ABSTRACT
All cases of spondylodiscitis diagnosed in our hospital between January 93 and April 96 have been analysed retrospectively. With regard to potentially severe complications, spondylodiscitis is an important differential diagnosis of back pain. In our results 50% of the patients had a positive bacterial culture either from blood or tissue. No complication has been observed. The most relevant diagnostic procedures are: determination of CRP, magnetic resonance imaging and eventually computed tomography in combination with biopsy and blood cultures. Magnetic resonance imaging is a very sensitive method for early stage osteomyelitis. Antimicrobial therapy should be based on the result of culture and sensitivity tests. An antibiotic with good penetration into bone is preferred.
Subject(s)
Back Pain/etiology , Bacterial Infections/diagnosis , Discitis/diagnosis , Aged , Aged, 80 and over , Back Pain/drug therapy , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacterial Infections/drug therapy , Bacteriological Techniques , Diagnosis, Differential , Discitis/drug therapy , Female , Humans , Intervertebral Disc/microbiology , Intervertebral Disc/pathology , Magnetic Resonance Imaging , Male , Microbial Sensitivity Tests , Middle Aged , Tomography, X-Ray ComputedABSTRACT
The mode of treatment for femoral neck fractures at the Kantonsspital Liestal depends on age primarily. Patients over 70 years of age are treated with a unipolar endoprosthesis. Screws are being used in cases of medial femoral neck fractures, DHS in cases of lateral fractures. Total hip arthroplasty is only indicated in patients with evident osteoarthritis. 78 femoral neck fractures were seen in a 3-year-period. 50 endoprostheses were used in 49 patients. The mean age at time of surgery was 80 years. 70% of the patients have died at a mean survival time of 2 1/4 years. 13 out of a total of 14 surviving patients were investigated. The follow-up of 10 surviving patients reveals radiographically a mild protrusion in one case only. Clinically all 13 surviving patients are not compromised by the endoprosthesis after 5 years. We consider the implantation of a unipolar endoprosthesis in patients with femoral neck fractures at age over 70 years the treatment of choice. There is an acceptably low risk for protrusion as a late complication in regard to a reduced life expectancy.
