To compare the effectiveness of arthrodiastasis with shelf acetabuloplasty for Perthes' disease in older children, by assessing the radiological outcome in matched pairs of children at skeletal maturity. Retrospective observational study case series.Objective
Design
We report 3 cases from different centres of infantile tibia vara in which the deformity was due to slippage of the proximal tibial epiphysis on the metaphysis; the aim of this study was to define the features of this previously unreported condition, and their implications for management. Three cases of tibia vara secondary to atraumatic slippage of the upper tibial epiphysis on the metaphysis were identified from three different centres. The case notes and imaging studies were retrospectively reviewed to distinguish common clinical and radiographic features.Introduction
Method
During the cold snap in the West of Scotland 20 December 2009 to 10 January 2010 there was a cluster of uncommon lower limb injuries in children from sledging accidents. These cases are presented as a series. This retrospective descriptive study details acute orthopaedic admissions for the period of the cold snap. The case-notes for all admissions were reviewed for diagnosis, mechanism of injury. Five (ex 20 ie 1/4) trauma admissions involved sledging: (1) combined avulsion of anterior and posterior cruciate ligaments left knee (2) Lisfranc injury, (3) distal femoral fracture, (4) distal tibial plafond fracture, (5) pelvis, patella also forearm and facial fractures. These cases are analysed in more detail Sledging injuries comprise a substantial portion of workload and morbidity. In children, there is a propensity for lower limb and higher energy trauma. Tertiary referrals and non-standard trauma equipment may be required.
Aseptic loosening of orthopaedic implants has a major financial impact on the Health Service. The process is thought to be caused by wear particles that are phagocytosed by macrophages and hence stimulate bone resorption via a cytokine response. Previous work suggests that factors inhibiting or enhancing bone resorption act through regulation of the OPG and RANK-L mechanism. The objective of this study was to identify the role of RANK-L and OPG within the cytokine response leading to orthopaedic implant loosening. Ten samples of cellular membrane obtained during revision arthroplasty surgery were analysed with basic histological staining, immunohistology and polymerase chain reaction (PCR). In vitro studies were also carried out using explanted cancellous bone, to which PMMA particles were added and bone resorbing osteoclastic cells were identified by their Tartrate-Resistant Acid Phosphatase (TRAP) activity. PCR identified the presence of OPG in all of the periprosthetic samples, with RANK-L shown in 40% of the specimens. Immunoreactivity was shown for CD3, CD68 and RANK-L. In vitro studies confirm that there is an initial burst of inflammatory cytokine activity that then subsequently plateaus. A balance of RANK-L and OPG regulates bone resorption at the bone/implant interface of implants by stimulating a significant initial inflammatory response which leads to loosening.
Therapy against Methicillin resistant Staphylococcus aureus (MRSA) infection is mainly restricted to the glycopeptide agents (vancomycin and teicoplanin), which require parenteral administration. At present oral antibiotic therapy against MRSA infection is not available. Linezolid is a recently introduced oxazolidinone synthetic antibiotic which acts by inhibiting the initiation of bacterial protein synthesis. It is effective against MRSA, glycopeptide resistant enterococci and all pneumococci irrespective of their penicillin or macrolide resistance. It has excellent oral bioavailability however, there are no data on the penetration of linezolid into osteoarticular tissues. This aim f this study was to measure the concentration of Linezolid in osteoarticular tissues after oral and intravenous administration. Ten patients undergoing primary total knee replacements for osteoarthritis or rheumatoid arthritis were included in the study. Linezolid was given orally 600mg BD dose for 2 days prior to operation and a final IV 600mg dose 1h before induction on the day of operation. Intra-operatively at 30min after induction, blood, synovial fluid, synovium, muscle and bone samples were collected, processed and assayed for Linezolid concentration. The assay was performed by High Performance Liquid Chromatography (HPLC) method at Antimicrobial Research Laboratory, Westmead Hospital, Bristol. High concentrations of Linezolid, above the Minimum Inhibitory Concentration (MIC≤ 4) were obtained all sites. Mean (± SD) concentrations for different tis- were: serum 23.0 (6.5) mg/L, synovial fluid 20.1 .4) mg/L, synovium 18.0 (5.6) mg/kg, muscle 18.5 (6.6) bone 8.5 (3.9) mg/kg Treatment of Methicillin resistant
