QUESTION: Which of the following statements is true regarding septic arthritis?
A. Gonococcal arthritis is the most common type of monoarticular septic arthritis in individuals under 30 years of age
B. Infection occurs most commonly by direct inoculation
C. There is a unimodal distribution
D. Widening of the joint space is an early sign seen on X-ray membrane
THE ANSWER IS A.Septic arthritis is defined as an infection of a joint by bacterial or fungal organisms. Classically, septic arthritis presents with fever, joint pain, and effusion, typically in the large joints. Fever is usually present, but may be absent in immunocompromised individuals. Gonococcal arthritis remains the most common form of joint infection in individuals under 30 years of age. Acute nongonococcal septic arthritis in adults is most often caused by gram-positive organisms (Staphylococcus aureus). Overall, Staphylococcus aureus is the most common cause of septic arthritis with an increasing frequency of methicillin-resistance.
Although direct inoculation (B) and contiguous spread from bony and soft tissue occur, bacterial pathogens most commonly infect the joint space by hematogenous spread. Septic arthritis is bimodal (C) with peaks for young children and adults over age 55. Plain films are usually normal in septic arthritis. Widening of the joint space (D) may occur due to a joint effusion, but this is a late sign.
Adams BD, Lowery DW III: Arthitis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 114:p 1477-1481
#2QUESTION: Which of the following is the most common complication associated with an anterior shoulder dislocation?
A. Axillary nerve injury
B. Bankart lesion
C. Greater tuberosity fracture
D. Hill-Sachs defect
THE ANSWER IS D.
A Hill-Sachs deformity is the most common complication of an anterior shoulder dislocation, occurring in up to 40% of cases. The defect is a depression fracture of the posterolateral surface of the humeral head that results from compression of the dislocated head by the lower glenoid rim. Prolonged dislocation leads to larger deformity size. Not surprisingly, a Hill-Sachs defect is also more likely with recurrent anterior dislocations.
Brachial plexus injury or damage to the axillary nerve (A) occurs in up to 14% of anterior shoulder dislocations. Axillary nerve injury is usually a neuropraxia and complete recover is expected. A Bankart lesion (B) is a fracture of the anterior aspect of inferior glenoid rim and occurs between 10% and 20% of traumatic anterior shoulder dislocations. Fracture of the greater tuberosity (C) occurs in up to 15% of anterior dislocations.
Simon RR, Sherman SC: Knee, in Simon RR, Sherman SC (eds): Emergency Orthopedics, ed 6. New York, The McGraw-Hill Companies Inc., 2011, (Ch) 16:p 343-346
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