ABSTRACT
We present an unusual case of haematogenous osteomyelitis in the diaphysis of the tibia of an adult leading to a subacute presentation with an extracortical abscess. Fluid from the abscess grew methicillin resistant Staphylococcus aureus (MRSA) on culture; MRSA with the same antibiogram had been grown from the patient's blood seven years earlier following a bowel resection. Drainage of the abscess and curettage of the bone lesion together with appropriate antibiotic therapy led to resolution of the osteomyelitis.
Subject(s)
Abscess/surgery , Methicillin-Resistant Staphylococcus aureus , Osteomyelitis/surgery , Staphylococcal Infections/surgery , Abscess/pathology , Adult , Humans , Magnetic Resonance Imaging , Male , Musculoskeletal Pain/microbiology , Osteomyelitis/pathology , Staphylococcal Infections/pathology , TibiaABSTRACT
INTRODUCTION: The objective of this study was to assess if there is a significant learning curve in the treatment of developmental dysplasia of the hip. PATIENTS AND METHODS: We followed up cases of developmental dysplasia of the hip treated by a single surgeon over a 12-year period. There were 96 cases, 56 treated by open reduction and 40 treated by closed reduction. Assessment was made of the incidence and degree of avascular necrosis in the treated hips, as a radiological outcome measure. RESULTS: Plotting the cumulative percentage of satisfactory outcomes demonstrated an increasingly high percentage of satisfactory results with increasing number of procedures performed, i.e. as the surgeon progressed up the 'learning curve'. CONCLUSIONS: This study demonstrates a learning curve in the treatment of developmental dysplasia of the hip. It may be possible to draw parallels to other treatments, and also support for the growing trend to specialisation.
Subject(s)
Clinical Competence/standards , Hip Dislocation, Congenital/surgery , Orthopedic Procedures/standards , Orthopedics/education , Humans , Infant , Medical Audit , Retrospective Studies , SpecializationABSTRACT
We present a study of the pressures developed at the bony prominences (greater trochanter, iliac crest and sacrum) when a pelvic binder was applied to 10 healthy individuals. The pressures developed between the pelvic binder and the skin over the prominences were all greater than the pressure recommended at interfaces to avoid the development of pressure sores. This suggests that patients with pelvic fractures who are treated with temporary pelvic binders are at risk of developing pressure sores. This should be recognised and the skin inspected if the binder is to be in place for a prolonged period.
