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Rabies is an encephalitis caused by rabies virus, whose transmission occurs upon contact with infected animals' saliva. The diagnosis is usually performed post-mortem through a direct fluorescent antibody test (DFAT). If the DFAT results are negative, they must be confirmed with an isolation test, usually the mouse inoculation test (MIT), which implies the suffering and death of the animals, high costs and most importantly, up to 28 days to confirm a negative result. Another issue related to rabies diagnosis is the sample collection and storage, which is critical for the rabies virus' RNA genome. Thus, this study aimed to evaluate (i) reverse transcriptase polymerase chain reaction (RT-PCR) and Rabies Tissue Culture Infection Tests (RTCIT) in comparison to DFAT and MIT and (ii) FTA

Background: Due to the recent introduction of new biologic drugs for chronic migraine, a global evaluation in real clinical practice is necessary. Objective: The objective was to evaluate the effectiveness and safety in real clinical practice of drugs targeting the calcitonin gene-related peptide receptor (CGRPr) in patients with chronic migraine. Methods: Single-center, restrospective study (2019-2022), including patients with chronic migraine treated with erenumab, galcanezumab, or fremanezumab. Effectiveness variables were recorded, namely, number of migraine headache days per month (MHD), Migraine Disability Assessment Scale (MIDAS) score, and Headache Impact Test–6 (HIT-6) score, assessing changes at week 12, 24 from baseline. Toxicity was recorded following the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 criteria. Results: In all, 104 patients were included (46.2% erenumab, 41.3% galcanezumab, 12.5% fremanezumab). A reduction in MHD, MIDAS, and HIT-6 was achieved at weeks 12 and 24 with erenumab (p75% at week 24 than those intensified; P = 0.041). There was no difference in efficacy ( P = 0.154) or improvement in quality of life ( P = 0.783, P = 0.150), but there was greater toxicity ( P < 0.001) among nonresponders with erenumab 70 mg versus erenumab 140 mg. Conclusions: The results confirm the effectiveness and safety of anticalcitonin gene-related peptide (CGRP) drugs in real clinical practice. However, the study shows little benefit from erenumab intensification, with similar effectiveness and worse tolerability than the standard dose.

Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care. Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information. One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic. Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.

Purpose Short stems use has increased substantially despite variable results reported in the literature. The purpose of this study was to report the rate of complications using a short stem implanted through the direct anterior approach (DAA), and to evaluate mid-term clinical and radiological results focusing on femoral stem fixation. Methods Between April 2009 and November 2014, 698 elective total hip arthroplasties (THAs) were performed using a fully hydroxyapatite-coated short stem (AMIStem-H®). The mean age was 65.7 years (SD 12.6). Patients were invited for clinical and radiological evaluation, and to complete patient-reported outcomes questionnaires at two and five years after surgery. The mean follow-up was 6.2 years (range 2–9.73 years). Results During the study period, 59 (8.5%) patients died and 24 (3.4%) were lost to follow-up. There were six (0.9%) dislocations and 12 (1.7%) fractures, seven occurred intra-operatively. Twenty-nine (4.2%) THAs required revision surgery. Eleven THAs were revised for aseptic loosening of the stem at a mean 4.9 years (1.2–7.3 years). Five years after surgery, radiographs of 324 THAs (324/425 eligible = 76.2%) were available. Stem subsidence ≥ 2 mm was present in 42 cases (12.9%), proximal radiolucencies in 101 hips (31.5%), cortical thickening in 52 (16.0%), and a pedestal in 219 (67.6%). An Engh score between − 10 and 0 was associated with lower HHS pain subscore (p = 0.005), a higher risk of stem revision for aseptic loosening (18.8% vs. 2.7%; p = 0.008), and was more frequent in younger patients with ASA score 1. Conclusion Patients presenting radiological alterations at five years had an increased risk of revision for aseptic stem loosening and also inferior clinical results. Our study warrants further continued scrutiny of mid- and long-term survivorship of the AMIStem-H®, with radiological results at five years indicating suboptimal fixation of the stem in younger and active patients.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation. Depuis 1996, le registre genevois des arthroplasties aux HUG recueille, archive et diffuse des informations pertinentes de haute qualité concernant les arthroplasties primaires de la hanche et du genou ainsi que les procédures de révision réalisées au Service de chirurgie orthopédique et traumatologie de l’appareil moteur. Les patients sont suivis pendant toute leur vie avec la prothèse. Le registre a été essentiel pour mieux comprendre et ensuite améliorer la prise en charge de patients avec arthroplastie de hanche et de genou. Il continuera à remplir sa mission et à assurer une transmission encore plus efficace des connaissances obtenues vers tous les groupes concernés (stakeholders) et à leur implémentation.

