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  • ISSN: 2373-9290
    Volume 4, Issue 2
    Case Report
    Mohamed Mohamed*, Rohit Singhal, Jamie Howie and Eugene Toh
    Stress fractures are an uncommon injury in children and often present diagnostic dilemmas. They may have features both clinically and radiologically in common with infection and malignancy. Early suspicion is critical in order to eliminate the need for invasive investigations, incorrect treatment and distress to both child and parent. We report the case of a 12 year old boy who presented with unilateral leg pain and subsequently diagnosed with bilateral proximal tibial stress fractures and a unilateral proximal fibula stress fracture. Stress fracture is an uncommon diagnosis in children thus it is important to maintain a high index of suspicion and if necessary to investigate for and exclude the possibility of more sinister pathologies such as infection or neoplasm.
    Short Communication
    Benigno Zenteno*
    Nowadays, one of the main orthopedic diagnostic problems is the referral of the Patient to other physicians that do not examine the injured individuals themselves.
    Review Article
    Iulian Nusem* and Marjoree Sehu
    Early diagnosis together with appropriate treatment is essential for the management of septic arthritis of the hip. Abnormal joint anatomy and intra-articular injections increase the risk of joint infection in adults. In children-young age, male gender, respiratory distress syndrome, umbilical artery catheterization, phagocytic deficiencies, haemoglobinopathies, joint interventions and instrumentation of the urinary or intestinal systems are risk factors. Staphylococcus aureus is the most commonly identified pathogen while a growing concern is the methicillin-resistant Staphylococcus aureus. Most adults present with one or two week history restricted motion and painful joint. At least two sets of blood cultures should be obtained before initiating antibiotic treatment. Blood samples for white blood cell count, erythrocyte sedimentation rate and C-reactive protein concentration should also be obtained. Synovial fluid white cell count of > 50,000 cells/mm3 is considered diagnostic for septic arthritis. Specimens for gram-stain and culture should be obtained before antibiotic therapy is started. Repeat aspiration is an available option in the paediatric age group, but open arthrotomy remains the gold-standard for surgical treatment. As opposed to arthrotomy, hip arthroscopy offers a minimally invasive approach, increased access to the hip joint and improved visualization, while eliminating risks such as a vascular necrosis of the femoral head, joint instability, need for large surgical exposure, scarring, postoperative pain and prolonged hospital stay. The initial antibiotic choice is based on the patient's clinical history and risk factors, local prevalence of drug-resistant pathogens and Gram-stain results. As Staphylococcus aureus is the most common pathogen empiric antibiotic treatment with b-lactamase-stable penicillins is recommended. UK guidelines recommend intravenous antimicrobial therapy for two weeks followed by four weeks oral therapy.
    Nikhil Nair and Nikhil Gupta*
    Fluorosis occurs due to excessive fluorine entry into the body. Dental, skeletal and non-skeletal fluorosis is different types of fluorosis. Endemic skeletal fluorosis is prevalent in many countries including India. Conventional radiographs and more recently MRI are helpful in diagnosis of fluorosis which classically reveals a wide and intriguing spectrum of findings. We review the various radiological findings in a case of fluorosis.
    Pelin Arican*, Bernatekin Okudan, and Nur Kodaloglu
    Planar bone scintigraphy is a radionuclide imaging used for the evaluation of many pathologies such as osteoarthritis, trauma, degeneration, infections and tumors in the joints of the upper and lower extremity. However, planar images cannot reach satisfactory results especially in the wrist, foot and ankle with complex structures and small bones. Recently use of Single Photon Emission Computerize Tomography/Computerize Tomography (SPECT/CT) is increasingly widespread. SPECT/CT combines scintigraphic findings with morphological findings. It provides accurate anatomical localization of increased radiotracer uptake and evaluates morphological changes of this area. SPECT/CT increases diagnostic accuracy and specificity of planar bone scintigraphy. It improves patient management and treatment planning. Although bone SPECT/CT application is widely used in oncology patients, the number of studies about the role of assessment in the extremities and joints are limited.
    The aim of this review is to evaluate the contribution of bone SPECT/CT to the pathology of shoulder, elbow, hand-wrist, hip, knee, foot and ankle joint and to give examples from our cases.
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