Acute Pancreatitis Secondary to Cocaine Intoxication: A Case Series.

Gallstones, alcohol use, hypertriglyceridemia, and hypercalcemia have been considered the most common causes of acute pancreatitis; however, about 20% of the cases remain idiopathic since no definite cause can be established. It has been noticed that there is a small number of patients who have presented to the hospital with a diagnosis of acute pancreatitis who have concurrently been using cocaine yet have no recent alcohol use and no gallstones. The purpose of this series of case reports is to review the evidence behind the association between cocaine and pancreatitis.

Atypical Manifestation of Adult Polycystic Kidney Disease in an Elderly Individual.

Autosomal dominant polycystic kidney disease (ADPKD) is a rare genetic disease. Diagnosis of ADPKD is usually made by the number of renal cysts on the ultrasound for each age category. There are two types of ADPKD, and the patients with the second type have later onset of symptoms, with slower disease progression than in the first type.

Functional Outcomes After Muscle-Sparing Fixation of Flail Chest Injuries.

Objectives: To present outcomes in a multicenter review of a large number of flail chest patients.

Design: Retrospective case series.

Setting: One urban Level I and 1 urban Level II trauma center.

Clinical Outcomes of Surgical Stabilization of Flail Chest Injury.

Introduction: Recent reported success in surgical stabilization of flail chest has been described in small series, but scant evidence exists for this procedure in the orthopaedic literature.

Methods: We reviewed 88 consecutive patients who underwent surgical stabilization of flail chest, along with 88 consecutive patients with flail chest who underwent traditional closed management before initiation of our algorithm change to surgical management.

Results: Surgical stabilization of flail chest injuries led to statistically significant decreases in hospital length of stay, ventilator-dependency time, pneumonia, tracheostomy, and mortality rate.

An Observational Study of the Factor Xa Inhibitors Rivaroxaban and Apixaban as Reported to Eight Poison Centers.

Study Objective: Rivaroxaban and apixaban are part of a new group of oral anticoagulants targeting factor Xa and approved by the Food and Drug Administration in 2011 and 2012. These oral anticoagulants are administered at fixed daily doses, without the need for laboratory-guided adjustments. There are limited data available on supratherapeutic doses or overdose of the oral Xa inhibitors.

Multifocal juvenile osteochondritis dissecans of the knee: a case series.

Background: This retrospective case series reports on a group of patients with multifocal juvenile osteochondritis dissecans (MJOCD) of the knee and discusses demographic data, lesion location, stage, and treatment results.

Methods: Records of patients identified with MJOCD of the knee at a single institution were retrospectively reviewed. Demographic, radiographic, and surgical results were recorded.

The posterior approach to pelvic ring injuries: A technique for minimizing soft tissue complications.

Surgical techniques and fixation strategies for the treatment of unstable posterior pelvic ring injuries continue to evolve. The safety of the posterior surgical approach in particular has been questioned due to historically high rates of wound related complications. More contemporary studies have shown lower infection rates, however concern still persists.

Necrotizing fasciitis in a pediatric orthopedic population.

Few studies have analyzed necrotizing fasciitis in children, and all have relied on cases of necrotizing fasciitis in the abdomen, head, and neck region. The authors sought to correlate the preoperative values of several laboratory tests previously validated in the adult literature, such as the Laboratory Risk Indicator for Necrotizing Fasciitis, with surgically confirmed necrotizing fasciitis in children to provide clinical guidance for the preoperative laboratory workup of necrotizing fasciitis. A retrospective chart review was performed on consecutive patients younger than 18 years with a diagnosis of necrotizing fasciitis.

Recurrent low-energy intrathoracic dislocation of the scapula.

Dislocation of the scapula is a rare disorder. The nomenclature in the literature can be confusing as a result of nonspecific terms such as locked scapula and dislocated scapula when referring to both intra- and extra-thoracic dislocations. After a thorough review of the literature we further define and classify scapular dislocations to better understand prognosis and patient education.

Medial collateral ligament recession for chronic medial knee laxity.

The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament.

Evaluation of Primary Total Knee Arthroplasty Incision Closure with the Use of Continuous Bidirectional Barbed Suture.

The purpose of this study is to determine whether operative time for primary total knee arthroplasty can be decreased with the use of a continuous barbed suture. Five hundred patients were retrospectively reviewed and divided into groups based on whether incision closure utilized a continuous barbed suture or an interrupted biodegradable suture. We identified additional variables to determine their relationship to operative time, including body mass index, age, gender, and side of replacement.

Effectiveness of a nasal saline gel in the treatment of recurrent anterior epistaxis in anticoagulated patients.

