Rare septic arthritis of the wrist and carpus primary osteoarticular manifestation of Mycobacterium tuberculosis: A case report.

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.

Preoperative Optimization Before Elective Total Joint Replacement.

The identification and preoperative optimization of modifiable risk factors is proposed to be an effective method to decrease complications and improve the value of elective total joint arthroplasty. It is important to highlight the best practices as well as controversies in the preoperative evaluation and treatment of patients undergoing total joint arthroplasty.

Predictors of Adverse Local Tissue Reaction in a High-Risk Population.

BACKGROUND: Adverse local tissue reaction (ALTR) is a recognized complication of total hip arthroplasty (THA) with metal-on-polyethylene (MoP) bearing surface implants. Specific models of THA implants have been identified as having a higher incidence of ALTR. The purpose of this study is to determine if serum metal levels, patient symptoms, implant factors, and imaging findings can be predictive of ALTR within this high-risk population. METHODS: We retrospectively reviewed an observational cohort of 474 patients who underwent MoP THA and were at increased risk of having ALTR. Patients were stratified based on the presence or absence of ALTR. Patient symptoms, serum metal ions, implant head offset, and imaging findings were compared. RESULTS: Patients with ALTR were more likely to be symptomatic (52.9% vs 9.9%, P < .0001). The presence of ALTR was associated with significantly higher serum cobalt and chromium levels (6.2 ppb vs 3.6 ppb, P < .0001; 2.3 ppb vs 1.2 ppb, P < .0001). Head offsets greater than 4 mm were associated with a higher prevalence of ALTR (53% vs 38%, P = .05). On metal artifact reduction sequence magnetic resonance imaging, patients with ALTR had larger effusions (4.7 cm vs 2.1 cm, P < .001) and a higher incidence of trochanteric bursitis (47% vs 16%, P < .001). CONCLUSIONS: In high-risk MoP implants, serum cobalt and chromium levels are elevated, even in patients without ALTR. A larger femoral head offset is a risk factor for the development of ALTR. Our study suggests that patients presenting with painful THA and elevated metal ions require risk stratification based on patient symptoms, metal artifact reduction sequence magnetic resonance imaging findings, and implant factors.

Volar Carpus Dislocation Following Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Rare Complication.

Scapholunate advanced collapse (SLAC) is a frequently encountered cause of wrist arthritis. For stage 2 disease, proximal row carpectomy (PRC) is an accepted treatment for which the literature has documented satisfactory outcomes and generally low complication rates. However, we report a case of SLAC wrist treated with PRC complicated by postoperative volar dislocation of carpus, to our knowledge a complication not yet reported in the literature. The patient developed atraumatic volar carpus dislocation after a routine PRC. This was treated with subsequent return to the operating room with closed reduction and percutaneous pinning of the wrist. Adequate reduction of the carpal dislocation was achieved and maintained after removal of pins. This case shows that closed reduction and percutaneous pinning is a valid option in this rare complication.

Nephroblastoma Arising in a Primary Testicular Teratoma in a Nonatrophic Testis of a 50-Year-Old Man.

Extrarenal nephroblastoma is an extremely rare tumor thought to be related to teratoid tumors of germ cell origin. Because few cases have been reported, no standard method for categorizing and managing these tumors exists. To our knowledge, there have only been 3 adult cases of nephroblastoma arising in a germ cell tumor of testicular origin in a nonatrophic testis, all in men aged 19 to 22 years and with aggressive clinical courses. We report a case of nephroblastoma in a nonatrophic testis, with nephroblastoma being the only non-germ cell component, in an older patient and with a more indolent clinical course that was responsive to localized treatment.