– the effects of endotoxins have been blamed for all the effects of Gm neg septicemia; – hyperpyrexia, vasoconstriction followed by vasodilation, … – the initial clinical symptom of bacilemia is usually a shaking chill; – it is not unusual for the patient to initially have an elevated BP followed by a marked fall … 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
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
– Anatomy: – origin: ischial tuberosity w/ tendon of biceps femoris; – insertion: pes arserinus – action: – flexes and medially rotates the calf at the knee; extends, adducts and medially rotates the thigh at the hip; – reversed … Read more
L 1 | L 2 | L 3 | L 4 | L 5 | S 1 | S 2 S 3 –Ilio Psoas —- — Sartorius —– – … Read more
– Anatomy: – origin: upper and lower aspect of ischial tuberosity: – insertion: posterior surface of medial condyle of the tibia; – action: flexes and medially rotates the calf at the knee. extends, adducts and medially rotates the thigh at the hip; … Read more
– Discussion: – General Discussion: Erythrocyte Sedimentation Rate – elevation of sed rate can be a reliable test for diagnosis of infected THR; – greater than 85% of pts w/ infection about THR have elevated sed rate & 79 % have a rate of more than 50 mm / hour; … Read more
– See: Acetabular Component Menu Discussion it is controversial as to whether screws are necessary in THR, and there are relative advantages and disadvantages; cups should be designed with only 2-3 holes so as to maximize the porous coating surface and to minimize conduit for osteolysis; acetabular cup insertion: advantages of screw insertion: theoretically, screw … Read more
– Controversies: Should the Contralateral Hip be Pinned? – many surgeons note that it is difficult to maintained close follow up of the contra-lateral (un-pinned) hip which can often slip despite good compliance on the part of the patient; – consider prophylactic pinning of the contralateral hip in patients at high … Read more
– Anatomy: – arises from lumbrosacral plexus: L4, L5, S1, S2, S3; – nerve emerges from pelvis below piriformis & enters thigh between ischial tuberosity & greater trochanter; – in 10% of patients, the sciatic nerve is separated in greater sciatic foramen by all or part of the piriformis; – sciatic nerve is … Read more