Search

Background: Trochanteric bursitis or greater trochanteric pain syndrome is a common disorder and frequent cause of lateral hip pain. It can lead to severe functional impairment with increase morbidity and poor quality of life. The purpose of the current study was to identify and evaluate relationship between health-related factors, as prognostic indicators, and clinical outcomes. Methods: A single-centre, prospective study was conducted and 60 patients (62 hips) were included with a minimum 12 months of follow-up. Clinical outcomes were evaluated using Hip Outcome Scale, Single Assessment Numeric Evaluation and Visual Analogue Scale. Radiological assessments and health-related factors were documented in an attempt to understand their validity as predictors of clinical outcomes. Complications and recurrence rates were also analyzed. Results: Univariate model revealed that an increased BMI ( p = 0.001; OR = 1.05; 95% CI, 1.02–1.07); number of previous corticosteroid infiltrations ( p = 0.001; OR = 1.28, 95% CI, 1.11–1.48); longer time from symptom onset to surgery ( p = 0.001; OR = 1.19; 95% CI, 1.12–1.28); smoker status ( p = 0.001; OR 11.2; 95% CI, 3.30–44.2); and the presence of prior lumbosacral fusion (LSF) ( p = 0.001; OR 13.8; 95% CI, 2.96–101); were prognostic factors predisposing for poor clinical outcomes. Among prognostic health-related factors were medical comorbidities such as emotional distress ( p Conclusions: Better overall physical function was predicted by lower number of corticosteroid infiltrations, shorter time span from symptom onset to surgery, non-smoker status and the absence of prior lumbosacral fusion. Obesity, smoking, the presence of emotional distress, fibromyalgia and hypothyroidism seem to increase the risk of poor clinical outcomes. A proper selection and/or correction of modifiable prognostic factors could reduce the incidence of endoscopic treatment failure and, as a consequence, improve patient outcomes and quality of life. However, future efforts should focus on experimental and randomised studies to fully determine these associations.

To evaluate the usefulness of a multiplex polymerase chain reaction (PCR) assay as a complementary tool in the diagnosis of prosthetic joint infections in the routine setting of a clinical microbiology laboratory, with a special focus on patients at high risk of culture-negative infections and high suspicion of infection.The results obtained in the routine care setting with the use of the commercial multiplex PCR (Unyvero i60©, Curetis AG, Holzgerlingen, Germany) were retrospectively reviewed. The test was performed in samples of patients with suspected prosthetic joint infection, which were also processed for conventional diagnostic methods, including sonication of the implant when possible. Patients selected for the test were those with negative cultures after a 24-h incubation period.Ninety-nine PCRs were performed, 57 of which were diagnostic of infection according to 2018 MSIS criteria. Nine patients received antibiotics within the 15 days prior to the diagnostic procedure. Tested samples included synovial fluid (33), sonication fluid (56) and tissue biopsies (10). The PCR test detected microorganisms in 26 samples: including two cases of polymicrobial infection. Eleven patients were diagnosed by using PCR only. The most frequently detected microorganism in PCR was Coagulase-Negative Staphylococcus in 11 samples, followed by Staphylococcus aureus in five. One sample was positive for the bacteria universal primer, included in the 2.0 version of the kit. Only one discrepancy was detected between a negative PCR and a positive culture. One sample was also positive for a resistance marker (detection of mecA gene in a case of methicillin-resistant S. aureus infection).The incorporation of the Unyvero ITI multiple PCR technique in patients selected by clinical experts is a useful tool for the diagnosis of bone and joint infections in a routine care setting. A close clinical-microbiological collaboration improves the usefulness of this kit for the management of patients with these infections.

We report a patient with previous history of long-term bisphosphonate intake who suffered the fracture of both femurs consecutively. The radiological characteristics of both fractures allowed to catalog a posteriori of atypical fractures associated with the prolonged treatment with bisphosphonates. Atypical fractures represent an entity of recent definition that in the last years have attracted considerable attention due to the publication of an increasing number of cases. The aim of this paper is to emphasize the importance of its clinical suspicion before they appear and the characteristics of this type of fractures to provide the most appropriate clinical and surgical treatment.

The aim of the study was to analyse the validity of the Ottawa rules for the X-ray request in A&E for ankle and midfoot injuries in paediatric patients. An observational and prospective study was carried out applying the Ottawa rules to patients attending the Accident and Emergency (A&E) department in Toledo, due to ankle or midfoot injuries from the 1 July 2003 to the 1 February 2004. A total number of 190 patients were included in this study and 29 of these were found to have a fracture. Assessment of the ankle and/or midfoot injuries was made by the orthopaedic junior or senior staff, applying the Ottawa rules. An X-ray request was made for every patient seen, regardless of the Ottawa rules results. The results showed that the sensitivity for the Ottawa rules was 96.9% (95% CI, 94–99.1%). The negative predictive value was 96.6% (95% CI, 96.5–100.1%). The specificity was 36% (95% CI, 29.2–42.9%). The positive predictive value was 21.4% (95% CI, 15.5–27.2%). It can be concluded that The Ottawa rules make up valid instrument for the decision of X-ray request in patients under the age of 18 with ankle and/or midfoot injuries.

After accidental sport traumatisms, radiological exploration of the injured zone can show infrequent accidental findings. We present the case of a 15-year-old girl, with no significant medical history, who on investigating a wrist traumatism revealed multiple sclerotic areas in the carpal bones in X-rays with no associated symptoms. This is a rare case of osteopoikilosis.