ABSTRACT
Mycobacterium tuberculosis is one of the oldest and most studied infections, yet it remains one of the most common causes of infection-related death worldwide. The majority concern pulmonary tuberculosis. Therefore, extrapulmonary cases are rare and are often neglected in the differential diagnosis, especially in chronic musculoskeletal complaints. Nevertheless, osteoarticular manifestation of tuberculosis can cause disabling destruction of bone, cartilage, and surrounding soft tissues which may be exacerbated by a delay in diagnosis. This case report documents a case of primary osteoarticular tuberculosis causing septic arthritis of the wrist and carpus. In our case, the patient had no pulmonary burden of tuberculosis, which further delayed diagnosis and lead to irreversible damage to the wrist as well as carpus. This case illustrates the need to consider this diagnosis in at risk populations in order to prevent a delay in diagnosis and treatment.
ABSTRACT
Three-part proximal humerus fractures in the elderly continue to be difficult to surgically treat. We evaluated the Hawkins wiring (HW) technique, which utilizes figure-of-eight tension band wiring, to treat three-part proximal humerus fractures involving the greater tuberosity. Currently, there is a paucity of data detailing patient outcomes and radiographic follow-up of this technique. The purpose of this case series is to evaluate patient reported outcomes and radiographic follow-up for fractures treated with this technique. Over two years, six patients at our institution underwent HW to treat three-part proximal humerus fractures. Average DASH and Oxford Shoulder scores (OSS) were 20.4 (range, 1-40) and 40 (range, 33-46) respectively. All patients had satisfactory return of function after surgery. Radiographic union was achieved in all six patients and there were no reported complications. HW technique is an efficacious treatment for three-part proximal humerus fractures in elderly patients.
