Department Of Orthopaedics Research Articles

Comparative Characteristics of Patients Structure in the Orthopedics Department of a Clinical Hospital in a Region Remote from the Front Line during Peacetime and the First Year of a Full-Scale War in Ukraine

Objective. To analyze changes in the nosological structure of patients, treatment technologies, to outline the peculiarities of surgical interventions in the trauma profile of a civilian clinical hospital during the war period and to emphasize the need for relevant knowledge and skills of specialists in the treatment of combat trauma and its consequences.Methods. A comparative analysis of the clinical and nosological structure of 2,475 patients were treated during the year before the war and 3,838 patients during the full-scale war year. Among them, 83.1 % were civilians, 7.7 % were temporarily resettled, and 9.2 % were military personnel. The study utilized bibliosemantic, medical-statistical, and clinical methods. Results. During the active phase of the war, the Orthopedics Department of the civilian clinical hospital provided specialized medical assistance to both civilian populations and military personnel injured during hostilities. The relative number of hospitalized men increased by 4.83 %, and although the absolute number of those urgently hospitalized decreased. Despite the overall increase in the number of operations per patient, surgical activity in the Orthopedics Department decreased from 86 to 80 %. The intensification of inpatient treatment organization, patient preparation for subsequent stages of surgical interventions in the Rehabilitation Department, and outpatient medicine work collectively reduced the average bed-day in the Orthopedics Department by 12.3 %. Conclusions. Thus, during the war, the structure of patients in the Orthopedics Department of the civilian medical clinical institution changed, with an increase in the relative number of male patients and those with multiple and combined injuries. A notable feature of the treatment process organization during hostilities is the phasing of the treatment of the wounded not only at the levels of medical evacuation but also within the clinical hospital. The intensification of the organizational component and the outpatient link of the treatment process allowed for a reduction in bed-days and the provision of inpatient treatment to a larger number of patients.

Failure of Hip Reconstruction in Children With Cerebral Palsy: What Are the Risk Factors?

Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey This article does not contain any studies with human participants or animals performed by any of the authors. This study was a retrospective chart review that received approval from our hospital’s institutional review board. A.I.: measurements, manuscript preparation. I.G.: study design, measurements, manuscript preparation. N.H.A.: study design, statistical analysis, and manuscript preparation. The authors declare no conflicts of interest.

A Retrospective Study of the Presentation, Diagnosis, Management, and Outcomes of 27 Patients with Osteogenesis Imperfecta at a Single Center in Türkiye.

BACKGROUND This retrospective study aimed to evaluate the presentation, diagnosis, management, and outcomes of 27 patients diagnosed with osteogenesis imperfecta at a single center in Türkiye between January 2011 and January 2020. MATERIAL AND METHODS We analyzed data from the medical records of 27 patients with osteogenesis imperfecta admitted to Çukurova University Faculty of Medicine, Department of Orthopedics and Traumatology, between January 2011 and January 2020. The data included the clinical examination notes of the cases classified according to the Sillence and Shapiro systems, age, sex, parental consanguinity, genetic analysis (DNA isolation) results, the number and localization of past fractures, treatment methods, complications, hypermobility, and ambulation scoring. RESULTS The mean age of the patients (n=13 male, n=14 female) was 10.4±7.4 years, ranging from 3 to 39 years. Almost half (n=15, 55.6%) had consanguineous parents. The patients had 131 fractures during the 9 years between January 2011 and January 2020, with the femur being the most commonly fractured bone; 13 patients (48.15%) received surgical and conservative treatments, while the remaining 14 underwent only conservative treatments. The results revealed a strong association between the number of fractures and the types of genetic mutations (P=0.004). CONCLUSIONS Study findings indicate that the type of genetic mutation was not significantly correlated with the risk of treatment complications in osteogenesis imperfecta cases. Nevertheless, the study reveals a noteworthy association between the type of mutation and the number of surgeries required. Specifically, patients with the COL1A1 mutation needed more surgeries.

Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital

BackgroundAntimicrobial resistance is a major global health threat. Therefore, promising new antibacterial technologies that could minimize our dependence on antibiotics should be widely adopted. This study aims to identify the barriers and facilitators of the adoption of new antibacterial technologies in hospital patient care.MethodsSemi-structured interviews, based on the Consolidated Framework for Implementation Research, were conducted with healthcare professionals related to the orthopedics department of an academic hospital in The Netherlands.ResultsIn total, 11 healthcare professionals were interviewed. Scientific evidence for the effectiveness of the technology was the most explicitly mentioned facilitator of adoption, but other (often contextual) factors were also considered to be important. At the level of the inner and outer setting, high costs and lacking coverage, competition from other firms, and problems with ordering and availability were the most explicit perceived barriers to adoption. Participants did not collectively feel the need for new antibacterial technologies.ConclusionsBarriers and facilitators of the adoption of new antibacterial technologies were identified related to the technology, the hospital, and external factors. The implementation climate might have an indirect influence on adoption. New antibacterial technologies that are scientifically proven effective, affordable, and easily obtainable will most likely be adopted.

Demographic Influence on Percutaneous Tenotomy Outcomes in Chronic Lateral Epicondylitis

Background: Chronic lateral epicondylitis, or tennis elbow, affects individuals irrespective of age, gender, or occupation, impacting their functional arm movement and quality of life. Percutaneous tenotomy presents a minimally invasive treatment option, yet its efficacy across different demographic groups remains underexplored.
 Methods: This retrospective study at the Department of Orthopaedics, Dr. RPGMC Kangra at Tanda, included 45 patients undergoing percutaneous tenotomy for chronic lateral epicondylitis. Patients were assessed pre-operatively and at intervals up to 36 months post-operation using NRS, DASH, and Oxford scores.
 Results: Significant improvements in pain and functional scores were observed across all demographic groups, with no single demographic factor significantly influencing treatment outcomes.
 Conclusion: Percutaneous tenotomy is universally effective in treating chronic lateral epicondylitis, offering significant pain relief and functional recovery across diverse demographic groups.
 Keywords: Chronic lateral epicondylitis, Percutaneous tenotomy, Demographic influence, Pain relief, Functional recovery..

A perforation of a duodenal diverticulum in a 97-year-old patient after total gastrectomy and Roux-en-Y reconstruction: a case report

Most duodenal diverticula (DD) are asymptomatic and rarely develop perforations. Perforation is the most serious complication of DD and often requires emergency surgery. A 97-year-old woman who had undergone total gastrectomy and Roux-en-Y reconstruction 30 years ago was referred to our department with chief complaints of abdominal pain and fever during her hospitalization after femoral neck fracture surgery in the orthopedic department. Contrast-enhanced computed tomography showed free air and residue in the abdominal cavity and right retroperitoneum, and an emergency laparotomy was performed. The abdominal cavity was mildly contaminated, and a 6-cm DD with a 1-cm perforation in the wall of the diverticulum on the contralateral side of the mesentery of the duodenum was found. Diverticulectomy and duodenal closure were performed and a drainage tube was placed. The patient experienced no complications and was transferred to the orthopedic department on postoperative day 10. Reports of perforation of DD after gastrectomy are very rare. Particular attention should be paid to perforation of DD after Billroth-II and Roux-en-Y reconstructions as they involve the formation of a duodenal stump that differs from the normal anatomy and may be highly invasive surgical procedures, depending on the degree of inflammation and fistula formation.

Functional outcome of diaphyseal fractures of forearm in children treated with titanium elastic nailing system

Background: Forearm fractures are common injuries in children, with diaphyseal fractures of the forearm being among the most frequent injuries treated in the pediatric population. This study aimed to assess the functional outcome of diaphyseal fractures of the forearm in children treated with the titanium elastic nailing system. Methods: This prospective observational study was conducted at the Department of Orthopaedics, Mainamoti Medical College, Cumilla, Bangladesh from January 2020 to December 2022. The study included 67 patients aged 6-15 with diaphyseal forearm fractures treated with the titanium elastic nailing system, selected through purposive sampling. MS Office tools were used for data analysis. Results: According to the functional outcome criteria described by Price et al., it was observed that in the highest number of patients (86.56%), the functional outcome was excellent, followed by good, fair, and poor outcomes found in 8.96%, 2.99%, and 1.49% of the cases, respectively. As the postoperative complications, the delayed union was found among 4%, and skin infection was found among 3% of cases. Conclusions: Considering the excellent outcomes and lower complication rate, the titanium elastic nailing system may be considered a very effective and safe treatment method for the management of diaphyseal fractures of the forearm in children.

The Effects of the COVID-19 Pandemic on the Pattern of Fractures in Taif City, Saudi Arabia.

