Arthroscopic Removal of a Missed Wooden Foreign Body in the Metacarpophalangeal Joint.

We report a case of a missed wooden foreign body in the metacarpophalangeal (MP) joint of the right little finger following a workplace injury. The patient presented to our institution with a persisted pain and limited range of motion of the MP joint 1 week following the injury. Plain radiographs detected no foreign body or fractures. However, detailed examination as ultrasonography (USG) and computed tomography revealed the presence of a foreign body of 10 × 1.5 mm size in the MP joint capsule. The excision of the radiolucent foreign body was performed arthroscopically and was confirmed successful removal using intraoperative USG. The foreign body was recognized as a wooden piece. The patient was immediately pain free postoperatively and regained full range of motion. Arthroscopy can be a practical, reliable method to remove a radiolucent foreign body located in a small joint in a minimally invasive manner, and USG can help surgeons confirm no remnants left.

Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique.

Background: Primary aim to identify the ideal medial joint gap in extension needed to prevent post-operative flexion contracture following total knee arthroplasty (TKA) in varus osteoarthritic knees by the modified gap balancing technique. A secondary aim was to analyze multiple factors that influence knee extension in TKA by modified gap balancing. Methods: This is a prospective cohort study of 150 patients diagnosed with osteoarthritic varus knee who underwent TKA using the modified gap balancing technique. Operative and clinical records were assessed to determine factors including age, BMI (Body mass index), pre-operative extension angle and the medial extension laxity. Patients were followed for 6-months post-operatively and reviewed for knee extension angle. Results: Six months final follow-up information was available for 148 patients with an average age of 75.5 years. Pre-operative knee extension and BMI were significantly associated with post-operative knee extension. Post-operative flexion contracture of ≧ 100 was not seen in any of 34 patients with a medial extension laxity ≧ 0 mm who had no pre-existing flexion contracture, and in 1/9 (11.1%) patients with a medial extension laxity ≧ 1 mm who had pre-existing flexion contracture. Conclusions: Pre-operative extension angle and BMI significantly influence the post-operative knee extension angle in TKA using the modified gap balancing technique. A medial extension laxity of at least 1 mm is ideally needed to prevent post-operative flexion contracture in patients with a pre-existing contracture ≧ 100. Level of evidence: Level II; Prospective cohort study.

Resurfacing Egg-shell Patellar Defect in a Single-staged Primary total Knee Arthroplasty - A Case Report.

Introduction: Patellofemoral biomechanics are a very critical factor for patient satisfaction after total knee arthroplasty. Patellar defects in a primary total knee arthroplasty are rare. We present a rare case of valgus deformed knee with an eroded egg-shell like patella managed with primary knee arthroplasty. Case Report: A 58-year-old female with bilateral knee pain for 35-years presented to us with a bilateral valgus knee. The knee range of movement was restricted more on the left side and severely restricting her activities of daily living. She had an egg-shell like eroded patellar defect in an osteoarthritic knee for which, she underwent primary total knee arthroplasty and patellar resurfacing with autologous bone graft harvested from the tibial cut bone. Conclusion: We have presented a rare case of a combination of patellar defect in an Osteoarthritic knee which was managed by modified gapbalancing technique of TKA with a novel method of patellar resurfacing in a single stage with good functional results at 1-year postoperatively. This case improves our understanding of the management of such complex scenarios and, more importantly raises the questions our understanding and need of classification of such patellar defects in a primary arthritic knee.

Successful two-stage primary total knee arthroplasty for infective arthritis of the knee - our experience.

BACKGROUND: The incidence of septic arthritis is 2-10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. PATIENTS AND METHODS: Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. DISCUSSION: With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2ndstage reducing hospital stay, morbidity, and cost.Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection.Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. CONCLUSION: All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.

First Report of Candida auris Spondylodiscitis in Oman: A Rare Presentation.

BACKGROUND: Candida auris is an emerging superbug which was recently discovered and has spread widely across the world. With a steady rise in incidence involving multisystems, this presents a unique challenge to caregivers. CASE DESCRIPTION: A 50-year-old man with sickle cell disease, diabetes mellitus, and multiple surgeries presented with progressive low back pain radiating to bilateral limbs and intact neurology. Radiologic and laboratory investigations suggested spondylodiscitis with epidural collection, which was operated with posterior decompression and stabilization. The tissue analysis was reported as C. auris, which was accordingly treated with caspofungin. Magnetic resonance imaging at 4 months showed resolution of infection with return of inflammatory markers to normal. CONCLUSIONS: C. auris appears to be an emerging superbug, which is hospital-acquired. All practitioners must be aware of its existence and presentation. Given the low incidence, high mortality, and no clear guidelines of management so far, formulation of any such strategies is complicated. Further studies and research are needed for this superbug.

A Rare Case of Heterotopic Ossification of the Patella Tendon in an Adolescent Presenting with Tendon Rupture.

Heterotopic ossification is the abnormal formation of mature, lamellar bone in nonosseous tissue such as tendons, ligaments, muscles, and soft tissue. We discuss a rare case of a young adolescent with patellar tendon rupture postheterotopic ossification. A 13-year-old male presented to us with knee pain and inability to extend for 6 weeks following trivial trauma. Preliminary radiological investigations revealed a high riding patella with ossification in the patella tendon. The magnetic resonance scan confirmed the same with patellar tendon disruption and heterogeneous ossification. He underwent surgery with patella tendon repair, augmentation with autograft, and had complete recovery at 6 months' follow-up.

Ventral holocord spinal epidural abscess managed surgically in a critical setting.

BACKGROUND: Extensive epidural abscess is an uncommon entity which is increasing in the aging population. Its prevalence is also greater among those with diabetes mellitus and in those who are immunocompromised. Here, a 59-year-old female presented with a spinal epidural abscess (SEA) warranting operative intervention. CASE DESCRIPTION: A 59-year-old female with a history of diabetes and hypertension, presented with the acute onset of a high-grade fever, generalized back pain, and an evolving quadriparesis. Preliminary laboratory studies revealed elevated inflammatory markers. The magnetic resonance scan showed a ventral epidural abscess extending from C1-2 to the L5 level. She underwent urgent surgical decompression using a Nelaton catheter placed through an L4-L5 hemilaminectomy and threaded cephalad (40 cm); this resulted in a complete recovery. CONCLUSION: This case study underscores a unique way of managing an anterior holospinal SEA extending from the C1-2 through the L5 spinal levels.