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients.

Medial malleolar fractures: a biomechanical study of fixation techniques.

Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures.

Clinical characteristics of patients with isolated calf vein thrombosis in a large teaching hospital.

Objective. To identify the clinical characteristics of a patient population newly diagnosed with acute isolated calf deep venous thrombosis (ICDVT) by duplex ultrasound scan (DUS). Methods.

Lower extremity bypass graft occlusion after intramedullary fixation of intertrochanteric hip fracture on a fracture table.

This article presents a case of a 90-year-old woman who previously underwent a common femoral to anterior tibial artery bypass grafting with a Gore-Tex graft (Gore Medical, Flagstaff, Arizona). She subsequently sustained an ipsilateral intertrochanteric hip fracture after a mechanical fall and underwent internal fixation with an intramedullary nail using a fracture table. In the immediate postoperative period, she developed limb-threatening ischemia in her leg due to graft thrombosis.

Septic knee-induced deep venous thrombosis in a young adult.

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins.

Osteomyoplastic and traditional transtibial amputations in the trauma patient: perioperative comparisons and outcomes.

We hypothesized that patients undergoing transtibial amputation osteomyoplasty would have better functional outcomes than patients undergoing traditional transtibial amputation. We conducted a retrospective review of the medical and radiographic records to evaluate and compare 26 patients who underwent transtibial amputation osteomyoplasty and 10 patients who underwent traditional transtibial amputation, with specific attention to perioperative complications and functional outcomes. At >1 year follow-up, patients who underwent amputation osteomyoplasty had significantly improved rates of return to work and decreased rates of revision than patients who underwent traditional transtibial amputation.

Metastatic esophageal adenocarcinoma of the carpus.

We report on a rare case of metastatic esophageal adenocarcinoma to the wrist developing years after diagnosis and treatment of the primary lesion. Awareness of the potential for developing these lesions should be raised, particularly in the absence of systemic symptoms.

Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient.

Background: Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty.

Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices.

Objective: To examine outcomes of robotically assisted laparoscopic hysterectomy in patients with benign conditions involving high uterine weight and complex pathology.

Methods: A multicenter study was undertaken in five community practice settings across the United States. All patients who had minimally invasive laparoscopic hysterectomy with robotic assistance March 2006 through July 2009 and uterine weights of at least 250 g were included.

Bilateral patellar tendon rupture at different sites without predisposing systemic disease or steroid use.

Simultaneous bilateral patellar tendon ruptures are extremely rare, and even more rare in patients without systemic disease. We describe bilateral simultaneous patellar tendon disruptions in the absence of systemic disease or steroid usage, with one tendon disruption at the inferior pole and the other an intrasubstance tear. The different locations of the ruptures are also exceedingly rare, as only two cases of non-identical ruptures have ever been reported.

Distal focal femoral deficiency.

This report represents an interesting case of a rare distal focal femoral deficiency with a complication of hip dislocation. The deformity at the distal femur was erroneously given an initial diagnosis of proximal focal femoral deficiency, and we believe that other similar patients have been given this incorrect diagnosis. Additional reports of such patients will allow further identification of associated pathology.

Excursion of oscillating saw blades in total knee arthroplasty.

Intraoperative disruption of the medial collateral ligament during total knee arthroplasty is an uncommon complication that can be avoided by retractor placement as well as by careful cutting of the femur and tibia. This study evaluated the excursion of a small and large oscillating saw blade and compared the data against the widths of both the medial and lateral femoral condyle cuts. We discovered that the large saw blade had a statistically significantly larger excursion than the medial and lateral condyle width in women, as well as the lateral condyle width in men.

Bacterial growth on articulating spacers: an in vitro study.

We fashioned cement disk-shaped spacer models using antibiotic-loaded Palacos and embedded polyethylene and titanium into the surface of half of the models and inoculated the models with methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S aureus (MRSA), or Staphylococcus epidermidis, and placed them in nutrient broth. Vancomycin was loaded into the cement of the MRSA spacer models and tobramycin into the MSSA and Staphylococcus epidermidis models. In the MSSA and MRSA models, no organisms survived beyond 48 hours in the antibiotic bath regardless of the presence of additional materials.

Osteomyelitis in the diabetic foot: diagnosis and management.

Neuropathic ulcerations and altered immune function place the diabetic patient at increased risk for polymicrobial osteomyelitis of the foot and ankle. The optimal method for evaluation and management of this difficult condition is controversial, and further studies are needed. Infected ulcers with exposed or palpable bone can be assumed to have underlying osteomyelitis.