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Infection in orthopedics

David J Tennent, Stefanie M Shiels, Jessica A Jennings, Warren O Haggard, Joseph C Wenke
BACKGROUND: Contaminated traumatic open orthopedic wounds are frequently complicated by polymicrobial contamination and infection. In high-risk wounds, the standard of care comprises debridement and irrigation combined with antibiotics which can be applied directly or combined with systemic antibiotics. Recently, bioabsorbable chitosan sponges have been shown to be an effective single-agent delivery device for local antibiotics with and without negative pressure wound therapy (NPWT). Severely contaminated orthopedic wounds, however, are often complicated by polymicrobial infections, necessitating multiple antibiotic agents...
March 15, 2018: Journal of Orthopaedic Surgery and Research
Aldo Riesgo, Frank Liporace
Periprosthetic joint infection (PJI) is one of the most catastrophic and difficult to manage complications following total hip and total knee arthroplasty. As the number of total joint arthroplasties continues to increase, the burden of PJI will continue to further strain resources. As such, orthopedic surgeons consider four principles crucial in appropriately managing difficult or complex cases of PJI: identification, debridement, antibiotics, and patience. Indications and techniques for nonoperative treatment, debridement with implant retention, and one- and two-stage exchange arthroplasty are reviewed...
March 2018: Bulletin of the Hospital for Joint Diseases
Mark Gage, Frank Liporace, Kenneth Egol, Toni McLaurin
Treatment of traumatic bone defects is dictated by a multitude of clinical factors including the defect size, patient comorbidities, soft tissue condition, and the possibility of infection present in the defect. With a variety of treatment strategies described, it is critical to choose the approach that will maximize outcomes in addressing this difficult problem. When addressing small-scale defects, bone grafting is the primary treatment. For large-scale defects, there are two major options to consider: induced membrane technique and distraction osteogenesis...
March 2018: Bulletin of the Hospital for Joint Diseases
Teng-Fei Zhu, Wen-Guo Zhao, Han-Lin Zheng, Jia-Xiang Wu
OBJECTIVE: To investigate the application effect of damage control orthopedics for the treatment of severe multiple fractures. METHODS: From January 2014 to December 2016, 23 patients with severe multiple fractures were treated with the damage control orthopedics (DCO), included 14 males and 9 females with an average age of (41.57±8.29) years old ranging from 28 to 60 years old; the NISS averaged(27.70±5.44) points ranging from 18 to 40 points. As the control group, 27 patients with severe multiple fractures were treated by the early total care(ETC) technology from Jan...
February 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
R J Cong, J F Liu, Y Jiang, Duolikun Dilixiati, X D Hou, L P Zheng
Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed...
March 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Feng Yang, Ming-Sheng Tan, Ping Yi, Xiang-Sheng Tang, Qing-Ying Hao, Ying-Na Qi
OBJECTIVE: To compare the clinical effect between spinal card decompression combined with traditional Chinese medicine and simple spinal card decompression for cervical spondylotic myelopathy. METHODS: From June 2012 to June 2015, 73 patients with cervical spondylotic myelopathy were treated, including 42 males and 31 females, aged from 29 to 73 years old with a mean of 50.9 years old. The patients were divided into the simple operation group (34 cases) and the operation combined with traditional Chinese medicine group(39 cases) according to the idea of themselves...
January 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Keila M Maher, Kwadwo Owusu-Akyaw, Jingzhu Zhou, Mary Cooter, Allison K Ross, Robert K Lark, Brad M Taicher
INTRODUCTION: Surgical correction of pediatric scoliosis is associated with significant blood loss. Minimizing estimated blood loss and blood transfusion is beneficial as transfusions have been associated with increased morbidity, including risk of surgical site infections, longer hospitalizations, and increased cost. Although there is evidence that African-American or Black adults are more likely to require intraoperative blood transfusion compared with Caucasian or White adults, the reasons for this difference are unclear...
March 9, 2018: Paediatric Anaesthesia
Kah Wei Tan, Zhiwen Joseph Lo, Qiantai Hong, Sriram Narayanan, Glenn Wei Leong Tan, Sadhana Chandrasekar
Objective : The use of negative pressure wound therapy (NPWT) for post-surgical cardiothoracic, orthopedic, plastic, and obstetric and gynecologic procedures has been described. However, there are no data regarding its use for lower limb bypass incisions. We aimed to investigate the outcomes of NPWT in preventing surgical site infection (SSI) in patients with lower limb arterial bypass incisions. Materials and Methods : We retrospectively used data of 42 patients who underwent lower limb arterial bypass with reversed great saphenous vein between March 2014 and June 2016 and compared conventional wound therapy and NPWT with regard to preventing SSI...
December 25, 2017: Annals of Vascular Diseases
Philipp Schuster, Markus Geßlein, Michael Schlumberger, Philipp Mayer, Hermann Josef Bail, Jörg Richter
PURPOSE: No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus. METHODS: Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee)...
March 6, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Hirokazu Shoji, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Tatsuki Mizouchi, Naoto Endo
BACKGROUND: In spinal instrumentation surgeries, surgical site infection (SSI) is one of the complications to be avoided. However, spinal instrumentation surgeries have a higher rate of SSI than other clean orthopedic surgeries. The purpose of this study was to investigate the risk factors for SSI following spinal instrumentation surgeries and contribute to the prevention of SSIs by identifying high-risk patients. METHODS: Records of 431 patients who underwent spinal instrumentation surgeries from 2011 to 2014 with a minimum follow-up period of 90 days were retrospectively reviewed...
