ABSTRACT
Iatrogenic calcinosis cutis is due to the intravenous administration of calcium gluconate or calcium chloride to treat hypocalcemia. The arthors report three cases of calcinosis cutis with calcifications involving the upper or lower extremities in neonates following the extravasation of calcium gluconate. Three neonates, a 2-week-old girl, 4-week-old boy, and a 4-week-old girl, were consulted for indurated nodules after the intravenous administration of calcium gluconate at the intensive care unit. Complete remission of palpable nodule and calcification was observed on the radiograph at three weeks, four weeks and six months after the initial presentation in each. All three neonates with iatrogenic calcinosis curtis were resolved spontaneously without functional and cosmetic complications. According to enhancement of the patient's cognition about benign disease, a suitable explanation of the disease and avoiding unnecessary treatment through an early diagnosis of iatrogenic calcinosis cutis will reduce a number of potential medical malpractice disputes.
Subject(s)
Female , Humans , Infant, Newborn , Male , Administration, Intravenous , Calcinosis , Calcium Chloride , Calcium Gluconate , Calcium , Cognition , Dissent and Disputes , Early Diagnosis , Hypocalcemia , Intensive Care Units , Lower Extremity , MalpracticeABSTRACT
PURPOSE: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. MATERIALS AND METHODS: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. RESULTS: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p < 0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). CONCLUSION: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.
Subject(s)
Humans , Anti-Bacterial Agents , Arthroplasty , Arthroplasty, Replacement, Knee , Blood Sedimentation , C-Reactive Protein , Follow-Up Studies , Fungi , Hand , Infection Control , Joints , Knee , Range of Motion, Articular , Replantation , Retrospective StudiesABSTRACT
Periprosthetic joint infection (PJI) of the hip can be difficult to treat and can lead to a number of problems including: i) severe functional decline of the hip joint and ii) increasing financial burden for patients due to long treatment periods and the need for repeated surgical interventions. Because there is risk of inadequate control of infection or relapse of a preexisting infection following the treatment of PJI through surgery, it is important to closely observe clinical symptoms such as systemic fever. Kikuchi-Fujimoto disease is usually a self-limiting disease characterized by fever and cervical lymphadenopathy. We report one case of Kikuchi-Fujimoto disease, with literatures review, that was mistaken for an infection relapse after surgical treatment of the PJI due to sustained fever postoperatively.
Subject(s)
Humans , Fever , Hip Joint , Hip , Histiocytic Necrotizing Lymphadenitis , Joints , Lymphatic Diseases , RecurrenceABSTRACT
BACKGROUND: The aim of this study was to assess demographics, clinical outcomes, and complications of classic floating elbow in adults. METHODS: Six patients with ipsilateral diaphyseal fractures of the humerus, radius, and ulna were reviewed retrospectively. All patients were treated operatively and available for follow-up at a minimum of 1 year after surgery. The average age of the patients was 45.2 years (22-64 years) and the average follow-up period was 37.0 months (14-103 months). They were evaluated with postoperative outcome measures, including a visual analog scale (VAS) for pain, Mayo elbow performance score (MEPS), and American Shoulder and Elbow Surgeons (ASES) shoulder score. Residual complications were also evaluated. RESULTS: Five patients (83.3%) had open fracture, and 4 patients (66.7%) presented with associated nerve injury. All fractures were united within postoperative 4 months, except 1 delayed union. The average VAS pain score, MEPS, and ASES shoulder score at the final follow-up examination was 2.5, 79.8, and 67.5 respectively. Three patients including 2 cases of joint stiffness with incomplete recovery from nerve injury and 1 case of complex regional pain syndrome had poor clinical outcome. CONCLUSIONS: Although the classic floating elbow is rare, these injuries potentially have associated problems such as open fracture or nerve injury. The presence of residual neurological symptoms predispose to poorer clinical outcomes.
Subject(s)
Adult , Humans , Demography , Elbow , Follow-Up Studies , Fractures, Open , Humerus , Joints , Outcome Assessment, Health Care , Radius , Retrospective Studies , Shoulder , Ulna , Visual Analog ScaleABSTRACT
BACKGROUND: The aim of this study was to assess demographics, clinical outcomes, and complications of classic floating elbow in adults. METHODS: Six patients with ipsilateral diaphyseal fractures of the humerus, radius, and ulna were reviewed retrospectively. All patients were treated operatively and available for follow-up at a minimum of 1 year after surgery. The average age of the patients was 45.2 years (22-64 years) and the average follow-up period was 37.0 months (14-103 months). They were evaluated with postoperative outcome measures, including a visual analog scale (VAS) for pain, Mayo elbow performance score (MEPS), and American Shoulder and Elbow Surgeons (ASES) shoulder score. Residual complications were also evaluated. RESULTS: Five patients (83.3%) had open fracture, and 4 patients (66.7%) presented with associated nerve injury. All fractures were united within postoperative 4 months, except 1 delayed union. The average VAS pain score, MEPS, and ASES shoulder score at the final follow-up examination was 2.5, 79.8, and 67.5 respectively. Three patients including 2 cases of joint stiffness with incomplete recovery from nerve injury and 1 case of complex regional pain syndrome had poor clinical outcome. CONCLUSIONS: Although the classic floating elbow is rare, these injuries potentially have associated problems such as open fracture or nerve injury. The presence of residual neurological symptoms predispose to poorer clinical outcomes.
Subject(s)
Adult , Humans , Demography , Elbow , Follow-Up Studies , Fractures, Open , Humerus , Joints , Outcome Assessment, Health Care , Radius , Retrospective Studies , Shoulder , Ulna , Visual Analog ScaleABSTRACT
PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of the trochanteric flip osteotomy in cases of femoral head fractures. MATERIALS AND METHODS: Between May 2000 and January 2012, we evaluated 14 cases of femoral head fractures treated by trochanteric flip osteotomy in combination with the Kocher-Langenbeck approach after a minimum follow-up of one year. There were 13 men and one woman and the average follow-up period was 36.4 months. The clinical results were evaluated according to Merle d'Aubigne-Postel scores and the Thompson-Epstein scoring scale and the radiological results were evaluated according to time to union of fractures and osteotomy site. We also evaluated the incidence of complications. RESULTS: At the last follow-up, mean Merle d'Aubigne-Postel score was 16.4 and 11 cases out of 14 patients presented with good to excellent, two cases presented with fair, and one case presented with a poor clinical result according to the Thompson-Epstein scoring scale. Radiologically all cases achieved union of fractures and osteotomy site and the mean time to union of the osteotomy site was 7.9 weeks. Complications included one case of heterotopic ossification which did not disturb hip function, two cases of avascular necrosis of the femoral head, and one case of post-traumatic osteoarthritis. CONCLUSION: The trochanteric flip osteotomy in the case of a femoral head fracture showed good clinical and radiological results through good visualization and accurate reduction of the fracture site. However, conduct of further studies including larger number of patients is needed in order to evaluate the incidence of complications such as avascular necrosis of the femoral head.