– Pts w/ RA: – may be prone to bacterial infections because of inherent phagocytic defect or because of long-term oral or intraarticular administration of corticosteroid or other immunosuppressive agents; – staph. aureus is recovered from 80 % infected rheumatoid joints; Nongonococcal Bacterial Arthritis in Adults Treated at Boston U.Med Center; … Read more
– See: – septic arthritis – general orders and treatment – Discussion: – septic arthritis of the hip is a surgical emergency; – it is essential that dx be made ASAP to prevent joint damage; – if any pus is obtained from arthrotomy, … Read more
Diff Dx » Evaluation (before antibiotics are infused) synovial fluid analysis culture & gram’s stain; leukocyte count glucose and viscosity (both decreased w/ infection); blood culture, CBC, CRP, & sed rate radiographs (and possibly ultrasound): need to rule out concomitant metaphyseal osteomyelitis; misc: bone scans Treatment based on antimicrobial suseptabilities as well as patient age: … Read more
– Diff Dx: – reactive transient synovitis (toxic synovitis) – in the report by Kocher MS et al., the authors sought to distinguish transient synovitis vs sepsis on the basis of lab data and patient history; – independent clinical predictors between … Read more
– Discussion: – classically described as causing heel pain in older children, just prior to fusion of the calcaneal apophysis (between ages 12-15 yrs); – diff dx: seronegative arthritis – often associated with tight heel cord; – it has been argued in the past that the radiographic fragmentation of … Read more
– See: vascular malformations of the upper extremity – Clinical Presentation: – usually begins incidiously – vague weakness, wt loss, diffuse stiffness, aching, burning polyarticular arthritis; – diffuse edema of hands; – skin and GI manifestations are common; – hand: … Read more
– Discussion: – anatomy and ligamentous contraints: – ligaments of the wrist – SL interosseous ligament – SLD is most common and most significant ligament injury of wrist; (carpal instability); – risk factors: ulna minus configuation, slope of radial articular surface, and lunotriquetral coalition; – spectrum of injury: (increasing severity) – ref: Association of lesions of … Read more
Distal avulsion fractures of the scaphoid. Long-Term Results of Fracture of the Scaphoid. A Follow-up Study of More Than Thirty Years. Percutaneous screw fixation for fractures of the scaphoid Complications of scaphoid silicone arthroplasty. Kinematic considerations of the wrist Prosthetic silicone scaphoid strains: effects of intercarpal fusions. Complications and results of scapho-trapezio-trapezoid arthrodesis. Silicone-rubber implant arthroplasty … Read more
– See: Avascular Necrosis of the Scaphoid – Discussion: – often result from undiagnosed or undertreated non displaced scaphoid fractures, especially when associated w/ carpal instability; – even when found as late as 6 mo after the injury, frx of scaphoid, esp at the waist and distal location, may go on to heal; … Read more
– Work Up for Scaphoid Fracture: (w/ discussion) – clinical differential diagnosis: – distal radius frx – transscaphoid perilunate dislocation: – scaphoid impaction syndrome – radiographs and determination of stability (CT scan) – non diagnostic radiograph (bone scan) – tubercle frx – transverse waist frx – proximal pole frx – treatment: … Read more