger extension bilaterally. These deficits had two completely different aetiologies, Posterior Interosseous Nerve (PIN) Syndrome and extensor tendon rupture. No previous report in the literature has used elbow arthrography as a diagnostic tool in a patient with PIN Syndrome. Elbow arthrography confirmed the abnormality at this joint and aided in appropriate management.