Aim. Gram negative bacteria (GNB) are emerging pathogens in chronic post-traumatic osteomyelitis. However, data on multi-drug (MDR) and extensively drug resistant (XDR) GNB are sparse. Methods. A multi-centre epidemiological study was performed in 10 countries by members of the ESGIAI (ESCMID Study Group on Implant Associated Infections). Osteosynthesis-associated osteomyelitis (OAO) of the
There have been a worldwide change in the susceptibility patterns of antibiotics by many community-acquired microorganisms including those associated to wound infection after open fractures. However, the current antibiotic prophylaxis practice adopted by orthopedic surgeons to prevent infectious complications following open fractures has not changed, since Gustilo and Andersen classification was published several decades ago. Few studies have addressed the current pattern of infectious organisms identified in open fracture wounds and its susceptibility to antibiotics that have been empirically used. We aim to study the incidence of community-acquired resistant organisms isolated in
The authors comment on the treatment of patients suffering from spina bifida. The indications to surgical-orthopaedic approach for lower limb correction in patients with spina bifida are outlined. According to the authors’ experience, the therapeutic approach should be aimed at treating deformities of the
When total ankle arthroplasty (TAA) is performed, although tibial osteotomy is instructed to be perpendicular to long axis of tibia, there is no established index for the talar bone corrective osteotomy. Then, we have been deciding the correction angle at the plan for adjustment of the loading axis through whole
Aim. To assess the spread of foot infection and its impact on the outcomes of major amputations of
Aims: To evaluate the effectiveness of the Ilizarov method in treating septic nonunions of
It has been determined the prognostic importance of P-53 suppressor in 26 patients with osteogenous sarcoma of long tubular bones of
The degree of correction was controlled during the operation with the navigation system and compared with pre- and postoperative 2.5D ultrasound measurements to avoid projection errors of long standing x-rays.
The postoperative 2.5D ultrasound leg axis analysis showed a maximum of +/− 2° difference between the pre-, intra- and postoperative measurements.
This first results show a promising increase of accuracy while radiation can be reduced. The actual values show that the main goal to increase the intraoperative accuracy in corrective osteotomies can be achieved with computer aided surgery.
1. Arterial spasm may be expected in any injury resulting in stretch of the arterial system. 2. Excessive traction in the treatment of fractures may well initiate diffuse arterial spasm. 3. In fractures that have permitted shortening of the vascular system for a considerable period, spasm may be initiated when a return to normal length is made.
For injuries to the lower leg or forearm, supplemental support from soft tissue compression (STC) with a splint or brace-like system and combined with external fixation could be done effectively and quickly with a minimal of facilities in the field. Soft tissue compression (STC) in functional braces has been shown to provide rigidity and stability for most closed fractures, selected open fractures and can supplement some other forms of fracture fixation. However, soft tissue injuries are compromised in war injuries. This study was designed to evaluate if STC can provide adequate rigidity and stability either with, or without other forms of fixation techniques of simple fractures or bone defects after standardised soft tissue defects. The load was applied either axially or in bending as the bending configuration is more like conditions when positioned on a stretcher in the field.Summary
Introduction
Current treatment modalities for chronic non-healing leg ulcers are time consuming, expensive, and only moderately successful. The use of sub-atmospheric pressure dressings, available commercially as the vacuum-assisted closure (VAC) device, has been shown to be an effective way to accelerate healing of various wounds. There is patented computer-controlled system technology available that is established V.A.C.(KCI Concepts, San Antonio, Texas) treatment. Reducing costs associated with wound treatments is therefore becoming an increasingly important issue in health care. This study included 45 patients with open wounds of the lower extremity with exposed tendon, bone, hardware or with osteomyelitis. Fifteen wounds were the result of trauma. Thirty wounds were non-traumatic (twenty dehisced or infected orthopedic surgical wounds, five pressure sores and five miscellaneous wounds). We use the vacuum therapy as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. Treatment efficacy was assessed by semi-quantitative scoring of the wound conditions (signs of rubor, calor, exudate and fibrinous slough) and by wound surface area measurements. In our technique, the system consist of a sterilized simple foam sponge, a vacuum drain, two blood infusion kit and a negative pressure aquarium air pump, one liter salin bottle, an steril drape. It’s mean applying time ten minutes and mean cost at the first time 36 dollars consecutive seances 11 dollars (the aquarium air pump 15 dollars – an electrical engineer change it positive to negative air pressure mode). Forty-five patients who needed open wound management before surgical closure were included in this study. Healing was characterized by development of a clean granulating wound bed (“ready for surgical therapy”) and reduction of wound surface area. To quantify bacterial load, cultures were collected. The total quantitative bacterial load was generally stable. However, nonfermentative gram negative bacilli showed a significant decrease in vacuum-assisted closure-treated wounds, whereas Staphylococcus aureus showed a significant increase in vacuum-assisted closure-treated wounds. Succesfull wound closure was obtained 43 of 45 patients. 41 wounds were closed with split-thicknees skin graft. The median time to complete healing was 31 days (27.5 to 34.5) and wound bed preparation was 7 days (5.8 to 8.2) in the non-computerized V.A.C. therapy, similar with the computerized therapy 29 (25.5 to 32.5–7 days 5.7 to 8.3) This study shows a positive effect of vacuum-assisted closure therapy on wound healing, expressed as a significant reduction of wound surface. The costs of computerized wound care were higher than our techique of V.A.C. and similar clinical results at the end.
In 36 patients was carried out short-lived hyperglycemia and local hyperthermic prolonged intraarterial chemotherapy on the background of modificators of short-lived hyperglycemia in the department of general oncology of R. O.S. C of the H.M of the Republic of Uzbekistan. Tumour has localized in distal part of femoral bones in 18 patients, in proximal part of cannon bones in 13. Treatment was carried out by the scheme of Syclophosphan 1000 mg/m2 doxorubicin 90 mg/ m2 48-hourly unbroken infusion, cycplatin 100 mg2 in the dependence from efficacy of the treatment has been carried out from 1 to 4 courses In 3–4 hours time after beginning prolonged intraarterial chemotherapy unbrokenly began short-lived hyperglycemia by the way of introduction i/v solution of glucose 20% to1500ml. Maximal concentration of the blood sugar level has composed 18–23ml in the period of treatment. Then local hyperthermia with USD apparatus was carried out in 30MG frequency regime with exposition of 20 min. time. Control group of the patients has composed patients, who has performed system chemotherapy by analogical scheme CAP (in 34 patients). In the patients group, who received prolonged intraarterial chemotherapy with modificators (short-lived hyperglycemia with local hyperthermia) in 4 (11, 1%) patients have been observed full effect, in 25 patients (69, 4%) partial effect, in 5 (13,9%) stabilization, and in 2 (5,6%) progressing of tumour process. Safe operation was performed in 17 patients (47, 2%), crippling in 4 (11,4%) patients, conservative treatment in 15 patients (41,6%) in this group. In patients, who was carried out system chemotherapy full effect was marked in 2 (5,9%) patients, partial effect in 8 (23,5%), stabilization in 15 (44,1%) and progressing in 9 (26,5%) patients. Safe operations were carried out in 3 (8,8%), crippling operations in 19 (55,9%), other 12 (35,3%) patients are under observation after conducting 9 courses of chemotherapy and beam therapy without operation in conservative treatment. Endovascular chemotherapy in combination with local hyperthermia and short – lived hyperglycemia allows overcoming medicinal steadiness and increases quantity of safe operations. That’s why combination prolonged intraarterial chemotherapy with modifications is aimed.
The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells. HIPGEN is a multicentre, multinational, randomized, double-blind, placebo-controlled trial. A total of 240 patients aged 60 to 90 years with low-energy femoral neck fractures (FNF) will be allocated to two arms and receive an intramuscular injection of either 150 × 106 PLX-PAD cells or placebo into the medial gluteal muscle after direct lateral implantation of total or hemi hip arthroplasty. Patients will be followed for two years. The primary endpoint is the Short Physical Performance Battery (SPPB) at week 26. Secondary and exploratory endpoints include morphological parameters (lean body mass), functional parameters (abduction and handgrip strength, symmetry in gait, weightbearing), all-cause mortality rate and patient-reported outcome measures (Lower Limb Measure, EuroQol five-dimension questionnaire). Immunological biomarker and in vitro studies will be performed to analyze the PLX-PAD mechanism of action. A sample size of 240 subjects was calculated providing 88% power for the detection of a 1 SPPB point treatment effect for a two-sided test with an α level of 5%.Aims
Methods
Introduction. Upright body posture is maintained with the alignment of the spine, pelvis, and
Objectives. The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the
Primary malignant bone and soft tissue tumours often occur in the
Introduction. Angular deformity in the
Background. Postural change after total hip arthroplasty (THA) is still a matter of discussion. Previous studies have mainly concentrated on the pelvic motions. We report the postoperative changes of the global sagittal posture using pelvic, spinal and