1/7. Infectious keratitis after photorefractive keratectomy in a comanaged setting.A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Salvage of impending replant failure by temporary ectopic replantation: a case report.Temporary ectopic replantation of amputated parts has been reported previously as an alternative to orthotopic replantation in difficult cases. We report a case in which the left arm initially was replanted orthotopically with subsequent development of extensive infection. The impending vascular failure of the replanted arm was salvaged by reamputation and temporary ectopic transfer of the arm to the groin region. Nine days later the arm was transferred back to the clean humeral stump. The functional result was similar to that of a standard transhumeral replantation, with 30 degrees to 120 degrees of active range of elbow motion, basic grip pattern, and S3 sensibility.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/7. Management of infection about total elbow prostheses.Deep infection was a complication after twelve (7.3 per cent) of 164 primary total elbow replacements. Two additional patients who had an infection about an elbow prosthesis were referred for treatment after total elbow replacement elsewhere. A statistical analysis of all of these primary total elbow arthroplasties, including the two in patients who were referred from outside institutions, identified preoperative factors that placed a patient at significant risk for subsequent infection. The risk factors included a previous operation on the elbow, a previous infection in the region of the elbow, psychiatric illness, class-IV rheumatoid arthritis, drainage from the wound after operation, spontaneous drainage after ten days, and reoperation for any reason. Three modes of treatment were used for patients who had an established infection: debridement and salvage of the implant, resection arthroplasty, and arthrodesis. After early operative debridement and suppression of the infection with long-term antibiotic therapy, three patients were able to retain the prosthesis, with restoration of range of motion and function of the upper extremity. One prosthesis was reimplanted after a six-week course of intravenous administration of antibiotics.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap.Total-knee arthroplasty has provided many patients with excellent long-term functional results. However, exposure of a total-knee replacement usually eventuates in failure. The relatively superficial location of the prosthesis, the need for early active motion, previous surgical incisions, and a variety of systemic factors may militate against early wound healing. Restoration of well-vascularized soft-tissue cover can salvage an otherwise disastrous situation. The authors recommend early operative intervention upon observation of wound breakdown, devitalized skin edges, or significant subcutaneous infection leading to necrotic overlying skin. The operative procedure found to salvage the majority of prostheses consists of adequate debridement, antibiotic irrigation (of the joint, if exposed), and coverage with a well-vascularized muscle flap, preferably the medial gastrocnemius muscle. The operative technique and ultimate long-term outcome are reviewed based on experience with 10 consecutive patients presenting with a jeopardized knee prosthesis. Follow-up ranged from 1 to 6 years. Representative case histories are presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/7. Arthroscopic irrigation and debridement of infected total knee arthroplasty: report of two cases.Various methods have been described for the treatment of the acutely infected total knee arthroplasty. These include antibiotic suppression, open debridement and irrigation, exchange arthroplasty, resection arthroplasty, arthrodesis, and amputation. A method not frequently reported is arthroscopic irrigation and debridement. Two cases of acutely infected total knee arthroplasty treated with arthroscopic irrigation and debridement are presented. In both cases there was a benign postoperative course averaging five months. Both infections were secondary to hematogenous seeding from a distant focus of infection. The patients presented within approximately 12 h after the onset of knee symptoms and were taken for arthroscopic irrigation and debridement within 12 h after presentation. Gram-positive organisms sensitive to the antibiotics being used were cultured in both. Postoperative knee function and range of motion returned rapidly and disability was minimal. At average 30-month follow-up both patients were pain free, had full activity of daily living, and had no clinical or radiographic evidence of infection. Arthroscopic irrigation and debridement appears to be an effective method of treatment in select cases of infected total knee arthroplasty.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. The Roger Anderson device in the treatment of fractures of the distal end of the radius.One of the more common as well as difficult fractures to manage is the extension compression fracture of the distal end of the radius. In the physiologically younger patient we believe that every effort should be made to preserve the integrity of the radiocarpal joint and maintain motion of the hand. We have used the technique described by Anderson and O'Neil to treat comminuted, displaced fractures of the distal end of the radius in twenty-five patients from April 1972 through April 1978. Twenty-one of these patients were available for follow-up examination at an average of nineteen months (range, six to forty months) following injury. There were sixteen satisfactory and five unsatisfactory functional results, and three complications. This form of external fixation should be avoided in the older, obese, and osteoporotic patient as well as in the unreliable and uncooperative patient. If these guidelines are followed, we believe that the Roger Anderson device provides satisfactory immobilization and functional results in the treatment of comminuted fractures of the distal end of the radius in the physiologically younger patient, who may be expected to place heavy demands on the wrist.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/7. Reimplantation for the salvage of an infected total knee arthroplasty.We retrospectively reviewed the results in fourteen patients in whom salvage of an acutely infected total knee arthroplasty was attempted between 1970 and 1981 by the implantation of a new prosthesis within two weeks of removal of the infected one. Salvage was successful in six of the seven patients with a low-virulence infection but in only two of the seven patients with a high-virulence infection. Of the eight patients for whom the result was a functioning prosthesis, two had significant restriction of motion and one had moderate pain. If these three patients are eliminated from analysis, the over-all success rate is only 35 per cent (five of fourteen patients). We concluded that the implantation of another prosthesis for the treatment of infection of a total knee arthroplasty should be done with caution, and preferably when the infection has been caused by a low-grade organism and after a waiting period of longer than two weeks.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |