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Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice.

Level of Evidence: Level V (Therapeutic)

Background: Percutaneous Kirschner wire (K-wire) fixation of hand and wrist fractures is a common trauma procedure, yet there remains little consensus on the best management of wires postoperatively. If wire’s ends are left external to the skin, it remains unknown which dressing regimen best reduces infection risk. We felt that a systematic review was required to assess the current consensus on this question within the published literature.

Methods: An electronic search was carried out across multiple databases. Abstracts were screened by two independent reviewers against inclusion criteria and, where necessary, full texts were reviewed. Nine eligible papers were identified, and data regarding type of procedure, dressing choice and infection rate was extracted.

Results: The included studies were widely heterogenous, and the standard of the evidence was, in general, poor. In most, dressing choice and infection incidence were not the primary intervention/outcome under study.

Conclusions: Based on the available literature, insufficient evidence exists to establish one dressing choice as having a lower infection rate. This highlights the need for further high-quality evidence in this area.

Level of Evidence: Level III (Therapeutic)

Cryptococcal infection is well-documented in immunocompromised individuals. Cutaneous manifestations are not as common and are often difficult to diagnose due to variable presentations. Furthermore, there have been reports of coexisting cutaneous Cryptococcus and malignancy. We describe a patient that presented with a fast-growing mass (suspected sarcoma) in the hand that was ultimately treated for a Cryptococcus skin infection. We believe familiarity with the possibility of coexistence of these two conditions in an immunocompromised host could have brought about earlier diagnosis and possibly more effective treatment.

Level of Evidence: Level V (Therapeutic)

Background: Identification of the risk factors for surgical site infection (SSI) can be a straightforward and cost-effective measure to reduce or prevent the occurrence of SSI. However, there are no studies that revealed risk factors for SSI for traumatic upper extremity amputation. The aim of this study is to investigate the risk factors that promote SSI after surgery for traumatic upper extremity amputation using a large nationwide database.

Methods: We used data from the Japan Trauma Data Bank. Diagnoses were defined using the Abbreviated Injury Scale code. We applied multivariate logistic regression to evaluate the infection risk factor. We chose age, sex, vital signs, cause and type of trauma, concomitant injury, diabetes, amputation level, Glasgow coma scale, Injury Severity Score (ISS) and blood transfusion within 24 hours following hospital arrival as confounders. Receiver operating characteristic (ROC) curve analysis was adopted to identify thresholds for change in infection risk. We also applied propensity score (PS) matching to adjust for confounding factors that may affect the outcome.

Results: A total of 1,150 patients (967 males, 183 females) had traumatic upper extremity amputation. The mean patient age was 46.5 years. A total of 21 patients (1.8%) suffered from SSI. ISS, blood transfusion, systolic blood pressure (BP) and the upper extremity amputation except for finger were identified as the independent significant risk factors for SSI occurrence by the multivariate analysis (p < 0.05, p < 0.005, p < 0.05 and p < 0.005, respectively). ROC modelling revealed that patients with ISS of over 9 or systolic BP of over 160 had a risk for SSI. After PS matching, the patients with blood transfusion or systolic BP of over 160 had a significantly higher risk of infection (OR 9.0; p = 0.01 and OR 7.0; p = 0.03, respectively).

Conclusions: In treating patients with these risk factors, we must be especially careful in performing thorough debridement and wound care.

Level of Evidence: Level II (Therapeutic)

A persistent infective tenosynovitis, caused by a non-pathogenic Neisseria species and involving the little finger and the thumb of a middle-aged woman, forming a horseshoe-type infection is presented. An extensive volar approach was utilised for excision of the granulomatous synovium and drainage of turbid fluid. Neisseria spp was isolated by tissue microbiology and targeted antibiotic therapy for 6 weeks was required to eradicate infection. The presence of low virulence microorganisms which might act as true pathogens should always be considered as a causative factor leading to persistent infections that require open surgical debridement and washout.

