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The economic burden exacted on health care systems is considerable and includes direct and indirect costs, with loss of personal earnings and burden to carers. The diabetic foot is a significant contributor to the global burden of disability and reduces the quality of life. It remains a considerable public health problem.
Charcot neuroarthropathy (CN) of the midfoot was traditionally treated non-operatively with off-loading in a total contact cast (TCC). After introduction of the super construct concept, promising results were reported, however there is a need for further studies on this concept. Analysis of non-operative versus operative treatment is presented as well as our results from a consecutive series of 20 patients operated with the superconstruct concept.

Twenty patients were operated from July 2017 until June 2020. Mean age was 58 years (50-80), mean weight was 116kg (68-156), giving a BMI of 31 (26-45). Preoperative patients off-loaded in a TCC until decreased swelling and skin temperature measurement or ulcer had healed, mean 16 weeks immobilization. Surgery was without tourniquet, using a standard medial and lateral incision. Mean follow up is 24 (5-40) months.

Mean operation time was 227 (150-315) minutes. Medial column fusion was mandatory, in five cases as an isolated procedure, in 12 cases in combinatioust be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up.
Superconstruct reconstruction of CN midfoot collapse is a safe procedure. There are incisional wound problems, recognition and fast treatment of these complications is important to achieve good results. There is a risk for overloading the ankle, initiating a new acute Charcot attack. Attention must be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up.
The aim of this study was to present our clinical outcomes and surgical technique in strut allografts preparation using staggered holes to enhance osteointegration and demineralised bone matrix (DBM) as an adjunct to cortical strut allografts in salvage revision arthroplasty patients.

Retrospective consecutive series of patients who required strut allograft femoral reconstructions with minimum 2 years follow up between 2012 and 2018. Frozen washed irradiated, cortical struts were used and prepared adding 2mm staggered drill holes along the length of the strut and applying DBM paste on the graft-host interface. Outcome measures included radiographic strut union, graft resorption, infection and complications.

15 patients included; 3 males and 12 females with median age 72 years (range 60-93). All had significant bony defects (Paprosky III/IV in 12 cases including 3 cases of periprosthetic hip fractures and further 3 cases of periprosthetic knee fractures around revision hinged implants). At final follow up, median 3.8 years (range 2.7-7.2), 14/15 (93.3%) struts had united at a median 6 months (range 5-8), complete incorporation with cortical round-off was seen at median 12 months (range 8-48) in 12/15 (80%) struts, 2/15 (13.3%) show radiographic evidence of proximal minimal graft resorptions although the remainder of the strut had integrated and were asymptomatic. There were no cases of infection.

Use of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.
Use of strut allografts helps to reconstruct bone defects, restore bone stock, and provide stable fixation for complex patterns of periprosthetic fractures around hip/knee implants and salvage revision cases with 93.3% union rate at median 6 months.
Leaving against medical advice (AMA) is associated with increased readmission rates, fragmented patient care, and healthcare litigation. Understanding the factors associated with trauma patients leaving AMA from acute care settings will help guide better communication with trauma patients and improve patient satisfaction. This study aims to assess the sociodemographic and in-hospital care characteristics of trauma patients that leave AMA from acute care centers across the U.S.

We pooled and analyzed eight years of data (2009-2016) from the National Hospital Ambulatory Medical Care Survey. The outcome variable was whether the patient left AMA or not. The main predictors were the triage class, weekend presentation, health insurance status, the presence of chronic diseases, and the receipt of therapeutic and diagnostic procedures. find more The sociodemographic characteristics -age, sex, and race/ethnicity, were measured as potential confounders in the developed model. We performed logistic regression and reported the unadjusted and adjusted odds of leaving AMA as well as the 95% confidence intervals.

The weighted percent of the trauma patient population that left AMA was 1.8%. The odds of leaving AMA decreased with advancing age, and increased among non-Hispanic Blacks, compared with non-Hispanic Whites. After adjusting for age, race, and gender, the odds of leaving AMA increased among patients that lacked health insurance (AOR 1.86; 95% CI 1.51-2.31), and had diagnostic procedures (AOR 2.79; 95% CI 2.32-3.36). The odds of leaving AMA reduced among trauma patients who were classified as emergent (AOR 0.70; 95% CI 0.50-0.98) and had therapeutic procedures (AOR 0.39; 95% CI 0.32-0.47).

Predicting trauma patients with increased odds of leaving AMA will inform intentional communication that may reduce leaving AMA rates and improve care.
Predicting trauma patients with increased odds of leaving AMA will inform intentional communication that may reduce leaving AMA rates and improve care.
Knee osteoarthritis (OA) is a leading cause of disability and functional limitations in aging adults. Total knee arthroplasty (TKA) is the gold standard treatment of this condition. The purpose of this study is to evaluate which patient characteristics are associated with proceeding to TKA.