Resume Introduction Le traitement chirurgical des lesions multiligamentaires (MLKIs) est actuellement prefere au traitement fonctionnel mais il persiste des interrogations concernant la meilleure strategie chirurgicale. Le meilleur moment pour operer, des greffes autologues ou heterologues, une chirurgie en un temps ou en sequentielle. Le but de cette etude etait d’evaluer les resultats laximetriques des reconstructions multiligamentaires par allogreffes en un temps. L’hypothese etait que l’utilisation de ces allogreffes congelees et non irradiees donne une laxite residuelle faible et des resultats cliniques satisfaisants. Methode Entre novembre 2013 et juillet 2015, 23 patients presentant une MLKIs ont eu une reconstruction multiligamentaire en un temps par allogreffe. La classification utilisee etait celle de Schenk (KD). Les resultats fonctionnels etaient evalues par les scores de KOOS (Knee injury and Osteoarthritis Outcome Score), de Lysholm, et IKDC (International Knee Documentation Committee Subjective Knee Evaluation Form) au recul minimum de 24 mois. Les laxites postoperatoires comparatives ont ete evaluees par radiographies en stress (valgus, varus, tiroir anterieur et posterieur) et exprimees en millimetres de differentielle (SSD) pour chaque laxite operee. Resultats Trois patients ont ete perdus de vue. Il y avait 6 lesions KD-I, 12 KD-II et 2 KD-IV, 12 lesions laterales et 10 mediales, 13 lesions aigues et 7 chroniques. Trois patients presentaient des lesions neurovasculaires associees. Le recul moyen etait de 29,4 ± 6,1 mois. La differentielle de laxite moyenne en valgus force etait de 0,2 mm ± 1,4 mm (−2,1–2,2 mm), de 1,4 mm ± 2,5 mm (−1,7–6,0 mm) en varus force. Le tiroir posterieur moyen differentiel etait de 7,2 mm ± 3,9 mm (1,2–16,0 mm), de 3,6 mm ± 5,1 mm pour le tiroir anterieur (−4,8–16,8 mm). L’IKDC objectif etait reparti comme suit : 4 grade A, 3B, 7C, et 6D. Trois patients se plaignaient d’instabilite residuelle. Le score IKDC subjectif postoperatoire moyen au recul etait de 67,2 ± 19,6, Le score Lysholm de 77,3 ± 16,5. Le profil moyen des parametres KOOS etait de 78,5 ± 16,6 pour la douleur, 67,7 ± 17,4 pour les symptomes, 86,5 ± 14,2 pour les activites quotidiennes, 56 ± 25,4 pour les sports, 47,2 ± 28,6 pour la qualite de vie. Dix-neuf patients ont refait du sport, 6 au meme niveau. Un patient a eu une arthrolyse arthroscopique pour raideur residuelle. Conclusions Les reconstructions multiligamentaires du genou en un temps par allogreffe non irradiee sont fiables et efficaces. Il persiste frequemment une laxite anteroposterieure mais les patients retrouvent une vie quotidienne normale et parfois la capacite de reprendre leurs sports au meme niveau. Niveau de preuve Niveau IV, Etude de cohorte.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation.Depuis 1996, le registre genevois des arthroplasties aux HUG recueille, archive et diffuse des informations pertinentes de haute qualité concernant les arthroplasties primaires de la hanche et du genou ainsi que les procédures de révision réalisées au Service de chirurgie orthopédique et traumatologie de l’appareil moteur. Les patients sont suivis pendant toute leur vie avec la prothèse. Le registre a été essentiel pour mieux comprendre et ensuite améliorer la prise en charge de patients avec arthroplastie de hanche et de genou. Il continuera à remplir sa mission et à assurer une transmission encore plus efficace des connaissances obtenues vers tous les groupes concernés (stakeholders) et à leur implémentation.

