Septic arthritis due to penicillin resistant neisseria gonorrhoeae unusual host and pathogen combination

Gonococcal infection is not commonly reported in our area. It should be kept in mind that Nisseria gonorrhoeae may cause septic arthritis resulting in a serious orthopedic problem. Penicellinase producing gonococci are appearing more nowadays. The typical host of this condition is female in the child bearing period. The presentation of such condition may be atypical. During the period 2004 to 2006 we received in AL-RAZI hospital three cases of acute gonococcal arthritis two of them had atypical presentation. We report these three cases with the diagnostic and therapeutic implications

Ochronotic knee arthyropathy

Homogentesic acid oxidase deficiency is associated with a rare metabolic disorder known as alkaptonurea or ochronosis. We report a patient with clinical and radiolgic findings of ochronosis affecting the spine and knee joints. Total joint replacement was performed to control severe right knee pain

Closed reduction and percutaneous fixation of non-osteoporotic tibial plateau fractures

To highlight the advangages and disadvantages of closed reduction and percutanous fixation technique in patients with tibial plateau fractures type I and II accord i n g to the Schatzker classification. Venue: Al-Razi Orthopedic Hospital, Kuwait. Material and methods: A prospective study included 23 patients with different types of tibial plateau fractures classified according to Schatzker classification. They were treated with closed reduction and percutaneous cannulated screw fixation to minimize surgical trauma. Our patients were followed up for a minimum of 18 months. We had 74% excellent results in type I fractures and 50% excellent results in type II with no statistical difference between these two types [p = 0.735]. The results were comparable to other publications using the same technique. Our results were also compared to those using arthroscopically assisted technique

Modified obtuse - angled lateral exposure of the calcaneum

The objective of this study was to compare the incidence of postoperative skin healing problems between the classic extensile lateral calcaneal approach and a modified obtuse-angle lateral exposure during the period 1994-2003. The classic extensile lateral calcaneal approach as described in the literature was used in 55 cases of calcaneal fractures, while the obtuse-angled approach was used in other 39 cases. The latter needed a short vertical limb with maximal posterior shift of its proximal end, in addition to an obtuse angle [>120 degrees] between the vertical and horizontal limbs. 16% of skin healing complications with variable degrees of severity were seen with the classic extensile lateral exposure, while no complication was encountered with the modified obtuse-angled lateral exposure

Treatment of delayed union and non-union of humeral shaft fractures using humeral locked nails

To assess the results and clinical outcome of treating humeral shaft delayed union and non-union using locked medullary nails. 21 cases of humeral shaft delayed union and non-union were treated by Russel and Taylor humeral locking nail at Al Razi hospital in the period from 1997 to 2001. 8 cases had delayed union and 13 had non-union. 13 cases had previous operative treatment while 8 cases had non-operative treatment. Antegrade nailing was done in all cases and all nails were fixed statically. 19 cases had their fractures united. Only 2 cases had persistent non-union. 18 cases had satisfactory shoulder function and 3 cases had loss of shoulder abduction between 40 and 65 degrees. The humeral locked nails can achieve satisfactory clinical results in treating humeral shaft delayed unions and non-unions

Hybrid external fixation in treatment of High energy Tibial plateau fractures

Small wire hybrid external fixation with supplementary minimal internal screws fixation presents an alternative method of adequate stabilization of high energy tibial plateau fractures. Twenty-two patients having Schatzker type V or IV high energy tibial plateau fractures were treated with this technique Minimum follow-up period was 12 months. Healing was seen in all fractures. There were 12 cases of pin tract infection and no case of septic arthritis. Two cases with residual fixed flexion deformity of 5-10 degrees were encountered in addition to three cases with radiologic evidence of lateral arthrosis. According to Rasmussen functional and radiologic scoring system nineteen cases out of twenty-two [86 percent] were scored as satisfactory. This technique avoids the devastating complications of the formal open reduction and internal fixation including surgical wound problems, infection and osseous tissue devitalization. In addition, it allows early mobilization and weight bearing

Posterior reduction, transpedicular screw fixation and fusion in the treatment of adult spondylolisthesis

To assess the results and clinical outcome of treating adult spondylolisthesis by posterior transpedicular screw fixation and spinal fusion. Thirty two cases of various degrees of spondylolisthesis including isthmic degenerative and iatrogenic types were treated at Al Razi Orthopedic Hospital in Kuwait between 1998 and 2001 by posterior reduction and pedicular screw fixation with posterior or posterolateral spinal fusion. Two spinal systems were used in this study, SOCON-SRI from Aesculap and USS from Synthes. The mean follow up period was 21.8 months. In thirty cases [93.8 percent], solid fusion was obtained with mean correction of percentage of slippage from 44 percent to 18 percent. Twenty seven patients [84.4 percent] had satisfactory functional recovery. Transpedicular screw fixation with posterior fusion offers a reliable and satisfactory treatment option of adult spondylolisthesis with high rate of successful fusion and functional recovery