Retrospective review of patients with knee osteoarthritis at a single institution was conducted. Demographic, radiographic and clinical patient characteristics were analyzed. The primary outcome measure was whether patients underwent TKA over the study time-period. Univariate comparisons between patients not undergoing surgery and those undergoing TKA were performed. Multivariate logistic regression was performed to evaluate risk factors for undergoing TKA.

Two hundred seven patients were included in the study. One hundred eighty seven patients (90.3%) did not undergo surgery, while 20 (9.7%) underwent TKA. No statistically significant differences in demographics were observed between patients who underwent TKA and trm the development of future predictive models.
Xpert MTB/RIF assay is a rapid automated molecular test with excellent reported sensitivity, specificity for diagnosis of pulmonary and extrapulmonary Mycobacterium
(MTB) infections. However, the clinical utility and accuracy in STB is not well established. A study was conducted to report on the sensitivity, specificity and clinical utility of the Xpert MTB/RIF assay in spinal tuberculosis (STB).

A retrospective review of medical records was performed for 136 patients that underwent spinal biopsy for suspected spondylodiscitis. Reports for acid fast bacilli (AFB) smear, gram stain, pyogenic culture, MTB culture, histopathology, Xpert MTB/RIF assay, and drug sensitivity testing were reviewed. '
was based on positive histopathology and/or MTB culture evidence and was considered as
. Any samples returning a positive pyogenic or fungal culture were considered as
. The sensitivity, specificity for Xpert MTB/RIF was assessed against the reference standard.

A total of 125 patients were considered for final analysis, 86 patients met the criteria for '
. This includes nine patients that were MGIT culture only positive; 45 that were histopathology only positive and 32 were both culture and histopathology positive. There were 39 culture proven (pyogenic-37 and fungal-2) patients included in
group. The 86 MTB
patients, included 53 (61.6%) tissue samples and 33 (38.4%) pus samples. The overall analysis showed a 65.1% sensitivity, 100% specificity, 100% PPV and 56.5% NPV for the Xpert MTB/RIF.

Gene Xpert MTB/RIF showed excellent specificity and was accurate in the identification of drug resistance. The sensitivity was 65% and sampling techniques using pus samples rather than tissue samples could be a possible reason for lower sensitivity.
Gene Xpert MTB/RIF showed excellent specificity and was accurate in the identification of drug resistance. The sensitivity was 65% and sampling techniques using pus samples rather than tissue samples could be a possible reason for lower sensitivity.Schenck's knee dislocation (KD) I is a very uncommon pattern of KD, where the knee presents with clinical or radiographic evidence of a KD with one of the ligaments of the central pivot preserved. The correlation between imaging and physical examination is of the highest importance to correctly classify this injury. Recently, there have been reports in the literature with large numbers of Schenk's KD I, however this is due to classifying multiligament knee injuries as if they all were KDs rather to an increase of the pattern. In this report the case of an 18-year old patient that sustained a KD with a preserved posterior cruciate ligament is presented.
Regeneration potential of Hamstring tendons after harvest assumes significant clinical relevance as its use has become widespread today. Methods which best assess the regeneration, extent and type of regeneration, plus issues related to functional loss are important for the surgeon to know. This review looks at the literature to find answers to the above questions.

To summarize the evidence in support of hamstring tendon regeneration, and the most appropriate modality for evaluation of regeneration. Additionally, to evaluate the regeneration in terms of complete or partial, extent and its impact on strength deficit and functional outcomes.

We did a systematic review of literature through specified search engines and identified 30 of 285 studies to be relevant (19 prospective and 11 retrospective).

Evaluation of above data suggests tissue regeneration at harvest sites does occur (78.9% of semitendinosus and 42.7% of gracilis tendons), but this regeneration is variable. No established definition of reged about the long-term consequences.
There is variable hamstring regeneration after harvest, with poorly defined definition of "regeneration". Some changes in the muscle itself, abnormal distal insertion and absence of regeneration in some are documented, along with strength deficits. Although overall functional deficits have been reported to be minimal, a definite change in the anatomy of the medial hamstrings is a factor to be kept in consideration. More information is needed about the long-term consequences.
Modified French osteotomy is commonly used method for the correction of cubitus varus deformity. Fixation of the osteotomy with figure of 8 wiring or 3.5mm cortical screws were found to be insufficient in holding the distal fragment in children above 8 years. In this study we used a Reconstruction locking plate for the fixation of osteotomy in those children and evaluated the results.

Modified French osteotomy and fixation with reconstruction locking compression plate was performed for eighteen cases of cubitus varus deformity within the time period of 5 years starting from March 2014 to February 2019.

The outcome of the study was assessed with Flynn's criteria, where 12 cases had excellent and 6 cases had good outcome. There were no complications and no revision surgeries were performed.

Reconstruction locking plate fixation of a modified French osteotomy in older children (above 8 years) provided excellent results in our study.
Reconstruction locking plate fixation of a modified French osteotomy in older children (above 8 years) provided excellent results in our study.
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