Gut microbiota-derived short-chain fatty-acid (SFCA) acetate protects mice against RSV A2 strain infection by increasing interferon-β production and expression of interferon-stimulated genes (ISGs). However, the role of SFCA in RSV infection using strains isolated from patients is unknown.We first used RSV clinical strains isolated from infants hospitalized with RSV bronchiolitis to investigate the effects of in vitro SCFA-acetate treatment of human pulmonary epithelial cells. We next examined whether SCFA-acetate treatment is beneficial in a mouse model of RSV infection using clinical isolates. We sought to investigate the relationship of gut microbiota and fecal acetate with disease severity among infants hospitalized with RSV bronchiolitis, and whether treating their respiratory epithelial cells with SCFA-acetate ex-vivo impacts viral load and ISG expression. We further treated epithelial cells from SARS-CoV-2 infected patients with SCFA-acetate.In vitro pre-treatment of A549 cells with SCFA-acetate reduced RSV infection with clinical isolates and increased the expression of RIG-I and ISG15. Animals treated with SCFA-acetate intranasally recovered significantly faster, with reduction in the RSV clinical isolates viral load, and increased lung expression of IFNB1 and the RIG-I. Experiments in RIG-I knockout A549 cells demonstrated that the protection relies on RIG-I presence. Gut microbial profile was associated with bronchiolitis severity and with acetate in stool. Increased SCFA-acetate levels were associated with increasing oxygen saturation at admission, and shorter duration of fever. Ex-vivo treatment of patients' respiratory cells with SCFA-acetate reduced RSV load and increased expression of ISGs OAS1 and ISG15, and virus recognition receptors MAVS and RIG-I, but not IFNB1. These SCFA-acetate effects were not found on cells from SARS-CoV-2 infected patients.SCFA-acetate reduces the severity of RSV infection and RSV viral load through modulation of RIG-I expression.FAPERGS (FAPERGS/MS/CNPq/SESRS no. 03/2017 - PPSUS 17/2551-0001380-8 and COVID-19 20/2551-0000258-6); CNPq 312504/2017-9; CAPES) - Finance Code 001.

Respiratory syncytial virus (RSV) is the major cause of infection in children up to 2 years old and reinfection is very common among patients. Tissue damage in the lung caused by RSV leads to an immune response and infected cells activate multiple signaling pathways and massive production of inflammatory mediators like macrophage migration inhibitory factor (MIF), a pro-inflammatory cytokine. Therefore, we sought to investigate the role of MIF during RSV infection in macrophages. We evaluated MIF expression in BALB/c mice-derived macrophages stimulated with different concentrations of RSV by Western blot and real-time PCR. Additionally, different inhibitors of signaling pathways and ROS were used to evaluate their importance for MIF expression. Furthermore, we used a specific MIF inhibitor, ISO-1, to evaluate the role of MIF in viral clearance and in RSV-induced TNF-α, MCP-1 and IL-10 release from macrophages. We showed that RSV induces MIF expression dependently of ROS, 5-LOX, COX and PI3K activation. Moreover, viral replication is necessary for RSV-triggered MIF expression. Differently, p38 MAPK in only partially needed for RSV-induced MIF expression. In addition, MIF is important for the release of TNF-α, MCP-1 and IL-10 triggered by RSV in macrophages. In conclusion, we demonstrate that MIF is expressed during RSV infection and controls the release of pro-inflammatory cytokines from macrophages in an in vitro model.