Level of Evidence: Level V (Therapeutic)

Spondylodiscitis is a infective processes of the spinal column, that can affect the vertebrae in isolation (spondylitis), the discs (discitis) or both (spondylodiscitis). Three infection pathways are described from a pathogenetic perspective: endogenous, exogenous, and per continuitatem. The hematogenic form is the most common (about 60%), but cases of direct inoculation following surgical procedures on the spine (15%) or contamination by contiguity (12%) are not rare. Diagnosis is based on clinical, laboratory, radiological, microbiological and histopathological data, where the magnetic resonance imaging is the technique of choice for the diagnosis. Treatment may be medical using antibiotics to eliminate the infection or surgery using spinal fixation to prevent spinal instability and ample debridement of infected tissue. We report on a patient who had spondylodiscitis due to a sigmo-rettal fistula caused by a intrarectal penetration of a toothpick which was accidentally swallowed by the patient; which was successfully treated with targeted antibiotic therapy and immobilization.

The objective of this review was to summarize and critically evaluate the clinical evidence of the effect of qigong exercise on immunity and its efficacy in the prevention or treatment of infectious diseases. Thirteen databases were searched from their respective inceptions through January 2011, and all controlled clinical trials of qigong exercise on immunity and infections were included. Quality and validity of the included studies were evaluated using standard scales. Seven studies including two randomized controlled trials (RCTs), two controlled clinical trials (CCTs) and three retrospective observational studies (ROSs) met the inclusion criteria. One study focused on functional measures of immunity (antigen-induced immunity) and six studies on enumerative parameters of immunity. No study on clinical symptoms relevant to infectious diseases could be identified. Overall, the included studies suggested favorable effects of qigong exercise on immunity, but the quality of research for most of the studies examined in this review was poor. Further rigorously designed studies are required, which should adhere to accepted standards of methodology for clinical trials.

One of the serious complications of Seymour fractures is infection. A 24-year-old male presented with the open infected distal phalanx fracture of the middle finger. Wound debridement, irrigation, use of antibiotics and external fixation with the aid of mini-Ilizarov provided a resolution to the infectious process and enabled us to achieve a stable osseous union in correct position.

Shiunko is a traditional botanic formula (ointment) which is used clinically for the treatment of wounded skin caused by cuts, abrasions, frost or burn. The aim of this study was to evaluate the effect of Shiunko on epithelization of wounded skin. Experimental cutting wounds on the back skin of Sprague-Dawley rats were induced. Different bacterial inoculations (Pseudomonus aeruginosa and Staphylococcus aureus) and treatment (Shiunko, Povidone-iodine and saline) were arranged herein. The incidences of infection and the speed of epithelization were evaluated. We observed that the incidences of wound infection following Pseudomonas aeruginosa inoculation were lower on both the Shiunko-treated group (0%, p<0.01) and Povidine-iodine-treated group (5%, p<0.05), than the saline-treated group (40%). The Shiunko-treated group reported higher percentages of complete epithelization not only on the sterilized wounds (100%) but also on the contaminated wounds (90%) when compared to the saline-treated group (60% sterilized wounds, 40% and 50% contaminated wounds) on day 7 (p<0.01). Povidone-iodine did not promote epithelization of wounded skin, whereas Shiunko did.

Background: Total Elbow Arthroplasty (TEA) for the rheumatoid arthritis (RA) has been popularized since 1980s. The outcomes of TEA using any type of implant design for RA has been satisfactory. On the other hand, many orthopedicians experience several postoperative complications. Among them, postoperative infection has still being the most troublesome and difficult to treat. This study is to clarify the causes of postoperative infection of TEA using Kudo’s prosthesis for RA and discuss how to manage and prevent infection.

Methods: 421 TEAs were performed for 405 cases with RA at the authors’ institute during the period between 1982 and 2007. They were followed up for 1~25 years (Av. 12.3 years). The authors examined pain, the range of motion, roentgenograms and complications postoperatively. We were able to start treatment within 4 weeks after occurrence of infection. For surgical management of infected TEAs, debridement of the synovium and removal of the prosthesis with loosening were performed for all cases. In addition, all cases have been regularly and strictly followed-up with the elbow protector to prevent recurrence of infection since 2008.

Results: There were 98 TEAs with the postoperative complications (23.3%). Eight out of 98 TEAs were infected (1.9%). Five of eight infected TEAs were primarily at the surgical scar site infection (SSSI) (60%), unknown causes in two, hematogenous course in 1. It’s obvious that surgical scar site infection (SSSI) was the leading cause of postoperative infection in this study. Thus, the authors made the elbow proctor to avoid injuries of the skin around surgical scar site (SSS). Since 2008, all of the TEAs and revised TEAs have been applied with this protector.

