Open talar dislocations without associated fractures.

AIM: Total dislocation of the talus first reported in 1680. It is a rare injury and without associated fractures is even rarer. Is generally considered to be one of the most disabling ankle injuries and occurs after high energy trauma. The primary goal of our study is the retrospective evaluation of complete talar extrusion without associated fractures and immediate reimplantation. MATERIALS AND METHODS: In the past nine years, nine patients with mean age 31.7 years were admitted to our center with a complete open talar extrusion. The dislocated talus was reduced and held in place with two Steinmann pins placed from the inferior aspect of the calcaneus, through the talus and into the inferior aspect of the tibia. An external fixator was used to stabilize the limb. The mean follow up time was 21.1 months. At the last follow up visit, six patients were evaluated both radiographically and functionally with the AOFAS score. RESULTS: Six patients were free of complications and the mean AOFAS Ankle-Hindfoot Scale score at the time of the last follow up visit was 82.5. Two patients had an infection, one had avascular necrosis of the talus and one had signs of subtalar joint arthritis. Two patients had to undergo arthrodesis. CONCLUSIONS: It is important to attempt reimplantation of the talus since a good final outcome is to be expected. Even in the case of a catastrophic complication this technique will ensure adequate bone stock for additional surgical procedures.

Sonication: a valuable technique for diagnosis and treatment of periprosthetic joint infections.

BACKGROUND: Periprosthetic joint infection (PJI) is the most severe complication, following joint arthroplasty. Identification of the causal microbial factor is of paramount importance for the successful treatment. PURPOSE: The aim of this study is to compare the sonication fluid cultures derived from joint prosthetic components with the respective periprosthetic tissue cultures. METHODS: Explanted prosthesis components for suspected infection were placed into a tank containing sterile Ringer's solution and sonicated for 1 minute at 40 kHz. Sonication fluid cultures were examined for 10 days, and the number and identity of any colony morphology was recorded. In addition, periprosthetic tissue specimens (>5) were collected and cultured according to standard practice. The duration of antimicrobial interruption interval before culture sampling was recorded. RESULTS: Thirty-four patients composed the study group. Sonication fluid cultures were positive in 24 patients (70.5%). Sixteen of thirty four periprosthetic tissue cultures (47.1%) were considered positive, all revealing the same microbial species with the respective sonication fluid cultures: 3 tissue samples showed polymicrobial infection. All tissue cultures were also found positive by the sonication fluid culture. CONCLUSIONS: Sonication fluid cultures represent a cheap, easy, accurate, and sensitive diagnostic modality demonstrating increased sensitivity compared to periprosthetic tissue cultures (70.5 versus 47.1%).

Treatment of osteitis pubis in non-athlete female patients.

BACKGROUND: Osteitis pubis represents a non-infectious inflammation of the pubic symphysis causing varying degrees of lower abdominal and pelvic pain. Although, the disease is believed to affect mainly young athletic patients, it is also encountered in other specific patient groups. Both conservative and surgical treatment options are available. While for elite athletes surgical treatment is indicated, leading to fast pain relief and mobilization, for non-athletic patients no clear indication can be established. METHODS: Eight non-athletic women with osteitis pubis, referred to our Department for treatment, were evaluated. All were initially treated conservatively with bed rest, per os non steroidal anti-inflammatory drugs and physical therapy. RESULTS: Seven patients improved significantly with conservative treatment while one displayed no improvement and was treated surgically with arthrodesis. CONCLUSION: We conclude that, for non-athletic female patients suffering from osteitis pubis, surgery is rarely required and that conservative treatment by means of non steroidal anti inflammatory drugs and physical modalities represents a fair option regarding pain and limitation of everyday activity.

Recto-femoral fistula presenting as emphysematous cellulitis of the knee: a case report & literature review.

Purpose. The rectofemoral fistula represents a devastating complication of colorectal surgery. Its early diagnosis and treatment are critical to obtain a good patient outcome. Case Presentation. A 75-year-old Caucasian female patient presented with high fever, ileus, low back pain, sciatic nerve palsy, and infection of the right knee. After numerous surgical debridements and antibiotic therapies, a rectofemoral fistula was diagnosed. Conclusion. Increased doctors' alertness is mandatory for the early identification and surgical treatment of patients suffering from a rectofemoral fistula before the stage of diffuse infection has significantly decreases their postoperative morbidity and mortality.