Background Recent reports highlighted the association between smoking and higher risk of postsurgical infections. The aim was to compare the incidence of prosthetic joint infection after primary total joint arthroplasty (TJA) according to smoking status. Methods A prospective hospital registry–based cohort study was performed including all primary knee and hip TJAs performed between March 1996 and December 2013. Smoking status preoperatively was classified into never, former, and current smoker. Incidence rates and hazard ratios (HRs) for prosthetic joint infection according to smoking status were assessed within the first year and beyond. Results We included 8559 primary TJAs (mean age 69.5 years), and median follow-up was 67 months. There were 5722 never, 1315 former, and 1522 current smokers. Incidence rates of infection within the first year for never, former, and current smokers were, respectively, 4.7, 10.1, and 10.9 cases/1000 person-years, comparing ever vs never smokers, crude and adjusted HRs were 2.35 (95% confidence interval [CI] 1.39-3.98) and 1.8 (95% CI 1.04-3.2). Beyond the first year, crude and adjusted HRs were 1.37 (95% CI 0.78-2.39) and 1.12 (95% CI 0.61-2.04). Conclusion Smoking increased the infection risk about 1.8 times after primary hip or knee TJA in both current and former smokers. Beyond the first year, the infection risk was similar to never smokers.

Academic research on subaltern communities often functions on the basis of extractive knowledge: The researcher, an agent, seeks out knowledge from the bodies of his research and brings that knowledge back to the academy. Through this extraction and its subsequent interpretation, Western scholars appropriate non-Western epistemologies and control how they are (re)presented. It is the extraction, coupled with the act of moving the knowledge from a minoritized place to a colonial one, that marks the violence and the epistemic injustice of coloniality. Engaging with theories from scholars including Walter Mignolo and Boaventura de Sousa Santos, this paper explores the movement (translation) of knowledge, the linguistic translation of non-Western works into Western languages, and linguistic translation as itself a form of movement of knowledge. The aforementioned are examples of what I term epistemic translations, which I maintain are inherently unjust. I then examine the ethics of Mariana Mora’s collaborative research process with Zapatista communities to offer an example of an endeavor that, instead of an epistemic translation, was a just, decolonial epistemic encounter. In so doing, I consider how epistemic translations can be decolonized by contemplating the ways in which academic researchers can establish reciprocity so that non-Western peoples are not the objects from which to extract knowledge, but subjects with agency in a two-way process of sharing and creating knowledge. I argue that it is only through praxes of co-laboring and reciprocity that a postcolonial epistemic justice in research and academia can be obtained.

Purpose: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. Methods: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. Results: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of tendays. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was threedays and the median delay between trauma and surgery was oneday. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. Conclusion: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.

Este estudo objetiva descrever o perfil de interesses profissionais de estudantes de Engenharia Civil e apresentar dois estudos de caso. Participaram 49 universitários brasileiros (35, 72% homens, 14, 28% mulheres) com idades entre 20 e 54 anos (M=26.10; DP=7.0). Dados quantitativos e qualitativos foram obtidos por meio do Berufsbilder Test de Achtnich (BBT-Br, versão brasileira, de Jacquemin). Dois estudos de caso são apresentados com base nos dados extraídos dos registros da entrevista semiestruturada. Os resultados mostram interesses por atividades relacionadas à racionalidade e ao pensamento lógico, condizentes ao curso de Engenharia. Entre os homens destacam-se interesses voltados para desafios e resolução de problemas e, entre as mulheres, para as relações interpessoais, corroborando evidência empírica. Em síntese, os interesses dos estudantes são congruentes com a área da Engenharia. Diferenças encontradas entre homens e mulheres foram consistentes com a literatura acerca de papéis e expectativas de gênero., This study aimed to describe the profile of vocational interests of Civil Engineering students and to present two case studies. Forty-nine Brazilian university students (35, 72% men, 14, 28% women), aged between 20 and 54 years old (M=26.10, SD=7.0), participated. Quantitative and qualitative data were obtained using the Brazilian version of the Berufsbilder Test (BBT-Br). Two case studies were presented based on data from the semi-structured interviews records. The results showed that both men and women expressed interests in activities related to rationality and logical thinking, consistent with the Engineering course. Among men, attention was focused on challenges and problem solving, and, among women, on interpersonal relationships, which corroborates empirical evidence. In summary, the students showed interests pertaining to the area of Engineering. Differences found between men and women were consistent with the literature on gender roles and expectations., (undefined)