The COVID-19 pandemic forced the world to take restricted orders to control the spread of SARS-CoV-2 by limiting and controlling people's movement inside their countries. According to previous studies, the shutdown and quarantine affected orthopedic trauma presentations and patterns in many countries. This study aimed to show the change in the pattern of fractures in Taif City, Saudi Arabia, during the curfew period during the COVID-19 pandemic in 2020 and compare it with the same period in 2019. A retrospective study of all patients with fractures who came to the emergency room and were treated by the orthopedic department at Alhada Armed Forces Hospital, King Abdulaziz Specialist Hospital, and King Faisal Medical Complex, Taif City. During partial and total lockdowns between March 23 and June 21, 2020, Data was collected from this period during September 2023. Demographics, fracture type and site, mechanism of injury, length of admission, if admitted, and the management plan were documented. These fracture cases were compared with those within the same period of March-June from the previous year. All statistical analysis was done using two-tailed tests. There was a decrease in the number of fractures at the time of quarantine, with 69 cases in the three months of curfew in 2020, compared to 184 cases in the same three months in 2019. There was a significant difference in the anatomical site of fractures between the two years, with decreased radius/ulna fractures (P= 0.035) and foot fractures (P=0.010). Most fractures during the lockdown were due to home accidents, with a significant decrease in motor vehicle accidents (P=0.009). The pattern of fractures in Taif City was affected by the movement restriction during the COVID-19 pandemic. The number of fractures decreased by 62.5% during the quarantine compared with the pre-pandemic period. A significant decrease was noted in the number of hospitalized patients (33%) during the COVID-19 lockdown compared to 65.8% in the pre-pandemic period.

Clinical outcome of posterior lumbar interbody fusion combined with Ponte osteotomy for reconstruction of coronal sagittal plane balance in degenerative scoliosis

Objective: To evaluate the clinical efficacy of posterior lumbar interbody fusion combined with Ponte osteotomy in the treatment of patients with degenerative scoliosis. Methods: The medical records and imaging data of degenerative scoliosis in department of orthopedics, Peking Union Medical College Hospital from 2013 to 2022 were retrospectively collected, and the shortest follow-up time was 1 year. A total of 38 patients were included, including 13 males and 25 females, aged 50-87(65.6±10.9) years old.The follow-up was12-119(43±20) months. Standing position full spine anteroposterior lateral X-ray examinations were performed on all patients preoperatively, postoperatively, and at latest follow-up. The length of hospital stay, complications, operation time, blood loss, instrumented segment, fusion segmen were recorded. The clinical scores and coronasagittal imaging indicators at three time points were compared. Results: The operation time was (274.5±70.5)min, and intraoperative blood loss was (619.2±93.5)ml. The coronal vertical axis was improved from (2.9±1.8)cm preoperatively to (1.2±1.0)cm postoperatively. The preoperative coronal Cobb angle was 16.6°±9.9° and the immediate postoperative correction was 6.4°±4.0°(t=-6.83, P<0.001). The difference was statistically significant (t=-6.12, P<0.001). The coronal Cobb Angle at the last follow-up was 5.7°±3.7°, and there was no significant orthopaedic loss at the last follow-up (t=-6.12, P<0.001).The sagittal vertical axis decreased from (5.6±3.9)cm preoperatively to (3.2±2.5) cm immediately after operation (t=-6.83,P<0.001), and was well maintained at the last follow-up[(2.7±1.8) cm,t=-7.77,P<0.001]. Lumbar lordosis increased from 21.8°±10.2° preoperatively to 35.8°±8.3° postoperatively(t=12.01, P<0.001)and 40.1°±8.6° at last follow-up(t=-10.21, P<0.001). Oswestry disability score (ODI score), visual analogue score (VAS) low back pain score and VAS leg pain score were also lower after surgery than before surgery (all P<0.05). Conclusion: Posterior lumbar interbody fusion combined with Ponte osteotomy can significantly improve the coronal and sagittal plane deformity and postoperative functional score in adult patients with degenerative scoliosis.

A prospective review of Cauda Equina Syndrome referrals received by an on-call orthopaedic department at a major trauma unit.

