The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 2012
Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis.
The serum erythrocyte sedimentation rate and C-reactive protein level, as well as the synovial fluid white blood-cell count with differential, are commonly used tests for the diagnosis of periprosthetic joint infection; however, their utility for the diagnosis of periprosthetic joint infection in patients with inflammatory arthritis is unknown. ⋯ The erythrocyte sedimentation rate, C-reactive protein level, and synovial fluid white blood-cell count with differential are useful for diagnosing periprosthetic joint infection in patients with inflammatory as well as noninflammatory arthritis, with similar optimal cutoff values and overall testing performance. The synovial fluid white blood-cell count and differential performed the best for the diagnosis of periprosthetic joint infection. Physicians evaluating patients with a failed or painful total hip or knee arthroplasty should not assume that elevation of the erythrocyte sedimentation rate, C-reactive protein level, and synovial fluid white blood-cell count with differential is secondary to inflammatory arthropathy; rather, elevation of these markers may indicate periprosthetic joint infection, and further evaluation for infection is warranted.
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J Bone Joint Surg Am · Apr 2012
Anterior shoulder instability associated with coracoid nonunion in patients with a seizure disorder.
An association between coracoid fracture and glenohumeral instability with both a seizure disorder and the subsequent development of coracoid nonunion has not previously been recognized. This is clinically important as patients with a seizure disorder and glenohumeral instability frequently require a primary osseous reconstructive procedure, such as coracoid osteotomy and transfer to the anterior glenoid rim (the Bristow-Latarjet procedure), to address glenoid osseous deficiency. We report on coracoid fracture nonunion in five patients with a seizure disorder and anterior glenohumeral instability and discuss the implications for surgical treatment. ⋯ We recommend having a high index of suspicion of coracoid fracture when treating patients with a seizure disorder who have anterior glenohumeral instability. In these patients, preoperative computed tomographic images allow the diagnosis of a coracoid nonunion to be made prior to surgery and help to determine whether there is sufficient intact coracoid bone to allow a Bristow-Latarjet procedure to be performed.