Respiratory syncytial virus (RSV) is the major cause of acute bronchiolitis in infants under 2 years old. Necroptosis has been implicated in the outcomes of respiratory virus infections. We report that RSV infection triggers necroptosis in primary mouse macrophages and human monocytes in a RIPK1-, RIPK3- and MLKL-dependent manner. Moreover, necroptosis pathways are harmful to RSV clearance from alveolar macrophages. Additionally, Ripk3−/− mice were protected from RSV-induced weight loss and presented with reduced viral loads in the lungs. Alveolar macrophage depletion also protected mice from weight loss and decreased lung RSV virus load. Importantly, alveolar macrophage depletion abolished the upregulation of Ripk3 and Mlkl gene expression induced by RSV infection in the lung tissue. Autocrine tumor necrosis factor (TNF)-mediated RSV-triggered macrophage necroptosis and necroptosis pathways were also involved in TNF secretion even when macrophages were committed to cell death, which can worsen lung injury during RSV infection. In line, Tnfr1−/− mice had a marked decrease in Ripk3 and Mlkl gene expression and a sharp reduction in the numbers of necrotic alveolar macrophages in the lungs. Finally, we provide evidence that elevated nasal levels of TNF are associated with disease severity in infants with RSV bronchiolitis. We propose that targeting TNF and/or the necroptotic machinery may be valuable therapeutic approaches to reduce the respiratory morbidity caused by RSV infection in young children., RIPK1-, RIPK3- and MLKL-dependent alveolar macrophage necroptosis triggered by RSV infection is mediated by autocrine TNF and harmful to viral clearance. Alveolar macrophage necroptosis may drive RSV disease pathogenesis. https://bit.ly/3fS34uw

ObjectiveThe optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.MethodsWe conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.ResultsWe enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.ConclusionsAfter initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.Trial registration numberNCT03615781.

Necrotizing fasciitis is a rare condition. Due to the agressivity of the infection and the amputation rate, it is very important to be aware of this diagnostic and do a proper surgical debridement. We describe a clinical case of a patient with a necrotizing fasciitis that needed two fingers amputation. After the antibiotic treatment and a second surgical debridement we performed a skin graft. The follow up at 6 months show a good function of the hand.

We read with great interest the (mostly justified) scientific remarks of our colleagues Coiffier et al 1 to our article,2 randomising to either 2 or 4 weeks of systemic targeted antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. This was a classical non-inferiority trial detecting a similar outcome, similar mechanical sequels and a similar proportion of antibiotic-related adverse events in the short-antibiotic treatment group when compared with the classical long antibiotic administration of 4 weeks.2 However, native joint septic arthritis is a very heterogeneous group of clinical entities with different epidemiological, microbiological and therapeutic aspects in humans. The spectrum varies between adult and paediatric patients, with and without concomitant adjacent osteomyelitis or immune suppression, pathogens ( Staphylococcus aureus, Pseudomonas aeruginosa , gonococci, viruses), anatomical localisations (extremities, hand, diabetic foot, spine, mandibular, shoulder, sacroiliac), settings (orthopaedic departments vs rheumatological services), origins (spontaneous, intravenous drug abuse, surgical site infections, post-traumatic, bites) and management (surgeons, rheumatologists, internists, emergency vs elective drainage).3 Of note, our trial accepted all surgically drained arthritis cases but was sufficiently powered for the overall population plus the subgroup of hand and wrist arthritis cases, which in turn were …