March 2, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Brittani Jones, Allyson C Berent, Chick W Weisse, Robert Hart, Leilani Alvarez, Anthony Fischetti, B David Horn, Douglas Canning
CASE DESCRIPTION A 14-week-old 7.7-kg (16.9-lb) sexually intact female Golden Retriever was evaluated because of urine dripping from the caudoventral aspect of the abdomen. CLINICAL FINDINGS Ultrasonography, radiography, excretory CT urography, and vaginocystourethroscopy were performed. Results indicated eversion of the bladder through the ventral abdominal wall with exposure of the ureterovesicular junctions, pubic diastasis, and an open vulva and clitoral fossa. Clinical findings were suggestive of bladder exstrophy, a rare congenital anomaly...
March 15, 2018: Journal of the American Veterinary Medical Association
K Keely Boyle, Thomas R Duquin
Infection after orthopedic procedures is a devastating and serious complication associated with significant clinical and financial challenges to the health care system and unfortunate patient. The time and resource-intensive nature of treating infection after orthopedic procedures has turned attention toward enhancing prevention and establishing quality improvement measures. Prevention strategies throughout the perioperative period include host optimization, risk mitigation, reducing bacterial burden and proper wound management...
April 2018: Orthopedic Clinics of North America
Paweł Baranowski, Tadeusz Płusa, Alicja Baranowska
Perioperative infections after orthopedic surgery are complications that extend the process of treatment and rehabilitation of patients. The multifactor mechanism of their formation has already been defined, which allows effective control of the threat. In addition to the introduction of ever safer surgical techniques, strict epidemic surveillance and acceptable by the body implanted materials, widely prophylactic perioperative antibiotic therapy is applied. The effects of this action are demonstrated in available clinical analyzes, which indicate a reduction in the scale of the threat...
February 23, 2018: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
A Siebe De Boer, Esther M M Van Lieshout, Gerson Van Moolenbroek, Dennis Den Hartog, Michael H J Verhofstad
BACKGROUND: Post-operative weightbearing guidelines for displaced intra-articular calcaneal fractures (DIACF) have been pragmatically developed in the past, however hardly adapted to current health care insights. A period of six to nine weeks of non-weightbearing is usually recommended. It is unknown whether an earlier start of weightbearing is advisable. OBJECTIVES: The primary aim was to evaluate the effect of time to post-operative weightbearing on Böhler's angle...
February 21, 2018: Injury
Seung-Han Shin, Yong-Suk Lee, Jin-Woo Kang, Wonwoo Kang, Yang-Guk Chung
Pins exposed out of the skin after surgery for mallet fractures keep patients from washing their hands. The authors buried the tips of all pins under the skin while performing extension block pinning for 14 patients with mallet fractures. The patients were allowed to wash their hands 4 to 5 days postoperatively, without any dressing or splinting. The pins were removed at a mean of 8 weeks postoperatively. Solid union was achieved in all 14 fractures. No pull-out or subsidence of the pin was observed. No patient developed infection or other pin-related complications...
March 1, 2018: Orthopedics
Nora Renz, Sabrina Cabric, Christian Morgenstern, Michael A Schuetz, Andrej Trampuz
INTRODUCTION: Bone healing disturbance following fracture fixation represents a continuing challenge. We evaluated a novel fully automated polymerase chain reaction (PCR) assay using sonication fluid from retrieved orthopedic hardware to diagnose infection. PATIENTS AND METHODS: In this prospective diagnostic cohort study, explanted orthopedic hardware materials from consecutive patients were investigated by sonication and the resulting sonication fluid was analyzed by culture (standard procedure) and multiplex PCR (investigational procedure)...
February 21, 2018: Injury
Bhavani Manivannan, Deepak Gowda, Pradeep Bulagonda, Abhishek Rao, Sai Suguna Raman, Shanmuga Vadivoo Natarajan
BACKGROUND: We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. METHOD: A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded...
February 26, 2018: Surgical Infections
Marco Laurenti, Valentina Cauda
Among metal oxides, zinc oxide (ZnO) is one of the most attractive materials thanks to its biocompatible and biodegradable properties along with the existence of various morphologies featuring piezoelectric, semiconducting and photocatalytic activities. All of these structures were successfully prepared and tested for numerous applications, including optoelectronics, sensors and biomedical ones. In the last case, biocompatible ZnO nanomaterials positively influenced cells growth and tissue regeneration as well, promoting wound healing and new bone formation...
February 22, 2018: Materials
Thijs H Oude Munnink, Anna Demmer, Roel H J Slenter, Kris L L Movig
The authors present a case of a 69-year-old man with arrhythmogenic right ventricular cardiomyopathy controlled with amiodarone and an infected orthopedic prosthesis requiring treatment with rifampicin. This combination involves a pharmacokinetic drug-drug interaction leading to subtherapeutic drug concentrations of amiodarone and its active metabolite. The long half-life of amiodarone and its active metabolite in combination with the late onset and offset of cytochrome P4503A (CYP3A4) induction by rifampicin makes this a challenging drug-drug interaction to cope with in clinical practice...
February 20, 2018: Therapeutic Drug Monitoring
Heidi B Kaplan, Justin A Miranda, Gloria R Gogola, Karen Gomez, Catherine G Ambrose
Polymerase chain reaction (PCR) has been proposed as a method to identify bacteria in clinical samples because it is more sensitive than culture techniques and can produce results rapidly. However, PCR can detect DNA from dead cells and thus cannot distinguish between live and dead cells in a tissue sample. Killed Staphylococcus aureus cells were implanted into the femurs and knee joints of rats to determine the length of time that DNA from dead cells is detectable in a living animal under conditions similar to common orthopedic infections...
February 2, 2018: Diagnostic Microbiology and Infectious Disease
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