Cauda Equina Syndrome (CES) is one of the genuine orthopaedic emergencies. Diagnosis of acute CES is challenging and may be missed, resulting in considerable medicolegal claims. In Ireland, nearly €21 million in compensation has been paid out over a 10-year period due to the diagnosis being missed. As a result, defensive practices have resulted in an increased number of referrals for CES to the on-call orthopaedic service in a major trauma unit. A prospective data-capturing exercise was carried out of all referrals for acute CES to the orthopaedic on-call department in a tertiary-level university-affiliated teaching hospital between August and November 2023. Qualitative data was captured including referral source, referring clinician grade, in-hours or out-of-hours referral, MRI on referral, red flags as identified by the referring team, red flags as identified by the orthopaedic team, and outcome. Forty referrals for CES were made over the duration of this audit. Seventeen (42.5%) referrals were made in-hours, and 23 (57.5%) were referred out-of-hours. Only five (12.5%) of these referrals had an MRI done at the time of the referral. No patients were transferred for an out-of-hours MRI to another hospital. Only five (12.5%) patients required surgical decompression-none of these patients required an out-of-hours emergent decompression. There is a lack of understanding as to what exactly is being referred-resulting in a referral volume which is over ten times the expected number of CES cases being made to our unit. The lack of out-of-hours MRI access poses a significant concern for patient outcomes.

A comparative study between 0.5% ropivacaine with 50 mcg of dexmedetomidine and 0.5% ropivacaine with 8 mg of dexamethasone for ultrasound-guided supraclavicular brachial plexus block – A randomized controlled study

Background: Peripheral nerve block analgesia is augmented using dexamethasone with perineural local anesthesia. Aims and Objectives: The study aimed to assess and compare the effects of dexmedetomidine and dexamethasone on the onset and duration of the sensory and motor block when added to 0.5% ropivacaine for the supraclavicular brachial plexus block. Materials and Methods: This randomized controlled study was conducted at the Department of Orthopedics, Government Stanley Medical College and Hospital, Chennai, for 6 months March 2021–September 2021). Eighty patients were randomly allocated into two groups. Group A (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexmedetomidine 50 mcg (0.5 mL)+normal saline (1.5 mL). Group B (40 patients) received ultrasound-guided supraclavicular brachial plexus block with 0.5% ropivacaine (30 mL)+dexamethasone 8 mg (2 mL). Results: The dexmedetomidine group had a significantly faster onset of sensory anesthesia (3.9 min) than the dexamethasone group (7.8 min), with a higher duration. The dexmedetomidine group also had a faster onset of motor anesthesia (4.9 min) and a longer duration of analgesia (892.3 min) compared to the dexamethasone group (538 min). The dexmedetomidine group also had a longer duration for rescue analgesia (906 min) than the dexamethasone group (727 min). Visual Analog scores at 10, 14 and 24th h were lower in the dexmedetomidine group than in the dexamethasone group, which is statistically significant (P&lt;0.001). Conclusion: Dexmedetomidine has a faster onset, longer duration, longer analgesia, and prolonged duration for rescue analgesia compared to dexamethasone for ultrasound-guided supraclavicular brachial plexus block, with bradycardia and sedation as side effects.

Functional outcome of distraction osteogenesis in infected nonunion of the tibia

Abstract Background: The tibia is a bone located beneath the skin. Open fractures of the tibia, which involve significant soft tissue damage and bone loss, pose a challenge for trauma surgeons. The prevalence of long bone fractures is on the rise, attributed to the escalating number of road traffic accidents and other household mishaps, resulting in an increased occurrence of nonunion cases. Consequently, this study aims to evaluate the healing rates in long bone nonunion fractures and examine the complications associated with the treatment device. Managing infected tibial nonunions remains a formidable task for orthopedic surgeons. Materials and Methods: A retrospective study was conducted on 30 patients diagnosed with infected nonunion of tibial fractures treated with limb reconstruction systems (LRSs) in the Department of Orthopaedics at Vinayaka Missions Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India. Inclusion criteria comprised patients aged between 20 and 55 years with tibial fractures failing to unite within 6 months, radiological evidence of nonunion, willingness to provide written informed consent and suitability for surgery. Results: The results revealed that most patients fell within the age group of 40–50 years, with an average age of 40.9 years in our study. Out of 30 patients, 17 were male and 13 were female. Regarding bony results, 20 patients (66.7%) exhibited excellent outcomes, 6 patients (20%) showed good results, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes. Functional outcomes showed that 20 patients (66.7%) experienced excellent results, 6 patients (20%) showed good outcomes, 3 patients (10%) had fair outcomes, and 1 patient (3.3%) had poor outcomes. Conclusion: This study concludes that the LRS fixator facilitates early ambulation, reducing the risk of osteoporosis, and soft tissue dystrophy. The average union time was 4 months, influenced by comminution, infection, nonunion type, smoking, and fracture pattern.