Background and purpose Revision total hip arthroplasty (THA) is associated with higher dislocation rates than primary THA. We compared the risk of dislocation within 6 months and all-cause re-revision during the whole study period using either the dual-mobility cup or the unipolar cup. Methods We used a prospective hospital registry-based cohort including all total and cup-only revision THAs performed between 2003 and 2013. The cups used were either dual-mobility or unipolar; the choice was made according to the preference of the surgeon. 316 revision THAs were included. The mean age of the cohort was 69 (25–98) years and 160 THAs (51%) were performed in women. The dual-mobility group (group 1) included 150 THAs (48%) and the mean length of follow-up was 31 (0–128) months. The unipolar group (group 2) included 166 THAs (53%) and the mean length of follow-up was 52 (0–136) months. Results The incidence of dislocation within 6 months was significantly lower with the dual-mobility cup than with the unipolar cup (2.7% vs. 7.8%). The unadjusted risk ratio (RR) was 0.34 (95% CI: 0.11–1.02) and the adjusted RR was 0.28 (95% CI: 0.09–0.87). The number of patients needed to treat with a dualmobility cup in order to prevent 1 case of dislocation was 19. The unadjusted incidence rate ratio for all-cause re-revision in the dual-mobility group compared to the unipolar group was 0.6 (95% CI: 0.3–1.4). Interpretation Use of a dual-mobility rather than a unipolar cup in revision THA reduced the risk of dislocation within 6 months.

Introduction Alors que le traitement chirurgical des lesions multiligamentaires du genou mene a de bons resultats, la strategie de prise en charge optimale est debattue, notamment sur le choix du type de greffe : autogreffe, allogreffe ou une combinaison des deux. Le but de cette etude etait d’evaluer les resultats cliniques et la laxite postoperatoire par radiographie dynamique apres reconstruction par allogreffe en un temps. Methode Entre novembre 2013 et avril 2016, 49 patients ont eu une reconstruction en un temps par allogreffe fraiche non irradiee, pour des lesions de deux ligaments ou plus du genou. Le recul minimum etait d’un an. Les genoux avec lesions neurovasculaires et antecedents chirurgicaux etaient exclus. Les patients ont ete evalues par les scores KOOS, Lysholm et IKDC. La laxite anterieure, posterieure, en varus et en valgus a ete mesuree par des radiographies dynamiques TELOSTM et exprimee par une differentielle en millimetres par rapport au genou sain controlateral. Resultats Vingt-six patients ont ete inclus. Ont ete evalues : 9 KD-I et 14 KD-III dont 10 lesions mediales, 13 laterales, 13 aigues et 10 chroniques. Le suivi moyen etait de 22,8 mois (12–39). La laxite differentielle moyenne en varus etait de 0,5 mm (± 1,3, −2,1 a 2,2), tous de grade A selon l’echelle IKDC. En valgus, 1,6 mm (± 2,4, −1,7 a 6). 10A et 2C. La differentielle au tiroir posterieur etait de 7,5 mm (± 3,4, 2,9–16), 1A, 5B, 8C et 4D. Au tiroir anterieur, 3,8 mm (± 5, −4,8 a 16), 11A, 2B, 3C et 2D. L’IKDC global etait : 3A, 3B, 10 C et 6D. Trois patients presentaient une sensation d’instabilite et etaient grade D. Les moyennes des scores etaient : IKDC 68,5 ± 19,2, Lysholm 78,3 ± 15,9 et KOOS : douleur 74,6 ± 19, symptomes 65,7 ± 17,2, activites quotidiennes 83,8 ± 18,7, sport 54,3 ± 26,7 et qualite de vie 46,6 ± 28,2. Vingt et un des 23 patients avait repris une activite sportive, dont 5 au meme niveau. Les patients avec un recul superieur a 18 mois avaient de meilleurs scores au KOOS : activites quotidiennes 89,2 (± 12,5) vs 72,3 (± 25) (p = 0,044), sport 62,7 (± 17,2) vs 36,4 (± 35,4) (p = 0,028). Deux patients ont eu une arthrolyse arthroscopique pour une raideur postoperatoire. Conclusion Les lesions multiligamentaires du genou peuvent etre traitees avec succes par reconstruction en un temps par allogreffe avec un taux faible de laxite. L’amelioration fonctionnelle se poursuit pendant au moins 18 mois. Niveau d’evidence Niveau IV, etude retrospective.

