Group B streptococcus (GBS) infection of the hip in otherwise healthy adults is a rare entity that is previously only reported following peripartum gynaecological procedure and instrumentation. We report a case of infection of the hip with GBS following spontaneous abortion. Delay in identification of infection as the cause of pain ultimately leads to irreversible joint destruction. This case report will heighten the awareness of the first contact providers as well as orthopaedic surgeons to be more vigilant for possible septic complications associated with gynaecological procedures/complications and subsequent painful joints. To our knowledge, this is the only case report showing association of GBS infection in hip associated with spontaneous abortion.

Neuropathic arthropathy of the knee (Charcot knee) is a rare pathology defined by progressive destruction of bone and soft tissue in a patient with underlying peripheral neuropathy. Historically, Charcot knee was associated with neurosyphilis, but it has been increasingly described as a late stage of diabetes. The pathophysiology of the disease is not completely understood, but theories include repetitive microtrauma and an abnormal neurovascular response. Patients present with a warm, swollen, and unstable joint and have rapid bone resorption and characteristic findings on pathology. Nonsurgical options for pain and dysfunction include total contact casting and bracing treatment. Pharmacologic management includes diphosphonates, although this use is considered off-label. Surgical management historically included knee fusion. However, recent case series have suggested that newer prostheses allow for successful arthroplasty in this cohort, although complications are higher when compared with joint arthroplasty in patients with normal neurologic function.N europathic arthropathy of the knee (Charcot knee) is a phenomenon that was first described over 150 years ago and is characterized by progressive destruction of the knee joint. Historically, Charcot knee was associated with tabes dorsalis, polio, and cerebral palsy; the disease was not reported in patients with diabetes mellitus until 1936. 1 More recently, diabetes has been described as the most common cause of Charcot knee, which coincides with both the rising prevalence of diabetes and the longer lifespan of patients with diabetes. 2,3 Other associated neurologic conditions that predispose patients to neuropathic joints include syringomyelia, leprosy, chronic alcoholism, cerebral atrophy, and familial dysautonomia. 1,4,5 Given the rarity of the disease, there are no epidemiologic studies estimating the prevalence of Charcot knee. However, up to 7.5% of patients with diabetes have some form of neuropathic arthropathy, most commonly affecting the feet. 3 Some authors suggest that the prevalence of Charcot knee in the diabetic cohort is roughly 0.45%. 6 With the increasing number of patients with diabetes and Charcot knee, a thorough understanding of

Open fracture is a risk factor for nonunion of diaphyseal tibia fractures. Compared with closed injuries, there is a relative lack of scientific knowledge regarding the healing of open tibia fractures. The objective of this study was to investigate which patient, injury, and surgeon-related factors predict nonunion in open tibial shaft fractures. A cohort of 98 patients with 104 extra-articular open tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) were treated surgically between 2007 and 2018 at a single level 1 trauma center and were retrospectively reviewed. Patients underwent irrigation and debridement followed by definitive intramedullary nailing or plate fixation. Patient, injury, and perioperative prognostic factors were analyzed as predictors of nonunion based on anteroposterior and lateral radiographs. The nonunion rate was 27.9% (n=29). There were 12 occurrences of deep infection (11.5%). The median follow-up was 14 months. High-energy mechanism of injury (hazard ratio [HR], 5.76), Gustilo-Anderson class IIIA injury (HR, 3.66), postoperative cortical continuity of 0% to 25% (HR, 2.90), early postoperative complication (HR, 4.20), and deep infection (HR, 2.25) were significant predictors of nonunion on univariable analysis ( P <.05). On multivariable assessment, only high-energy mechanism of injury, Gustilo-Anderson class IIIA injury, and early postoperative complication reached significance as predictors of nonunion. These data also indicate that lack of cortical continuity is a significant univariable radiographic predictor of nonunion. This is potentially modifiable, may guide surgeons in selecting patients for early bone grafting procedures, and should be assessed carefully in this high-risk population. [ Orthopedics . 2021;44(3):142–147.]

Background: Meniscal allograft transplantation (MAT) was developed with the goal of delaying the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents; however, there is a paucity of literature on MAT in this population. Purpose: To evaluate the epidemiology of MAT at pediatric hospitals in the United States, with specific attention to regional and characteristic trends. Study Design: Case-control study; Level of evidence, 3. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients younger than 25 years who underwent MAT between 2011 and 2018. Characteristic information and surgical history were collected for each patient. The database was also queried for all patients who underwent other meniscal surgeries (including debridement, meniscectomy, and meniscal repair) during the same period (controls). Characteristic and geographic data from the control group were compared with those of the patients who underwent MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscal surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve (18%) patients underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT (95% CI, 1.03-1.1; P = .002) compared with repair or meniscectomy. Patients who underwent MAT also had 2.0 times higher odds of being women (95% CI, 1.2-3.3; P = .01) and 2.0 times higher odds of being privately insured (95% CI, 1.1-3.6; P = .02). MAT was performed most frequently in the Northeast (4.9/1000 meniscal surgeries) and least often in the South (1.1/1000 meniscal surgeries) ( P < .001). Conclusion: In the United States, pediatric and adolescent patients who underwent MAT were older and more likely to be female and have private insurance than those undergoing meniscal repair or meniscectomy. MAT was only performed in 17 of 47 children’s hospitals that perform meniscal surgery. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.