Wide-Awake Surgery and Coronavirus Disease 2019: A Rural Experience

Surgeons across all subspecialties had to adapt to the COVID-19 pandemic to triage patients and steward hospital resources. Hand surgeons found themselves in a unique position to move some hospital-based procedures to a clinic-based setting, which has now impacted their post-pandemic practices. Performing procedures in the clinic using the wide-awake local anesthesia no tourniquet technique is interestingly similar to minor-surgeries traditionally carried out in a general surgery clinic. By abstracting institutional case volumes from orthopedic, hand, and general surgery departments from 2019 to 2022, we identified trends that further support the potential for clinic-based procedures in hand surgery. This communication provides a foundation to compare cost and surgical indications for wide-awake local anesthesia across surgical disciplines.

Combined effects of psychological and life style factors on pain intensity and/or disability in patients with chronic low back pain: A cross-sectional study

IntroductionChronic Lower Back Pain (CLBP) is a frequently encountered health issue in primary care settings, leading to global disability and imposing a considerable economic burden.ObjectivesThis study aimed to: (1) compare socio-demographic, health, lifestyle (sleep, physical activity) and psychological factors (depression, anxiety) between people with and without CLBP; and (2) quantify the correlations between these psychological and lifestyle factors, and clinical outcomes (intensity of CLBP and CLBP-related disability) in people with CLBP after considering other confounders.MethodsA cross-sectional study was undertaken at the neurosurgery and orthopedic outpatient department of Heraklion University Hospital between 2019-2021. Two hundred fifty three volunteers with CLBP and 116 without CLBP provided sociodemographic information, daily habits, medical history, subjective sleep/ sleep complaints, low back pain intensity and disability using a10-point numeric Visual Analogue Scale pain rating scale and Quebec Back Pain Disability Scale, as well as questions assessing impact of pain on mobility, self-care, routine activities and psychological status, respectively. Participants also completed the Zung Self-Rating Scale (SDS) for self-assessment of depression and Self-rating anxiety scale (SAS). Associations among CLBP, demographics, psychosocial or sleep disorders parameters and clinical outcomes were analyzed using multivariate models.ResultsPeople with CLBP exhibited a substantially greater prevalence of depressive, insomnia and obstructive sleep apnea (OSA) symptoms than controls (p &lt; 0.05). CLBP diagnosis was independently correlated with female gender, older age, as well as worse physical and mental health outcomes measured by (i) higher level of sleep symptoms such as sleepiness, OSA and insomnia symptoms and (ii) higher prevalence of physician-diagnosed depression, and moderate to severe depressive symptoms. The level of functional disability for CBLP patients (based on Quebec score) was independently associated with age, physician diagnosed depression, lower educational status, moderate to severe depressive symptoms and OSA symptoms. The combination of moderate to severe depressive symptoms with OSA or insomnia symptoms was the most important predictive factor for functional disability for CBLP patients (OR 13.686, 95% CI 4.581-40.885; p&lt;0.001).ConclusionsDepressive symptoms and subjective sleep disorders appear to relate to greater CLBP-intensity and/or CLBP-related disability in people with CLBP. To achieve the desired outcomes when treating patients with chronic CLBP, it is essential to employ a holistic approach, involving assessment and management of their psychological comorbidities, and sleep issues, that may improve quality of life in these patients.Disclosure of InterestNone Declared

Opioid use and disposal at 2 weeks post-surgery: Brief communication regarding excess opioids and disposal habits.

To measure the number of unused prescription opioids and disposal habits of patients following orthopedic shoulder surgery. A prospective observational study. Academic orthopedic sports medicine department. Sixty-seven patients undergoing shoulder surgery. Nine-question opioid use questionnaire. Responses to an opioid use questionnaire were collected at 2 weeks post-surgery. Outcomes of interest included the amount of initial opioid prescription used and the disposal of excess opioids. Sixty-seven patients completed the opioid use questionnaire. Forty-six (68.7 percent) patients reported having excess opioids at 2 weeks. Of the 46 patients with excess opioids, 57 percent disposed of the excess, and 43 percent planned to keep their opioids. Two-thirds of the patients reported having excess opioids, highlighting the issue of an overabundance of unused prescription opioids in America. Utilization of opioid-free pain management strategies and drug disposal kits should be explored to reduce the number of unused and improperly disposed opioids.

