Chronic arthritis in children and adolescents in two Indian health service user populations

BACKGROUND: High prevalence rates for rheumatoid arthritis, spondyloarthopathies, and systemic lupus erythematosus have been described in American Indian and Alaskan Native adults. The impact of these diseases on American Indian children has not been investigated. METHODS: We used International Classification of Diseases-9 (ICD-9) codes to search two Indian Health Service (IHS) patient registration databases over the years 1998–2000, searching for individuals 19 years of age or younger with specific ICD-9-specified diagnoses. Crude estimates for disease prevalence were made based on the number of individuals identified with these diagnoses within the database. RESULTS: Rheumatoid arthritis (RA) / juvenile rheumatoid arthritis (JRA) was the most frequent diagnosis given. The prevalence rate for JRA in the Oklahoma City Area was estimated as 53 per 100,000 individuals at risk, while in the Billings Area, the estimated prevalence was nearly twice that, at 115 per 100,000. These rates are considerably higher than those reported in the most recent European studies. CONCLUSION: Chronic arthritis in childhood represents an important, though unrecognized, chronic health challenge within the American Indian population living in the United States

Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability

Learning from the learning curve in total hip resurfacing: a radiographic analysis.

Contains fulltext : 79990.pdf (publisher's version ) (Closed access)BACKGROUND: Operation of hip resurfacing prosthesis is a technically demanding procedure accompanied by a learning curve. To our knowledge no objective data on this learning curve are available in the literature. METHODS: For the first 40 resurfacing hip prostheses implanted by a single-surgeon radiographic 'learning curve' analysis was performed. Optimal implant positioning on preoperative digital templating was compared with the eventual implant position postoperatively, measured by six establishes radiographic parameters and compared for four chronological cohorts of patients. RESULTS: A learning curve was clearly present and an optimal result was established in the last cohort. Pitfalls were a relatively steep cup position initially and a stem position in the posterior 1/3 of the collum. Besides marginal medialization a fully anatomic reconstruction of the center of rotation was achieved. CONCLUSION: In total hip resurfacing one should recognize the presence of a learning curve. This learning curve appears to be acceptable and a reproducible optimal implant positioning can be achieved quickly