Over the period 1990–2002, 12 patients, 3 male and 9 female, mean age 65 years (58–74), have been treated for deep infection after total knee arthroplasty (TKA). Two patients diagnosed with early and ten with late infection. Diagnosis was clinical, radiological (X-rays, 3 phase bone scan with Tc99m), laboratory (WBC, ESR, CRP) and from knee aspiration cultures. Of the inflammations, three were low grade.

Eight patients had resurfacing total knee replacement, while four hinged type (Endomodel). Five of the initial arthroplasties were referred cases.

Two phase revision was performed to all patients.

Initially there was removal of the prothesis and extensive surgical debridement. Staphylococcus Aureus was cultured from seven arthroplasties, Staphylococcus Epidermidis from three and Pseudomonas Aeruginosa from two.

After the prothesis removal, PMMA spacer with antibiotic was placed, in eleven cases molded to the shape of a TKA which permitted knee motion. A 6–8 week period of IV antibiotic therapy followed, which was based on intraoperative cultures and microbial sensitivity. Finally arthrodesis was performed in two knees, while in the other ten a new cemented TKA was place. All the patients received postsurgery antibiotics for 3–6 months.

No recurrences of infection were note over a follow-up period of 8 months to 10 years, one revision was performed for a fractured femoral stem.

In conclusion, two phase revision arthroplasty is proved to be an invaluable method in the treatment of deep infection after total knee arthroplasty.

Diving injuries are the cause of devastating trauma, primarily affecting the cervical spine. The younger male population is more often involved in such injuries. This study describes our experience on diving injuries treatment and offers a long follow-up.

During a 31-year period (1970–2001) 20 patients, 19 male and one female have been admitted with cervical spine trauma following a diving injury. All admissions have been made between May and September. One patient was lost to follow-up. The mean age of the patients was 23 years (16–47). The lower cervical spine was involved in 13 patients; four patients had lesions in the middle and upper cervical spine, while one patient had combined lesions. The most commonly fractured vertebrae were C5 and C6. Fracture-dislocation was evident in 10 patients, while a teardrop fracture was diagnosed in six patients. Six patients were classified, as ASIA A upon admission and bladder control was absent in 12. Only four patients were treated surgically, two with iliac bone grafting alone, one with posterior plating and one with an anterior plate plus graft. The other patients with initial neurological deficit were treated conservatively, because of their rapid neurological improvement, their lesion being regarded as stable. Fourteen patients were treated conservatively with steroids and Crutchfield skull traction or halo vest, followed by the application of a Minerva or Philadelphia orthosis.

The mean follow-up was 11 years (6 mo to 23.8 years). Four patients in the ASIA A category died in the first month of their hospitalization (two of cardiac arrest, one from pulmonary embolism and one from respiratory infection) and two remained unchanged. Six patients with ASIA B and C improved neurologically and one remained unchanged. Nine patients had developed urinary tract infection and two had respiratory infections. Two out of the four operated on developed superficial trauma infection.

In conclusion, diving injuries of the cervical spine demonstrate a high mortality and morbidity rate. The initial neurological deficit may improve with appropriate conservative treatment. The indications for surgical management are post-traumatic instability and persistent or deteriorating neurologic deficit.

The anatomy of the first metatarso-phalangealjoint and of dorsal dislocation of the phalanx are described. As with similar lesions in the hand, closed reduction is impossible because of interposition of the volar plate. Open reduction is essential and should be performed as soon as possible after the injury.