Aim

Bone and joint infections (BJIs) are serious infections requiring early optimized antimicrobial therapy. BJIs can be polymicrobial or caused by fastidious bacteria, and the patient may have received antibiotics prior to sampling, which may decrease the sensitivity of culture-based diagnosis. Furthermore, culture-based diagnosis can take up to 14 days. Molecular approaches can be useful to overcome these concerns. The BioFire® system performs syndromic multiplex PCR in 1 hour, with only a few minutes of sample preparation. The BioFire® Joint Infection (JI) panel (BF-JI), recently FDA-cleared, detects both Gram-positive (n=15) and Gram-negative bacteria (n=14), Candida, and eight antibiotic resistance genes directly from synovial fluids. The aim of this study was to evaluate its performance in acute JIs in real-life conditions.

Introduction

Success rate after Debridement-Irrigation, Antibiotic Therapy and Implant Retention (DAIR) for treatment of Acute Haematogenous (AH) and Early Post-surgical (EP) periprosthetic joint infection (PJI) varies widely among published studies. Prosthesis exchange is recommended to treat PJI after a failed DAIR. However, no early postoperative prognostic factors permitting to identify future failures have been described.

Aim

Cutibacterium acnes, a skin commensal, is responsible for 5–10% of prosthetic joint infections (PJI). All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI and rule out contamination. Unlike coagulase negative staphylococci, C.acnes shows a highly stereotypical susceptibility profile making impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple C.acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) C.acnes isolates grown from orthopedic device-related infections (ODRI) in a reference center for bone and joint infection.

Aim

Propionibacterium acnes is a skin commensal colonizing the deeper structures of the pilous bulb. It is responsible for 5–10% of lower limb prosthetic joint infections (PJI) but accounts for as many as 50% of shoulder arthroplasty infections. P. acnes PJIs characteristically feature limited systemic inflammation, limited polymorphonuclear infiltration and clinical signs compatible with aseptic loosening. All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI to increase specificity and rule out contamination. Whereas the antimicrobial susceptibility patterns of coagulase negative staphylococci are highly polymorphic and commonly allow the ready distinction of unrelated strains, P. acnes shows a highly stereotypical susceptibility profile and it is impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple P. acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) P. acnes isolates grown from PJI in a reference center for bone and joint infection.

Purpose of the study: Optimal management of proximal fractures of the humerus remains a subject of debate. We conducted a prospective epidemiological study to identify injuries encountered, determine the reproducibility of reference classifications and their pertinence for therapeutic decision making.

Material and methods: All patients presenting a proximal fracture of the humerus admitted to a teaching hospital from November 2007 to November 2008 were included using a standardised computer form. A CT-scan was obtained if necessary. Fractures were classified by three senior observers (CP, GM, AR) according to the Neer and AO classifications.

Results: Two hundred forty-seven fractures were collected in 75 men (30%) and 172 women (70%), mean age 66 years (18–97). There were 112 fractures on the dominant side (45%). Two patients had vessel injury and one an associated injury of the brachial plexus. One patient had an isolated injury to the axillary nerve. According to the Neer classification which describes 15 types of fractures, there was little or no displacement or 38% of the fractures and 97.5% of the fractures were classified within six groups: little or no displacement, surgical neck, trochiter fracture alone or with anterior dislocation, 3 or 4 fragment fractures. Using the nine subtypes of the AO classification, there were 58 A1, 55 A2, 42 A3, 43 B1, 9 B2, 5 B3, 14 C1, 18 C2 and 3 C3. Groups A and B included 88% of the fractures. Regarding the CT-scan, obtained in 40% of patients, changed the radiographic interpretation in six cases. Interobserver reproducibility was good. Orthopaedic treatment was given for 203 patients (82%). Operations were: fixation of the tuberosities (n=7), anterograde nailing (n=29), hemiarthroplasty (n=6), reversed prosthesis (n=2).

Discussion: This distribution of fractures of the proximal humerus corresponds well with data in the literature. Good quality x-rays can provide adequate classification without a CT-scan for the majority of patients. The classification systems currently used are quite exhaustive although the distribution in the subgroups is not homogeneous.

Purpose of the study: Among the causes of secondary congenital equinovarus club foot, neurological disorders predominate. The entity we examine here corresponds to irreversible pure motor paralysis with no sensorial disorder affecting the lateral compartment predominantly and sometimes associated with involvement of the anterior compartment. There is no literature on this entity. Beyond the question of the aetiology, the demonstration of this pathological condition can modify therapeutic strategy in order to prevent recurrence.

Material and methods: We examined 42 congenital equinovarus club feet with persistent pure motor paralysis involving the lateral compartment and sometimes the anterior compartment with a mean 10 years follow-up. The Dimeglio classification was used and an analytical muscle score was noted for each patient. Complementary tests included an electromyogramme when possible. Conservative treatment was the rule either using a functional method or the Ponseti method; surgery was then proposed when necessary for posteromedial release with or without palliative muscle transfer. The following procedures were performed: posteromedial release (n=33) and muscle transfer (n=26): tibialis posterior (n=22), tibialis anterior (n=3); hemisoleus (,n=1); tibialis posterior associated with flexor digitorum longus (n=3).

Results: Conservative treatment was used for all feet but all presented recurrence and required secondary surgery (33 posteromedial releases and 26 muscle transfers).

Discussion: This study opens the discussion on the similarity between idiopathic and arthrogryoposis club foot since the electromyography sometimes reveals an anomaly of the anterior horn. Thus club foot with pure motor and persistent paralysis involving the lateral and/or anterior compartment will not respond sufficiently to nocturnal contention if an adapted muscle transfer is not associated.

Conclusion: Muscle transfer to reactivate dorsal flexion of the foot enables a better functional outcome. First intention conservative treatment can be instituted while waiting for potential recovery. If the paralysis persists beyond one year, muscle transfer is indicated before the deformity recurs and requires an associated posteromedial release.