We report three cases of a closed Hawkins III talar neck fracture in which the posteromedially dislocated talar body was irreducible even with combined anteromedial and anterolateral approaches. Our intraoperative solution was to proceed with a medial malleolar osteotomy, which resulted in an easy reduction. The combined incisions provided excellent exposure for anatomic reduction and rigid internal fixation. At a mean follow-up of 4 years, all fractures had healed with no evidence of avascular necrosis or talar dome collapse.

Background: Providing effective, efficient well child-care can be challenging. Many obstacles exist for delivering well child-care to low-income populations including time, cultural barriers and limited resources. Urban, immigrant populations face unique social circumstances and stand to benefit from a model of care that provides parents with enhanced support and education. Group well child-care is a novel take on the traditional visit, creating a community of parents with similarly aged children with a consistent provider for the first year of life. This model …

Large-head metal-on-metal (MoM) total hip replacements (THR) have given rise to concern. Comparative studies of small-head MoM THRs over a longer follow-up period are lacking. Our objective was to compare the incidence of complications such as infection, dislocation, revision, adverse local tissue reactions, mortality and radiological and clinical outcomes in small-head (28 mm) MoM and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively. A prospective cohort study included 3341 THRs in 2714 patients. The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were performed in women, with a mean follow-up of 115 months (18 to 201). There were 883 MoM and 2458 CoP bearings. Crude incidence rates (cases/1000 person-years) were: infection 1.3 vs 0.8; dislocation 3.3 vs 3.1 and all-cause revision 4.3 vs 2.2, respectively. There was a significantly higher revision rate after ten years (adjusted hazard ratio 9.4; 95% CI 2.6 to 33.6) in the MoM group, and ten of 26 patients presented with an adverse local tissue reaction at revision. No differences in mortality, osteolysis or clinical outcome were seen. In conclusion, we found similar results for small-head MoM and CoP bearings up to ten years post-operatively, but after ten years MoM THRs had a higher risk of all-cause revision. Furthermore, the presence of an adverse response to metal debris seen in the small-head MOM group at revision is a cause for concern. Cite this article: Bone Joint J 2014; 96-B:868–75.

Introduction Les plaies palmaires avec des lesions des tendons flechisseurs sont frequentes en chirurgie de la main. Dans ce contexte, nous presentons nos resultats du protocole de mobilisation en flexion active protegee (MFAP), que nous utilisons depuis bientot 20 ans dans notre centre. Les etudes ayant evalue ce protocole sont encore peu nombreuses dans la litterature et l’influence des lesions associees (par exemple nerveuses) sont egalement rarement abordees. Dans les publications actuelles, le protocole MFAP semble demontrer des resultats satisfaisants par rapport aux protocoles passif ou semi-actif. Objectif Le but de cette etude est de presenter nos resultats et l’analyse de l’incidence des lesions associees avec le MFAP. Methode Les patients ont beneficie en postoperatoire d’une attelle de type Kleinert modifiee. Avec le concours de nos physiotherapeutes, les seances se deroulent en 3 parties. D’abord les patients beneficient d’une mobilisation passive globale, puis poursuivent sur le place-tenu developpe par Cannon et Strickland et pour finir, sur les mobilisations MFAP avec des flexions actives globales douces et progressives sous protection de l’attelle. Durant le premier mois, les patients sont vus tous les jours, week-end y compris. Nous avons mene une etude retrospective sur 143 dossiers de patients pris en charge entre janvier 2008 et decembre 2013. L’âge moyen de la cohorte etait de 35,6 ans et incluait 97 hommes soit 67,4 % des patients. Dans 81,9 % des cas, le traumatisme etait du a un objet tranchant. Un seul doigt etait atteint dans 82,6 % des cas. Chez 59,7 % des patients, des lesions etaient associees : nerveuses et arterielles dans 35,4 % des cas et uniquement nerveuses pour 23,6 % des patients. Resultats Le delai moyen de prise en charge dans le protocole MFAP etait de 6,5 jours. Le temps moyen du protocole de physiotherapie etait de 128,6 jours. Dans les suites operatoires, 48 patients (33,3 %) ont developpe une ou des complications. La complication la plus frequente etait le syndrome douloureux regional complexe (CRPS), qui est survenue chez 24 patients (16,7 %). Les autres complications ont ete les suivantes : adherences (8,3 %), allodynie (7,6 %), rupture tendineuse (5,6 %), insuffisance active en flexion (1,4 %) et infection (0,7 %). Nous avons releve un taux augmente de complications en cas de lesions nerveuses et arterielles associees (31,3 %) et de lesion uniquement nerveuse associee (33,3 %). Le taux de reprise chirurgical etait de 4,8 %. Conclusion Lors de la presence de lesions associees, on constate un taux de complications plus eleve. Les resultats actuels des protocoles actifs sont encourageants avec de faibles taux de complications et une recuperation plus precoce de la mobilite par rapport aux protocoles passif ou semi-actif. Le taux de rupture est comparable a celui decrit dans la litterature pour les methodes de reeducation passive.

