The American Journal of Orthopedics

JANUARY 2007 Volume XXXVI No. 1 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

1 Guest Editorial
George Cierny, III, MD D
Abstract not available.
Am J Orthop. 2007;36(1):E1-E2.

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Staphylococcus lugdunensis Osteomyelitis: A Case Report
Franco Vigna, MD, Michael Stracher, MD, Andrew Auerbach, MD, Amy Suss, MD, Kamran Majid, MD, and Charles Spero, MD
Abstract not available. Introduction provided instead.
Advanced techniques used to type coagulase-negative Staphylococcus have led to improved identification of pathogenic organisms. Staphylococcus lugdunensis has rarely been reported as an organism causing osteomyelitis. We report the first case of S lugdunensis osteomyelitis after a perforating injury.
Am J Orthop. 2007;36(1):E3-E4.

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Late Recurrent Salmonella Sacroiliac Osteomyelitis With Psoas Abscess in a Non-Sickle Cell Adult: Case Report
Robert N. Reddix, Jr., MD, Jean-Paul Montoya, MD, and Douglas L. Hurley, MD
Abstract not available. Introduction provided instead.
A review of the literature demonstrates few cases of Salmonella sacroiliac osteomyelitis in a non–sickle cell patient and few cases of primary Salmonella iliopsoas abscesses.^1-6 We report the first case involving both entities concurrently in the same non–sickle cell patient.
Am J Orthop. 2007;36(1):E5-E6.

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Gemella morbillorum Septic Arthritis of the Knee and Infective Endocarditis
Andrew Czarnecki, MD, George H. F. Ong, MD, Peter Pieroni, PhD, Elly Trepman, MD, and John M. Embil, MD L. Hurley, MD
Abstract not available. Introduction provided instead.
Gemella morbillorum is a commensal facultative anerobic gram-positive coccus found in the oropharynx and gastrointestinal, respiratory, and urogenital tracts of human beings.^1,2 Gemella morbillorum is a rare cause of infection with few reported cases. Gemella spp are related to the viridans group streptococci, causing similar infections and often posing a diagnostic challenge. The bacterium may exhibit alpha-hemolysis on sheep blood agar, which may lead to the initial presumptive identification as a viridans group streptococcus.³ In 1988, Streptococcus morbillorum was reclassified into the genus Gemella on the basis of DNA hybridization.⁴
Much of what is currently known about the clinical manifestations of infections caused by G morbillorum have been based on case reports. Gemella spp. have been most frequently associated with endocarditis^5,6 but also have been reported to cause abscesses,^7,8 meningoencephalitis,⁹ and sepsis in the immunosuppressed patient.^2,10
A literature review revealed only 3 reports of septic arthritis caused by G morbillorum^11-13 (Table). We report on a patient who presented with septic arthritis of the knee and infective endocarditis. Despite an extensive investigation, a portal of entry into the circulation for this organism could not be identified.
Am J Orthop. 2007;36(1):E7-E9.

10 Chronic Septic Bursitis Caused by Dematiaceous Fungi
Elie Gertner, MD, FRCP(C), FACP
Abstract not available. Introduction provided instead.
Septic bursitis is a commonly encountered condition. Because of the location of the olecranon and prepatellar bursae, they are the most frequently affected sites.1 The majority of cases of septic bursitis are due to bacterial pathogens, particularly gram-positive organisms (Staphylococcus aureus and streptococcal species). More recently, reports have appeared in the literature of chronic infectious bursitis caused by fungi and occurring in both immunocompromised and healthy immunocompetent individuals.
We report the first case of chronic, isolated, septic olecranon bursitis caused by Fonsecaea pedrosoi, review 3 other cases of bursitis caused by dematiaceous fungi, and discuss treatment.
Am J Orthop. 2007;36(1):E10-E11.

12 Hydatid Disease of the Lumbar Spine: Combined Surgical and Medical Treatment—A Case Report
Khaled M. Emara, MD, and Dina Marie Abd Elhameed, PhD
Abstract not available. Introduction provided instead.
Larval forms of the cestode worm Echinococcus cause hydatid disease. The life cycle of the parasite often involves dogs as final hosts and human beings and sheep as intermediate hosts; therefore, the disease is prevalent in sheep-raising countries (eg, the Middle East and Turkey). Human beings become infected by ingesting water or food contaminated by the parasite eggs. After the eggs hatch in the intestine, they migrate through the portal venous system to settle in the liver and lungs in most cases.¹ Rarely, the parasite reaches the systemic circulation. Spinal involvement represents 0.5% to 1% of all cases of echinococcosis. Spinal infection represents about 44% of skeletal echinococcal cysts.² Cysts are common in the dorsal spine, followed by lumbar and sacral sites.³
Hydatid disease of the spine could occur by direct extension from pulmonary or pelvic infestation; less commonly, it starts primarily in the vertebral body. In spinal involvement, the compression of neural tissue with resulting neurological deficit is relatively common.⁴
The treatment recommended is decompression of the neural tissue, excision of the cyst with or without stabilization, and postoperative antihelminthic drug therapy for a long duration to prevent late recurrence.⁵
Conclusions as to the best postoperative regimen with minimal side effects and easy patient compliance are not available yet because hydatid disease is a rare condition and too few cases occur to obtain proper statistics.⁵ Medical treatment could be in the form of albendazole or mebendazole, with or without praziquantel.⁶ Early discontinuation of medical treatment—with risk of recurrence—could be due to the gastrointestinal disturbances or hepatic side effects or the long duration of treatment needed.^5-8
We present a case of primary hydatid disease of the lumbar spine with no other organ involvement. The patient was treated by surgical excision followed by medical treatment in the form of albendazole for 11/2 years postoperatively. The patient now has been followed up for 6 years postoperatively with no recurrence.
Am J Orthop. 2007;36(1):E12-E14.

