Septic arthritis is a devastating condition; well-established criteria for diagnosis exist in the pediatric population, but not for adults. This study evaluated patient factors and laboratory parameters that may be associated with the diagnosis of septic arthritis in adults. A total of 458 knee aspirates for suspected septic arthritis were evaluated with serum and synovial leukocyte counts and differentials as well as Kocher criteria for pediatric septic arthritis. Twenty-two patients (4.8%) had septic arthritis confirmed by a positive synovial fluid culture. Erythrocyte sedimentation rate (ESR) and serum white blood cell (WBC) counts were not statistically different between the 2 groups, with 64% of septic arthritis patients having a normal serum WBC count and 77% being afebrile. Mean synovial fluid WBC count was 26,758 cells/µL and 70,581 cells/µL in the nonseptic and septic groups, respectively. The likelihood ratio for a synovial fluid WBC count greater than 65,000 cells/µL was 2.8 (95% confidence interval, 1.2-6.7). Evaluation receiver operating characteristic curves using synovial WBC counts resulted in a significant area under the curve of 0.66 (P=.02). To achieve 90% specificity, a WBC cutoff of 64,000 cells/µL was required with a corresponding sensitivity of 40%. There was no significant difference in the synovial cell differential of 80% vs 90% in diagnosing infection. Synovial fluid WBC count greater than 64,000 cells/µL yielded the optimal combination of sensitivity and specificity. Polymorphonuclear leukocytes, ESR, serum WBC count, fever, and weight-bearing status were not significant predictors of septic arthritis. This study demonstrates the limited utility of Kocher criteria in the adult population and the importance of synovial leukocyte counts. [Orthopedics. 2016; 39(4):e657-e663.].

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Current orthopaedic practice to fix femoral shaft and intertrochanteric fractures is intramedullary (IM) nailing. Technical errors in nailing often result in errant drill passes (EDP) during placement of distal interlock screws. This study determined if EDP create stress risers that significantly alter the biomechanical strength of the bone. Ten mm IM femoral nails were placed in 16 paired adult cadaveric distal femur specimens. Matched specimen pairs were randomized into two groups (n=16/group). Nails were statically locked distally with two 4.5 mm bicortical screws in both groups, with specimens in Group 2 being exposed to a 4.2 mm drill hole placed anterior and inferior to the nail, representing an EDP. Using the Instron 8874 Axial‐Torsion Testing System, torsional load to failure and rotational angle at failure were recorded. Student t‐tests revealed no significant decrease in load to failure for the distally locked group with an errant drill pass (p=0.435) or any differences in rotational angle at failure between groups (p=0.581). Introducing an errant drill hole while distally locking a femoral nail did not significantly decrease the specimens’ load to failure indicating that bone strength may remain uncompromised. This suggests that although these technical errors may occur intraoperatively, post‐operative outcomes may remain unaffected.Grant Funding Source : Not Applicable

Introduction: Pubic symphysis diastasis during pregnancy is a rare complication which can present as pain with ambulation, urinary dysfunction, and pelvic instability. A consensus treatment does not currently exist between surgical and conservative management. The authors present a case of severe pubic diastasis which was successfully treated using a conservative pelvic binder. Case Report: A 31year-old female presented with severe lower back pain following the uneventful delivery of her fourth child. On radiograph, a pubic symphysis diastasis of 5.5 cm was noted and she was subsequently fitted with a pelvic binder on post-partum day 3. She experienced a full range of motion and was pain free at six-week follow-up, with a diastasis of 2.1 cm present. At one year and three-month follow-up, the patient presented with a diastasis of 2.4 cm and continued to have full range of motion and mobility. Conclusion: This case contributes to the literature in showing that conservative treatment of pubic diastasis could be considered in cases where separation has exceeded normal physiologic limits.

Background: Distal radial fractures (DRF) are treated by internal fixation or closed reduction and casting (CRC). Over the years, various DRF classification systems and radiographic thresholds have been developed to guide management for orthopaedic surgeons, yet no gold standard has been established. This study sought to identify patients who presented with DRF and received treatment with CRC and determine if the process of selecting CRC-managed patients had improved by analyzing radiographic maintenance of reduction through final bone union. Methods: Retrospective review of a single-site database from 2012-2015 identified CRC-managed DRF with pre-CRC, post-CRC, and final-union radiographs. Outcomes compared included radial height (RH), radial inclination (RI), volar tilt (VT), teardrop angle (TDA), and ulnar variance (UV). Results: Post-CRC RH increased (7.5 to 10.4 mm, P<0.01) and regressed by 1.3 mm by union. RI increased (14.4 to 19.4 degrees, P<0.01) and returned to 17.3 degrees by union. Mean VT changed from −9.9 to 7.9 degrees (P<0.01) and to 1.1 degrees by union (P<0.05). TDA increased by union (34.1 to 44.5 degrees, P<0.01). UV changed from 1.2 to −0.2 mm (P<0.02) to 1.2 mm by union (P<0.01). At presentation the following parameters had differences when considering established favorable and unfavorable values at final-union: RH (9.58 vs. 5.26 mm), RI (16.9 vs. 8.1 degrees), and UV (0.4 vs. 3.9 mm) (all P<0.0005). Conclusions: Current literature demonstrated substantial variation in DRF management and expectations after CRC. This study revealed that RH greater than 9.5 mm and UV less than 3.8 mm at presentation were associated with successful reductions without functional deficit.