Rejected

During recent years, the detection of osteoarticular infections has increased, thanks to improvement and wide availability of diagnostic tools. Despite that, surgeons and patients still have to deal with long-term sequelae, including osteoarthritis, chronic osteomyelitis, and premature physeal arrest. Subsequent joint reconstruction is the most difficult challenge when the hip or knee has been affected. Most surgical procedures described to manage these devastating consequences are only palliative, with the goal focused on improving stability and pain control, but seldom ending with a highly functional joint. Premature physeal arrest has an unpredictable course after an osteoarticular infection. The prognosis depends on the age of the child, the type of injury (partial or total bony bar), the proportion of the physeal surface affected, and the bone compromised. Peripheral injuries lead to angular limb deformities, whereas central bars lead to limb-length discrepancies. Surgical treatment should be oriented to preserve physeal function and allow normal growth to resume. In those cases where preserving physeal function is not possible, the orthopaedic surgeon must deal with the sequelae of limb-length discrepancies and/or bone deformities.

Upper limb ischemia in patients with chronic kidney disease treated by haemodialysis is a known complication, but fortunately its progression into gangrene is not frequent. Ischemia occurs in 3.7-5% of dialysis patients, in dependence on the type of vascular access. The main cause behind the risk of digital upper limb ischemia in dialysis patients is the presence of an arteriovenous fistula. The higher the location of arteriovenous fistula, the higher the risk of onset of ischemia. In case of brachiocephalic and brachiobasilic fistulas, the risk for developing symptomatic ischemia is faced by 10-25% of patients, in case of radiocephalic fistula only by 1-1.8% of patients. In making the diagnosis we rely on the history of symptoms and physical examinations of both upper limbs. The patient may describe subjective symptoms as pain, having cold fingers, cramps during and outside dialysis, altered sensation and impaired finger movement. The therapy includes radiological intervention, removal of high-flow arteriovenous fistula, its closure, and amputation. The treatment aims to provide the patients with maximum possible multidisciplinary care and to prevent amputation. In this respect the orthopaedic examination is critical for further diagnosis and therapy of the patient at risk of upper limb impairment or for upper limb salvage.

Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P<0.001), but the traction therapy group had a greater reduction of LAD compared with the traditional group (P<0.01). Traction therapy consistently led to significantly greater relief of cervical vertigo symptoms, including dizziness, neck and shoulder pain, headache, inconvenience in daily living and work activities, impaired psychosocial adaptation, while improving quality of life. The efficacy of traction therapy for cervical vertigo surpasses that of traditional therapy, suggesting that traction therapy is potentially more clinically useful in treating these patients.

Symptomatic isolated costovertebral joint (CVJ) osteoarthritis is rare, and establishing this diagnosis is often difficult. There are few reports in the literature about how to surgically manage these lesions. Our aim was to describe a case of isolated osteoarthritis of the costotransverse joint (CTJ) successfully treated with a resection arthroplasty.

Managing postoperative pain even after laparoscopic groin hernia repair still remains an interesting challenge for clinicians especially for patients of high risk. Plenty of operative techniques and analgesic methods have been proposed in order to minimize postoperative pain after laparoscopic groin hernia repair. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain.

In Australia, high-dose sublingual buprenorphine and long-acting injectable buprenorphine are available. High-dose buprenorphine is used predominantly in the setting of opioid use disorder and has a role in chronic pain. Palliative care specialists are increasingly involved in pain management and end-of-life care for patients on these medications, yet there is a lack of education and training about high-dose buprenorphine for palliative care specialists. We describe our experience caring for John (fictional name), a gentleman with chronic pain and a new high-grade post-transplant lymphoproliferative disorder prescribed high-dose buprenorphine. We share the challenges and experience in caring for John as he deteriorated into the terminal phase and died of his illness. We include potential management options and the rationale for our decision to rotate John from high-dose sublingual buprenorphine to subcutaneous oxycodone. We conclude with practice implications and suggestions for improved patient care and clinician experience, including increased collaboration between palliative medicine, acute pain, and addiction medicine services, increased education and training for palliative care specialists about high-dose buprenorphine, and ultimately the development of consensus high-dose buprenorphine to oral morphine equivalence guidelines.

This study aimed to determine the efficacy and safety of celecoxib for pain management after total knee arthroplasty (TKA).

Over half of HIV infections in the U.S. are among young gay, bisexual, and other same-gender-loving men (SGLM). Symptoms affecting these individuals must be clarified in order to be detected and addressed by health care providers. This report describes the symptom prevalence in young SGLM living with HIV. Study participants in an urban context experienced high symptom burden with a median of 6.2 symptoms despite antiretroviral treatment with viral suppression. Most common symptoms included fatigue (57%), depression (54%), insomnia (53%), anxiety (44%), dizziness (33%), and headache (33%). This study showed that young SGLM with HIV experience a high number of symptoms given their age. Health care providers should work to alleviate this symptom burden that affects patients' quality of life and may influence engagement in care.

Ischemic stroke following a snakebite is a rare case. Snake venom consists of multiple components which can cause various symptoms and consequences. We report a case of ischemic stroke following snakebite, and this study was the first to report a case of ischemic stroke after snakebite in Indonesia.