Evaluating the Efficacy of Antibiotic Therapy in Non-responsive Sacroiliitis: A Comparative Study.

Sacroiliitis, characterized by inflammation of the sacroiliac joints, poses significant challenges in management, especially in patients unresponsive to standard therapies like non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. This study aimed to evaluate the efficacy of antibiotic therapy in such patients, addressing a critical gap in the current treatment approach. A total of 360 patients with lower back pain who presented to the outpatient department (OPD) of the Department of Orthopedics of a medical college in Northern India for six months were included in this study. With meticulous history taking, clinical examination, and radiological evaluation, 59 patients were diagnosed with sacroiliitis, out of which 31 were males and 28 were females, aged between 20 and 40 years, and were enrolled in this cross-sectional comparative study.Patients were divided into two groups: a control group (21 patients) receiving conventional treatment without antibioticsand a study group (38 patients) receiving conventional treatment plus antibiotics (who gave consent for treatment with antibiotics). The primary outcome was assessed using the Japanese OrthopaedicAssociation (JOA) score, with evaluations conducted at baseline, one month, and three months. Recovery rates were also calculated. SPSS trial software version 27 (IBM Corp., Armonk, NY) was used for statistical analysis. Both groups exhibited improvement in JOA scores over time. At the one-month and three-month follow-ups, the mean JOA scores and recovery rates showed no statistically significant difference between the control and study groups (p-values > 0.05). Adverse effects related to antibiotic use were not significant. The study concludes that the addition of antibiotics to the conventional treatment regimen for sacroiliitis does not provide significant benefit in terms of functional recovery or pain relief in patients non-responsive to NSAIDs and/or physical therapy. These findings underscore the importance of a targeted treatment approach based on the specific etiology of sacroiliitis and caution against unnecessary antibiotic use.

Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi.

Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi. We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi. Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery. The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.

Peripheral Blood Eosinophilia in Patients with Diabetic Foot Infection Receiving Long-Term Antibiotic Therapy.

Background: The eosinophil level in peripheral blood increases in response to various conditions, the most common being medication use. Since the outcome of increased levels of eosinophils can range from a benign finding to extensive damage to host organs and systemic consequences, this finding raises concern among clinicians. We aimed to assess the prevalence of prolonged antibiotic-therapy-induced eosinophilia and possible outcomes. Methods: We conducted a retrospective cohort study of diabetic patients admitted to the orthopedic department from December 2016 through December 2020 due to a moderate to severe diabetic foot infection and who received at least 14 days of antibiotic therapy. Patients were identified retrospectively through the orthopedic department registry, and their files were reviewed, extracting demographics, laboratory test results, antibiotic treatment, and outcomes. Results: The cohort included 347 patients; a total of 114 (32.8%) developed eosinophilia during the follow-up period. Patients who developed eosinophilia had a significantly longer duration of antibiotic treatment (p < 0.001) and a significantly longer hospitalization (p = 0.001). For multivariable analysis, the independent risk factors predicting drug-induced eosinophilia included older age, higher eosinophil count on admission (per quantile) and higher platelet count on admission (per quantile) (p = 0.012, p < 0.001, p = 0.009, respectively). There was no evidence of complications in patients who developed eosinophilia compared to patients who did not. No significant association with a specific type of antibiotic was found. Conclusions: We found a higher incidence of drug-induced eosinophilia than expected or previously described. The factors associated with eosinophilia included age and higher baseline eosinophil and platelet levels but not antibiotic type.

Functional results of total knee prosthesis in the treatment of rheumatoid arthritis: A case report of 64 patients

This is a retrospective study of 64 total knee arthroplasties for inflammatory rheumatism, implanted in the Traumatology and Orthopedic Surgery Department (A) of the HASSAN II University Hospital in Fez Morocco, from February 2008 to December 2022. The aim of our work is to demonstrate the value of total knee arthroplasty in improving the quality of life of young patients with inflammatory rheumatic diseases, notably through pain relief and improved joint mobility. Our series included 44 patients, representing 64 arthroplasties. The mean age at the time of surgery was 48 years. All our patients were followed up at the consultation with a clinical and radiological examination. The IKS score was used to assess knee condition before and after surgery. The surgical procedure consisted of total knee arthroplasty using a total knee arthroplasty. Clinical results after a mean follow-up of 60 months were satisfactory, with a marked improvement in the postoperative IKS score.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.