Radiological Case of the Month

Calcaneal Bone Osteomyelitis

Case Summary

A 51-year-old white man with a medical history significant for Type I diabetes mellitus and peripheral vascular disease necessitating multiple prior distal amputations presented with increasing right foot pain. He reported no recent trauma or corticosteroid therapy. Physical examination revealed prior transmetatarsal amputation and a large nonhealing ulcer that penetrated deeply to the lateral aspect of the ankle. In addition, erythema, warmth, and edema of the leg and foot were noted, leading to a strong clinical suspicion of osteomyelitis.

PT Soon After Hip Fracture Surgery Improves Mobility

"Patients who begin physical therapy immediately following hip fracture surgery have better mobility after 2 months than patients who start physical therapy later, according to results of a study published in the July issue of the Journal of the American Geriatrics Society."

Benzodiazepine Use Associated With Hip Fracture in Elderly

"Benzodiazepine use is associated with an increased risk of hip fracture in the elderly, according to researchers. 'It remains unclear whether benzodiazepine use increases hip fracture incidence,' Dr. Stephen B. Soumerai, of Harvard Medical School, in Boston, and colleagues write in the July 26th issue of the Archives of Internal Medicine."

Incidence of Whiplash Lower Than Expected

"A study of people involved in high-energy road collisions reported in the Aug. 1 issue of Spine showed a surprisingly low incidence of whiplash. 'Whiplash is considered to be a soft tissue injury of the neck sustained by occupants of motor vehicles. Use of the term in the past had been restricted to hyperextension injuries following a rear impact, but is commonly now used for all types of impact,' write Hammad Malik, MRCS, from Wrightington Hospital in Wigan, and Martyn Lovell, FRCS, from the Wythenshawe Hospital in Manchester, U.K. 'No relationship has been found between velocity or force of injury and incidence or outcome of whiplash.'"

Moderate Intensity Exercise Effective for Weight Loss

"Moderate intensity exercise is as good as vigorous exercise for reducing weight in sedentary women, according to the results of a randomized trial published in the Sept. 10 issue of The Journal of the American Medical Association. A second study from the Women's Health Initiative also suggests that vigorous exercise may be no better than moderate intensity exercise in preventing breast cancer."

Inhaled Steroids Do Not Appear to Raise Fracture Risk in Youngsters

"The use of inhaled corticosteroids, standard treatment for asthma, is not associated with a significant increased risk of fracture in children and adolescents, researchers report in the August issue of Pediatrics."

Follow Up Exam After Fracture

"Follow Up Exam After Fracture"

Cool!

Effectiveness of Topical NSAIDs in Osteoarthritis Limited to 2 Weeks

"Topical nonsteroidal anti-inflammatory drug (NSAID) use in osteoarthritis is only effective during the first two weeks of treatment and is comparable to placebo at one month, according to the results of a meta-analysis of 13 randomized controlled trials published in the British Medical Journal Online First July 30 issue. 'NSAIDs have been applied topically for decades,' writes Jinying Lin, MD, from the People's Hospital of Guangxi Province in the People's Republic of China, and colleagues. 'This route possibly reduces gastrointestinal adverse reactions by maximizing local delivery and minimizing systemic toxicity.'"

Can't go on prescribe Voveran gel anymore on a long-term basis!

Medscape Orthopaedics Journal Scan: July 2004

"Arthroscopic Knots: Determining the Optimal Balance of Loop Security and Knot Security"

Medscape Orthopaedics Journal Scan: July 2004

"Lateral Retinacular Release: A Survey of the International Patellofemoral Study Group."

Medscape Orthopaedics Journal Scan: July 2004

"Initial Fixation Strength of Flexible All-Inside Meniscal Suture Anchors in Comparison to Conventional Suture Technique and Rigid Anchors: Biomechanical Evaluation of New Meniscus Refixation Systems"

Medscape Orthopaedics Journal Scan: July 2004

"'All Inside' Meniscal Repair Devices: An Experimental Study in the Goat Model"

Total Ankle Arthroplasty Yields Mixed Results

"Findings from a new study suggest that total ankle arthroplasty with the Agility implant is an effective treatment for severe arthritis that provides durable results. According to another report, however, the procedure is associated with a relatively high reoperation rate."

Quadriceps Control in ACL Deficient People

"Diminished quadriceps control was observed when people with ACL deficiency performed static and dynamic tasks. The most striking feature of this impaired control was failure to turn the quadriceps 'off' when performing flexion tasks in which the knee extensors are usually 'silent'. Our findings suggest that quadriceps dyskinesia after ACL injury is relatively global. Changes in neural function and muscle physiology after ACL injury are put forth as the most likely source of the observed dyskinesia."

Treatment of Postmenopausal Osteoporosis

"In prospective trials, both bisphosphonates were effective in reducing vertebral and hip fractures in women with postmenopausal osteoporosis. In the only prospective trial evaluating hip fracture risk reduction as the primary end point, risedronate was effective at reducing hip fracture vs placebo. Both alendronate and risedronate are available in once-weekly formulations that have efficacy and tolerability profiles similar to the once-daily doses. Clinicians should review all available data for both agents as well as the medical history of the patient to make the most appropriate treatment choice."

Treatment of Postmenopausal Osteoporosis

"In prospective trials, both bisphosphonates were effective in reducing vertebral and hip fractures in women with postmenopausal osteoporosis. In the only prospective trial evaluating hip fracture risk reduction as the primary end point, risedronate was effective at reducing hip fracture vs placebo. Both alendronate and risedronate are available in once-weekly formulations that have efficacy and tolerability profiles similar to the once-daily doses. Clinicians should review all available data for both agents as well as the medical history of the patient to make the most appropriate treatment choice."

Weekly Oral Alendronic Acid in Male Osteoporosis

"Alendronic acid 70mg administered once weekly is an effective andconvenient alternative to daily dosing for the treatment of male osteoporosis."