Domestic violence: the role of the orthopaedic surgeon in identification and treatment.

Domestic violence is a major public health problem in the United States. As many as 35% of women visiting hospital emergency departments for trauma care are there because of injuries caused by intimate partner violence. The practicing orthopaedic surgeon may come in contact with these women in the emergency department as well as in the office setting. The ability to identify victims of abuse requires a sensitive approach and a specific set of skills. Once the victim has been identified, appropriate referral to local agencies is critical to help ensure the victim's safety. The issues surrounding identification, documentation, inquiry about safety, and activation of community services need to be incorporated into the core curriculum of resident training programs and the continuing education of the practicing orthopaedic surgeon.

Thoracic compression fracture in a basketball player.

Thoracolumbar pain is a frequent complaint of many athletes, but the cause is often difficult to diagnose. Compression fractures of the spine are rarely seen in athletics and are not always recognized as a potential cause of the symptoms. Reported here is a case of a T12 compression fracture in a male basketball player. Pain films revealed the percentage of loss of vertebral body height, thereby determining the stability of the fracture. If treated with a thoracolumbar spinal orthosis brace and activity restrictions, stable compression fractures heal without surgical intervention and athletes can return to activity within a number of months. Athletic trainers and physicians should maintain a level of suspicion for this injury when violent trunk flexion or lateral flexion is the mechanism of injury.

Chondromyxoid fibroma of bone: thirty-six cases with clinicopathologic correlation.

A series of 36 cases of chondromyxoid fibroma (CMF) of bone, a rare benign tumor that may be confused with chondrosarcoma, is presented to aid in correctly identifying and diagnosing these neoplasms. In this series, CMFs were found in patients of all age groups, with no predominance between sexes. Long bone tumors were more common in young patients, while small and flat bone lesions were more common in older patients. Radiographically, long, flat, and small bone lesions were well-defined and benign-appearing. Tumors in the vertebrae had a more aggressive appearance, with marked bone destruction. The histologic picture was of a pseudolobulated tumor with myxoid and chondroid regions. Tumor cells were at times bizarre, pleomorphic, and binucleate, but rarely contained mitoses. Curettage with or without bone grafting and en bloc resection were the most common modes of treatment. The majority of recurrences were seen in patients treated by curettage alone. Radiation therapy was associated with the development of sarcoma in one case. No cases of malignant transformation were found in this series, but unusually aggressive recurrences were noted in CMFs involving a phalanx, the cervical vertebra, and the sacrum.

Clostridium perfringens and Staphylococcus epidermidis polymicrobial septic arthritis. A case report.

Septic arthritis caused by Clostridium perfringens is extremely rare. Previously there has been only one report of Clostridium perfringens in combination with an aerobe causing septic arthritis. This report presents a 23-year-old man with a mixed aerobic/anaerobic septic arthritis treated with intravenous antibiotics and repeated surgical drainage. It is the only report to date of a polymicrobial septic arthritis involving both Staphylococcus epidermidis and Clostridium perfringens. This report and a review of the literature demonstrate the existence of polymicrobial septic arthritis and illustrate its fulminant nature.