Injury
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There is a choice of anti-MRSA antibiotic available with proven efficacy in the treatment of complicated skin and skin structure infection (cSSSI). Additional anti-MRSA antibiotics are in development, which have the potential to influence how such infections are managed. The emergence of resistance to current anti-MRSA agents, toxicity, and general lack of oral agents with proven efficacy for deep seated infection justify the development of new agents. ⋯ Combination therapy is often used in these patients, although there is a paucity of controlled trial data to support particular antibiotic combinations. As the choice of anti-MRSA agents increases, so does the need to identify which are best for the large variety of infections included in the group of cSSSIs. This is particular true for infections occurring in orthopaedic patients where poorly vascularised tissue, trauma or implanted prosthetic material, pose specific challenges.
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Proximal femoral fractures (PFFs) are a major health concern in the elderly population. Improvements made in implants and surgical techniques resulted in faster rehabilitation and shorter length of hospital stay. Despite this, the reduced physiological reserve, associated co-morbidities and polypharmacy intake of the elderly population put them at high risk of postoperative complications particularly of infectious origin. ⋯ MRSA was isolated in 49 (47%) of the cases; 38 patients (36%) ultimately underwent a Girdlestone's excisional arthroplasty. Mortality at 30 days and 3 months was 10% and 31%, respectively. It was noted that post-operative hip infection predisposed to a prolonged length of stay in the acute unit and subsequently to a more dependent destination after discharge.
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The advent of modern arthroscopic techniques has lead to widespread surgical repair of multiligament injuries of the knee. Although functional outcomes may be linked to the recovery of strength and range of movement, studies have failed to report objective measures of strength recovery. The primary aim of this study was to describe the recovery of isokinetic quadriceps and hamstrings' strength. The secondary aims were to describe the recovery of movement and function. ⋯ Muscle strength improves after multiple ligament reconstruction. There is no difference in outcomes for different muscle groups at 2 years. Deficits persist in comparison with the uninjured limb. A proportion of patients will be unable to return to the pre-injury occupation or sporting ability.
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Hoffa fractures represent coronal fractures of the femoral condyles. Isolated Hoffa fractures are rare and current management of these fractures is based on a few descriptions in literature. The goal of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment. ⋯ Hoffa fractures are intra-articular and are best treated by anatomical reduction and rigid fixation followed by early mobilisation. Open reduction increases the chances of achieving anatomical reduction and gives satisfactory functional results when coupled with aggressive rehabilitation.
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We asked whether locally applied recombinant-Bone Morphogenic Protein-2 (rh-BMP-2) with an absorbable Type I collagen sponge (ACS) carrier could enhance the consolidation phase in a callotasis model. We performed unilateral transverse osteotomy of the tibia in 21 immature male rabbits. After a latency period of 7 days, a 3-weeks distraction was begun at a rate of 0.5mm/12h. ⋯ Qualitative radiographic evaluation revealed hypertrophic calluses in the Group III animals. The rh-BMP-2/ACS also influenced the development of the cortex of the calluses as shown by the modified radiographic patterns in Group III when compared to Groups I and II. Densitometric analysis revealed the bone mineral content (BMC) was significantly higher in the rh-BMP-2/ACS treated animals (Group III).