A one year old boy was admitted with left shoulder pain with reduced range of motion of five days' duration associated. Inflammatory markers were raised and radiograph of the left shoulder revealed widening of the metaphysis of the proximal humerus. Empirically, he was started on intravenous C-penicillin and cloxacillin after initial joint aspiration yielded only synovial fluid with negative culture. Subsequent MRI revealed acute osteomyelitis of the proximal left humerus with concurrent septic arthritis of the shoulder joint. Cultures from the arthrotomy washout grew Salmonella sp, sensitive to ampicillin. He recovered following six weeks of intravenous unasyn ( ampicillin and sulbactum). This rare case of salmonella osteomyelitis in a non-sickle cell disease patient was diagnosed with serial laboratory and radiological studies and was successfully treated with adequate duration of antibiotics and operative intervention.
Introduction: Intra-articular hyaluronic acid (HA) is widely utilized in the treatment of knee osteoarthritis whereas platelet rich plasma (PRP) enhances the regeneration of articular cartilage. This study analyses the efficacy of HA and PRP in grade III and IV knee osteoarthritis. Methodology: This is a cross sectional study with retrospective review of 64 patients (101 knees) which includes 56 knees injected with HA+ PRP, and 45 knees with HA only. Results: During the post six months International Knee Documentation Committee (IKDC) evaluation, HA+PRP group showed marked improvement of 24.33 compared to 12.15 in HA group. Decrement in visual analogue score (VAS) in HA+PRP was 1.9 compared to 0.8 in HA group. Conclusion: We propose intra-articular HA and PRP injections as an optional treatment modality in Grade III and IV knee osteoarthritis in terms of functional outcome and pain control for up to six months when arthroplasty is not an option.
Study site: Melaka General Hospital, Malaysia