Clinical characteristics and treatment of clavicular osteomyelitis: a systematic review with pooled analysis of 294 reported cases.

Objective: This study aims to determine the incidence of Deep Venous Thrombosis after hip fracture surgery by using Doppler Ultrasonography. Study Design: Descriptive observational. Setting: This study was conducted in the Orthopedics Department at Mardan Medical Complex, Mardan - Pakistan. Materials and Methods: This study was performed on 50 consecutive patients of 40 years and above with proximal femur fractures (fracture of femoral head, femoral neck fracture and inter- trochanteric fractures) who were fulfilling the inclusion criteria. Informed consent was taken and operated on regular operation list. During the study period all the patients undergoing major orthopaedic surgery for Total Hip Replacement, Austin Moore Prosthesis, AO Screw fixation and Proximal femur fracture fixation by Dynamic Hip Screw and Interlocking Nail were investigated by Doppler ultrasonography by the same radiologist and were assessed for the occurrence of DVT. These patients were followed for 6 weeks post-operatively. The statistical significance of the results was analyzed using SPSS computer program. Results: The total numbers of patients were 50 with average age of 62 years +/- SD. Male to female ratio was 1.2:1. THR was performed in 3 (6%) patients, AMP in 11 (22%) patients, DHS was performed in 28 (56%) patients, AO screw was performed in 6 (12%) patients and Interlocking Nail was performed in 2 (4%) patients. Overall incidence of DVT in the entire study group was 4% (2 of 50 patients). None of the patient received any form of thromboprophylaxis during the entire study period. Conclusion: Our results suggest that incidence of DVT in Pakistani patients is low and is not comparable with American and European populations. Routine Thromboprophylaxis is perhaps not justified in every patient undergoing hip surgery. However, prophylaxis for patients with higher risk may be considered individually. 

Incidence of deep venous thrombosis after hip fracture surgery determined by doppler ultrasonography

Background Currently, both clavicular bacterial osteomyelitis (BO) and nonbacterial osteitis (NBO) remain not well understood owing to their much lower incidences. This study is aimed at summarizing similarities and differences between clavicular BO and NBO based on comparisons of literature-reported cases. Methods We searched the PubMed and Embase databases to identify English published literature between January 1st, 1980, and December 31st, 2018. Inclusion criteria were studies evaluating clinical features, diagnosis, and treatment of clavicular BO and NBO, with eligible data for synthesis analysis. Results Altogether, 129 studies with 327 patients were included. Compared with BO, clavicular NBO favored females (P < 0.001) and age below 20 years (P < 0.001) and mostly presented in a chronic phase (disease term exceeding 2 months) (P < 0.001). Although local pain and swelling were the top two symptoms for both disorders, fever, erythema, and a sinus tract were more frequently found in BO patients (P < 0.01). Although they both favored the medial side, lesions in the clavicular lateral side mostly occurred in BO patients (P = 0.002). However, no significant differences were identified regarding the serological levels of white blood cell count (P = 0.06), erythrocyte sedimentation rate (P = 0.27), or C-reactive protein (P = 0.33) between BO and NBO patients before therapy. Overall, the BO patients achieved a statistically higher cure rate than that of the NBO patients (P = 0.018). Conclusions Females, age below 20 years, and a long duration of clavicular pain and swelling may imply NBO. While the occurrence of a sinus tract and lesions in the lateral side may be clues of BO, inflammatory biomarkers revealed limited values for differential diagnosis. BO patients could achieve a better efficacy than the NBO patients based on current evidence.

/pdf/similarities-and-differences-between-clavicular-bacterial-ta0g48vi1h.pdf

Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases.

Aim To know the incidence of postoperative deep vein thrombosis after hip surgery in Indian patients. Method Our study comprises 108 patients undergoing major lower limb orthopaedic surgery. Evaluation by colour Doppler ultrasonography to detect DVT was performed on both lower limbs between seventh and 14th postoperative day. There were 15 total hip replacements (THR), 50 bipolar hemiarthroplasties and 43 proximal femoral fixations by intra-/extra-medullary implant. Only 17 (15.74%) patients showed Colour Doppler evidence of DVT without any complication. Results In THR patients, incidence of DVT is 20%; in bipolar hemiarthoplasty, it is 16%; and in the proximal femoral fixation, it is 13.95%. No case developed pulmonary embolism, and the current figure for the incidence of DVT is 15.74%. Conclusions From our study, it appears to be the difference in incidence of DVT in our country and in western countries, but incidence is not rare. Hence, chemoprophylaxis is necessary in Indian patients.

Is it necessary to use chemoprophylaxis in Indian patients after hip surgery

An elderly women with a chronic history of pain and swelling of the right clavicle was investigated. She also had constitutional symptoms. Clinical examination showed mild inflammatory signs over the lateral one-third of the clavicle and the swelling was hard. Clavicle X-ray showed a lytic lesion in the lateral-third of the clavicle and MRI revealed a focal hyperintense area with cortical breach involving the superior cortex of the clavicle. The diagnosis was confirmed as tubercular osteomyelitis after the biopsy, which showed chronic granulomatous inflammation, and the culture was positive for Mycobacterium tuberculosis. Pain resolved by 6 weeks, swelling by 4 months and complete radiological resolution was seen at 15 months after the initiation of antitubercular therapy. No deficit in function was seen. No relapse was noted at 1-year follow-up.

/pdf/tubercular-osteomyelitis-of-the-lateral-third-of-the-3rmtr1dpc8.pdf

Tubercular osteomyelitis of the lateral-third of the clavicle.

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Is it necessary to use chemoprophylaxis in Indian patients after hip surgery

Tubercular osteomyelitis of the lateral-third of the clavicle.