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Surgery to the temporomandibular joint
Published in John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan, Operative Oral and Maxillofacial Surgery, 2017
Arthrotomy refers to the direct surgical exposure of a joint. A temporomandibular joint (TMJ) arthrotomy is technically one of the more difficult surgical dissections in the maxillofacial region. Whilst the close proximity of the facial nerve is the main reason for the difficult surgical access, other important anatomical structures such as the complex distribution of the superficial temporal vessels also add to the complexity of the dissection. With the middle cranial fossa above, the internal maxillary artery medial to the TMJ, and the middle ear behind the TMJ, there is little room for surgical error as these anatomical structures are only a few millimetres away from the joint itself.
Principles of Operative Treatment
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Arthrotomy (opening a joint) may be indicated: (1) to inspect the interior or perform a synovial biopsy; (2) to drain a haematoma or an abscess; (3) to remove a loose body or damaged structure (e.g. a torn meniscus); and (4) to excise inflamed synovium. The intra-articular tissues should be handled with care, and if postoperative bleeding is expected (e.g. after synovectomy) a drain should be inserted. Following the operation the joint should be rested for a few days, but thereafter movement should be encouraged.
Parvimonas micra causing native hip joint septic arthritis
Published in Baylor University Medical Center Proceedings, 2021
Patrick M. Ryan, Bernard F. Morrey
Diagnostic arthrocentesis was performed followed by urgent arthrotomy, irrigation, and debridement of the hip joint with abscess drainage the following morning. Culture results obtained on a blood agar plate of the synovial fluid from the arthrocentesis and the surgical specimens both grew P. micra. This organism grew on two separate days from two separate locations and was thus confirmed. Cultures from the abscesses demonstrated no growth. The patient was empirically started on vancomycin and piperacillin tazobactam. C-reactive protein levels were trended during the hospital stay (Figure 2). The patient was then switched to ampicillin/sulbactam and doxycycline following susceptibility results and remained on this treatment regimen for 6 weeks through discharge to a long-term rehabilitation facility.
Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion
Published in Acta Orthopaedica, 2020
Bjoern Vogt, Robert Roedl, Georg Gosheger, Gregor Toporowski, Andrea Laufer, Christoph Theil, Jan Niklas Broeking, Adrien Frommer
The basic idea regarding the preference for a retrograde approach for tibial ILN implantation in contrast to the standard antegrade insertion technique is to avoid an entry-related effect on the knee joint. Antegrade tibial nail implantation always requires a knee arthrotomy (Fragomen and Rozbruch 2017) and bears the risk of joint effusion or hemarthrosis associated with pain and restricted ROM. Some patients develop persisting anterior knee pain and may become unable to kneel (Rothberg et al. 2019). Due to the retrograde ILN implantation inherently no approach-related effects on the knee joint were observed in our patients. On the other hand, plantar nail entry carries the risk of approach-related problems such as painful soft tissue irritation or delayed wound healing (Mosca et al. 2020). 3 of our patients had delayed plantar wound healing. No cases of deep infections or neurovascular injury occurred.
Prosthetic joint infection caused by Candida lusitaniae: report of a unique case
Published in Acta Clinica Belgica, 2019
Julia Bini Viotti, Monica Corzo-Pedroza, Jose Armando Gonzales Zamora
Optimal treatment of Candida PJI remains unknown. The combination of prolonged antifungal therapy and a two-stage exchange arthroplasty is recommended on the basis of limited data [2,19,22]. This strategy involves removal of all infected prosthetic components and cement followed by debridement of infected periprosthetic tissue (stage 1). Local antimicrobial-impregnated cement and devices are commonly used. In cases of Candida PJI, the role of antifungal-impregnated spacers remains to be elucidated [23]. Once the infection is thought to be eradicated, a repeat arthrotomy is performed and the joint is reassessed for signs of infection. If the operative inspection and frozen histopathology (if available) are negative for ongoing infection, a new prosthesis is implanted (stage 2). The optimal time for prosthesis reimplantation has not been established. Although a two-stage exchange arthroplasty is recommended in most cases of fungal PJI, successful treatment with only medical therapy has been described in a few patients [24–26].