Primary septic arthritis of the acromio-clavicular joint: case report and review of literature.

Primary septic arthritis of the Acromio clavicular joint is an uncommon disorder and is rarely seen even in an immunocompromised individual. We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function.

Flexible nailing of fractures in children using stainless steel Kirschner wires.

Elastic titanium nails are widely used for the established procedure of Elastic Stable Intramedullary Nailing (ESIN), but are costly. Thirty-five diaphyseal fractures in various long bones in children were treated by flexible nailing using stainless steel Kirschner (K) wires. The results were comparable with reports by other authors using titanium nails and stainless steel K wires. Cost-effective K wires and instrumentation are easily available. A stainless steel K wire is 92% cheaper than a Nancy nail and 84% cheaper than a Synthes titanium elastic nail. K wires can be used for flexible nailing of fractures in children with results comparable with those after using titanium nails.

Painless reduction of anterior shoulder dislocation by Kocher's method.

Kocher described his method of reduction of anterior shoulder dislocation in German, which was misinterpreted. A new element of traction was added which causes considerable pain. We present our experience with the original method in reducing 12 anterior shoulder dislocations without using sedation or anaesthesia. The original method is gentle, painless and requires neither sedation nor anaesthesia. Patient reassurance and confidence is essential. The patient initiates the movements, the surgeon just guiding him through the manoeuvre. It was successful in 10 dislocations. In two dislocations, the humeral head had to be gently guided laterally and superiorly into the glenoid using an index finger in the axilla. The method is easily reproducible after a demonstration. Patients can go home within a few minutes of the procedure.

Internal fixation of femoral shaft fractures in children by intramedullary Kirschner wires (a prospective study): its significance for developing countries.

BACKGROUND: To evaluate internal fixation by intramedullary Kirschner wires as a surgical technique in the treatment of femoral shaft fractures in children by a prospective study. METHODS: 17 femoral shaft fractures at various levels in 16 children aged 2-15 years were treated by closed intramedullary Kirschner wiring under image intensifier control between May 2000 and October 2003. No external splint was used. RESULTS: Fracture union was achieved in 6-14 weeks. Non-weight bearing crutch walking was started 2-3 days after surgery. Full weight bearing started 6-14 weeks. Average operative time was 40 min (range 20-72 min). Wires were removed after 8-22 weeks. There were no infections, no limb length disparity. One child had pin track ulceration. A big child of 14 years had angulation of the fracture. CONCLUSION: Intramedullary nailing of femoral shaft fractures in children by stainless steel Kirschner wires is an effective method, which compares well with other studies. It is a simple procedure, which can be easily reproduced. Blood loss is minimal, and the operative time short. There is no need pre-bend the wires in a C or S curve. Stainless steel Kirschner wires are cheap, universally available, and can be manufactured locally. The cost of Image intensifiers is affordable in most of the cities of the developing countries. The hospital does not have to maintain a costly inventory. Provides early mobility, return to home and, school. Gives a predictable clinical pathway and reduces occupancy of hospital beds. The technique was successfully applied for internal fixation of other diaphyseal fractures in children and some selected diaphyseal fractures in adults. Based on my experience and a review of the literature, I recommend this technique as a modality for treatment of femoral shaft fractures in children aged 2 to 14 years.