Introduction Les fractures luxations carpo-metacarpiennes (CMC) sont des lesions rares de la main. Differents traitements sont decrits pour la prise en charge des fractures luxations CMC. La mise en place d’une plaque d’arthrorise CMC est une option therapeutique. Toutefois, les resultats cliniques et radiologiques des fractures luxations CMC traitees par plaque d’arthrorise sont peu decrits dans la litterature. Objectif Le but de cette etude est d’evaluer les resultats cliniques et radiologiques des fractures luxations CMC traitees par reduction ouverte et par plaque d’arthrorise. Methode Nous avons revu retrospectivement les fractures luxations touchant les articulations CMC des doigts 2 a 5 traitees par reduction ouverte et stabilisation par plaque d’arthorise 2,0 entre avril 2011 et fevrier 2014. Les resultats cliniques et radiologiques ont ete evalues avec un minimum de 6 semaines de suivi. Resultats Dix patients (huit hommes, deux femmes) avec fracture luxation CMC ont ete inclus ; âge moyen 31,7 ans (allant de 21 a 61). Toutes les fractures luxations CMC ont ete traitees par reduction ouverte et par plaque d’arthrorise. De plus les gestes operatoires suivants ont ete faits : stabilisation inter-metacarpienne par broche de Kirschner ( n = 6), liberation du tunnel carpien ( n = 2), fasciotomie thenarienne ( n = 1), resection de la base du cinquieme metacarpe ( n = 1), osteosynthese metacarpienne ( n = 2) et lambeau scapulaire ( n = 1). Le temps moyen de suivi etait de 26,9 semaines (± 23 ; allant de 7 a 77 semaines). Dans cinq cas le mecanisme lesionnel etait a basse energie et dans les cinq autres cas a haute energie, dont deux cas avec une fracture ouverte. Parmi les dix cas, sept ont eu une ablation du materiel, trois uniquement les broches de Kirschner en moyenne a 9,2 semaines et quatre une ablation complete du materiel d’osteosynthese en moyenne a 21,3 semaines. Au dernier controle sept patients avaient une mobilite complete des doigts et une absence de douleurs ; deux patients presentaient un syndrome douloureux regional complexe. Les donnees cliniques de suivi etaient manquantes pour un patient. Les radiographies conventionnelles de suivi montraient dans tous les cas une absence de subluxation CMC et une consolidation osseuse en cours ou acquise. Conclusion La reduction ouverte et stabilisation par plaque d’arthrorise des fractures luxations CMC a permis d’obtenir une reduction anatomique et une bonne stabilite. Un deplacement secondaire n’a pas ete observe et les resultats cliniques a court terme sont bons.