Conclusions: The authors reported 8 infected TEAs: 5 cases were revised, 2 with the brace, 1 had above the elbow amputated. The regular and meticulous follow up and application of the elbow protector were useful to prevent infection of post-TEAs using Kudo’s prosthesis in RA. Since 2008, there have been no infection of post TEAs and revised TEAs.

In this paper, we consider a Hepatitis C model characterized by acute and chronic infections, treatment as a health-protective measure for the chronically infected is proposed, and its effect on the population is further highlighted. The model is perturbed by white noise and we incorporate Lévy jumps as means to depict abrupt fluctuations. We demonstrate the solution’s existence and uniqueness and deduce adequate criteria for the disease’s extinction and persistence. The importance of treatment as a protective strategy is manifested in its ability to eradicate or mitigate the propagation of the disease. We present numerical simulations to demonstrate the theoretical findings we have obtained.

A new non-autonomous predator-prey system with the effect of viruses on the prey is investigated. By using the method of coincidence degree, some sufficient conditions are obtained for the existence of a positive periodic solution. Moreover, with the help of an appropriately chosen Lyapunov function, the global attractivity of the positive periodic solution is discussed. In the end, a numerical simulation is used to illustrate the feasibility of our results.

This paper describes an evolutionary model based on sexual Penna model and shape space model with infection and immunity. Each individual is represented by Penna model with an immune system. In order to study how the infection and immunity influence the survival process, we modify the Verhulst factor. Then, we present the results of our simulations, and discuss the evolution of population and the effect of immunity respectively. In addition, we study the effect of the memory of the immune system and the effect of vaccination under different conditions.

We present a rare case of primary tuberculous tenosynovitis in a young patient with an acute history of non-penetrating traumatic injury. The patient had recently visited Pakistan and presented with sudden onset pain at the base of their right fifth digit after trying to catch a cricket ball. A provisional diagnosis of haematoma was made; however, ultrasonography revealed a mass attached to the A2 pulley. Surgical excision followed by histological examination and culture identified Mycobacterium Tuberculosis infection. This case serves to raise clinical awareness of this rare condition and highlight the importance of obtaining a travel history.

Infections following limb-saving surgeries still happen frequently and are refractory to treatment, even though the treatment of massive bone defects caused by bone resection of bone tumors has improved gradually. Once infections become intractable, they generally result in amputations in spite of all kinds of treatment. We report the case of a patient who developed an intractable infection after limb-saving surgery utilizing a massive frozen autograft and a tumor prosthesis, but whose limb was finally successfully salvaged by multiple surgical interventions. We conclude that continued perseverance in treatment after infections may enable preservation of the limb and restoration of good function.

Fibro-osseous pseudotumor of digits (FOPD) is an uncommon histological diagnosis. Clinical and imaging findings may resemble high-grade sarcoma or infection. We describe a patient with progressive pain and swelling at the dorsal surface of the first web space. MRI and CT imaging revealed an intramuscular heterogenous soft tissue mass defined by a mineralized peripheral ring. Core needle biopsy diagnosed FOPD. Eight months later a matured ossified nodule that was quite smaller than the initial soft tissue mass was excised. The patient is symptom free without local recurrence at 1 year follow up. Soft tissue masses of the hand pose a challenging diagnostic and therapeutic issue. An in depth interpretation of clinical, imaging and histology findings is important to avoid erroneous diagnosis and treatment.

In this paper, the individual is represented by a Bit-String based on the Penna model. The infection information is also denoted by a Bit-String including 0 and 1. The degree of getting an infection is rested with the matching degree between the Bit-String of the individual and the Bit-String of infection information. Thus, we define the Hamming Distance with age. The infection rules among individuals is described by Cellular Automata on the lattice with L * L. We discuss the existence and extinction for a certain infection on the process of evolution.

We investigate the switching feeding behavior of predators in the context of one single prey population, which is disease affected. We consider the case of hunting indiscriminately both types of prey, when the infected prey causes no harm to their predators, but assume also in another model that feeding on the infected individuals has a negative return on the predators. Some counterintuitive results are obtained and discussed.

A case of a 35-year-old male with necrotizing fasciitis of the hand is presented. Clinical manifestations of necrotizing fasciitis are discussed and intraoperative findings are highlighted to illustrate the disease process that initially affects the deep layer of the superficial fascia.

Korean and American Research Institutes Combine Approaches in Analysis of Viral Infectivity