PRINT PUBLISHING

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Editorial
E-Publishing Comes to AJO
Peter D. McCann, MD
Abstract not available.
Am J Orthop. 2007;36(1):10.

11 Health Care Technology Assessment: Implications for Modern Medical Practice. Part I. Understanding Technology Adoption and Analyses
Read G. Pierce, MD, Kevin J. Bozic, MBA, MD, Bruce Lee Hall, MBA, MD, PhD, and James Breivis, MD
In the modern era of rapidly rising medical costs, health care technology assessment—multidisciplinary evaluation of clinical and economic aspects of technology—has assumed an increasingly important role in health policy and clinical decision-making. This review examines health care technology adoption, its impact on medical and surgical practice, and recent trends in health care technology assessment. Part I discusses the difficult challenges posed by assessment and provides a guide to the methodologies used.
Am J Orthop. 2007;36(1):11-14

15 The Orthopedist as Clinical Densitometrist: Cost- and Time-Effectiveness
John G. Skedros, MD, Kim C. Bertin, MD, Joshua D. Holyoak, BA, Niki M. Milleson, BS, and Andrew Halley, MBA
We tested the hypothesis that an orthopedic surgeon and his or her staff can efficiently and economically provide a bone densitometry service. This hypothesis reflects a philosophy that orthopedists should take a more active role in identifying patients at risk for osteoporosis. We evaluated the cost-and time-effectiveness of an orthopedic surgeon and his medical assistant in completing reports and related correspondence for dual-energy x-ray absorptiometry scans conducted in an orthopedic subspecialty clinic. Cost analysis showed that completing 14 or 15 reports per month was required to break even and that completing up to 40 reports per month was a highly efficient and economic use of the surgeon’s time.
Am J Orthop. 2007;36(1):15-22

23 Flexible Intramedullary Nailing for a Segmental Radial Fracture of the Neck and Shaft in a Child
Efraim D. Leibner, MD, PhD, Naum Simanovsky, MD, Ofer Elishoov, MD, Erwin Sucher, MD, and Shlomo Porat, MD
Abstract not available. Introduction provided instead.
Although fractures of the midshaft radius and ulna are not uncommon in children, with a number of treatment options available and satisfactory outcome being the rule, displaced fractures of the radial neck are less common and the prognosis is guarded, especially in those with significant displacement or angulation.
In recent years, reduction and fixation of radial shaft fractures in children using flexible intramedullary nails has been gaining in popularity.^1-3 A technique of reduction and fixation of radial neck fractures has also been described.^4-6 We have not found descriptions of treatment of double or segmental fractures with this technique.
We present a patient with displaced fractures of the radial and ulnar shafts with a concomitant fracture of the ipsilateral radial neck, treated by intramedullary reduction and fixation using a single flexible nail for each bone.
Am J Orthop. 2007;36(1):23-25

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What Residents Need
Robert Harway, MD
Author Reply
Peter D. McCann, MD
Abstract not available. Introduction provided instead.
Am J Orthop. 2007;36(1):28.

29 Blastomyces dermatitidis Osteomyelitis of the Tibiaa
Catherine L. Weber, MD, FRCPC, Debra Bartley, MD, FRCSC, Abdulhakeem Al Thaqafi, MD, and John M. Embil, MD, FRCPC
Abstract not available. Introduction provided instead.
Blastomycosis is a rare fungal infection caused by the thermally dimorphic fungus Blastomyces dermatitidis. Study of sporadic cases and outbreaks indicates that the area of endemnicity for β dermatitidis in North America includes the Ohio and Mississippi River basins and the Canadian Provinces and American states that border the Great Lakes.^1-8 Blastomycosis often presents a diagnostic dilemma, having varied clinical manifestations and involving multiples sites in the body.⁶ A thorough travel history and a high index of suspicion are needed when a patient presents with a chronic granulomatous infection of lung, bone, and/or soft tissue. The case that follows and the ensuing discussion highlight the difficulty in establishing the diagnosis of blastomycosis.
Am J Orthop. 2007;36(1):11-14

34 Distal Biceps Tendon Repair: Anchor Versus Transosseous Suture Fixation
David M. Klein, MD, Neil Ghany, MD, William Urban, MD, and Steven A. Caruso, MEng, MD
Suture anchor fixation and transosseous suture fixation were compared in 12 fresh-frozen cadaveric radii using either No. 2 braided polyester suture or single Mainstay 3.5-mm threaded anchors (made at the time by Howmedica, Rutherford, NJ) with No. 2 suture. Suture fixation failed at a mean strength of 162 N (range, 129-179 N), anchor fixation at 136 N (range, 121-150 N). Neither technique is strong enough to safely allow immediate biceps activity. Nevertheless, suture anchor fixation to the radial tuberosity offers a lower but clinically comparable strength to transosseous suture fixation while limiting postoperative risks.
Am J Orthop. 2007;36(1):34-37

39 Assessment of Acetabular Version by Plain Radiograph
David C. Markel, MD, John L. Andary, MBA, MD, Paul Pagano, MD, and Sam Nasser, MD
Radiographs are routinely used to assess the condition and position of the acetabular component. The condition of the cement mantle, or the ingrowth potential, is usually easily recognized. Component–bone position can be assessed by using the method of Ranawat or by measuring abduction angles. Assessment of the version of an acetabular component is often overlooked. This angle or position is important relative to instability, impingement, and motion abnormality.
The opening angle or version can be implied from a true acetabular or cross-table lateral radiograph, but good-quality views are often difficult to obtain on an outpatient basis. Using the simple technique presented here, clinicians can assess the acetabular component for version on the basis of plain anteroposterior pelvis and hip radiographs.
Am J Orthop. 2007;36(1):39-41