Aims. To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity. Methods. Retrospective observational study. All visits to a traumatology ED were recorded, except for consultations for genitourinary, ocular and abdominal trauma and other ailments that did not have a musculoskeletal aetiology. Visit data were collected from March 14 to April 13 2020, and were subsequently compared with the visits recorded during the same periods in the previous two years. Results. The number of visits dropped from a mean of 3,212 in 2018 to 2019 to 445 in 2020. Triage 1 to 3 level visits rose from 21.6% in 2018 to 2019% to 40.4% in 2020, meaning a reduction in minor injury visits and an increase in major ones. There was a relative reduction of 13.2% in femoral fractures in the elderly. The rate of justified visits rose from 22.3% to 48.1%. Conclusion. A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones. Cite this article: Bone Joint Open 2020;1-10:617–620

Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Orthopaedic and Traumatology is the speciality most frequently involved in claims in Catalonia. The objective of the study is to perform a descriptive study of the claims regarding infection in Orthopaedic and Traumatology in Catalonia. We performed a retrospective study of the claims regarding infection in Orthopaedic and Traumatology from the prospective claims database of the Service of Professional Liability of The Catalonian Council of Official Colleges of Physicians. The time frame of data collection was from 2003 to 2013. We analyzed both the clinical and legal characteristics of the cases. During the 10-year period, 638 registered claims were related to the practice of Orthopaedic and Traumatology, and 74 (11,6%) were due to infection. The most frequent surgical procedure involved were arthroplasty (knee, hip or shoulder) (14, 18,9%), traumatic wounds and cellulitis (12, 16,2%), spine procedures (10, 13,5%) and arthroscopy (7, 9,4%). The most frequent anatomical site involved were foot and ankle (17, 22,9%), spine (15, 20,3%), knee (14, 18,9%), wrist and hand (11, 14,8%). The 68,92% of claims was solved by the courts and 29,73% by an “out-of-court” procedure. The average compensation in cases considered to have professional liability was 145.045€. Orthopaedic and Traumatology seem to be a specialty with a high risk for claims, and infection is one of the most important causes. The study of the claims can lead to improvements in prophylaxis, diagnosis and treatment of infection in Orthopaedic and Traumatology

Osteomyelitis caused by resistant bacterial strains can be dealt with antimicrobial agents which have a different mode of action compared to antibiotics. A very promising appears to be antimicrobial peptides (AMPs). We found and verified in vitro experiments that one of the most effective and least toxic antimicrobial peptides are contained in the wild bee venom. The aim of this study was to verify the efficacy of topically applied, synthetically prepared antimicrobial peptide (Hal 2/27) with carrier, originally isolated from the venom of the wild bee in experiments on laboratory rats. It was used 18 rats, which were indicated osteomyelitis of the left femurs. After a week of six rats were injected calcium phosphate carrier with AMP Hal 2/27, six rats received only a carrier without AMP and six other rats remained without further intervention. After a week, rats were sacrificed and X-ray was performed in all rats limbs. Rats who received carrier with AMP Hal 2/27 had less X-ray evidence of osteomyelitis of femurs compared to rats after administration of the carrier without AMP. Topical application of a new synthetic antimicrobial peptides isolated from wild bee venom (Hal 2/27) using local carriers seems to be a promising way to treat and prevent infectious complications in orthopedics and traumatology. Internal grant of University Hospital Motol, Advanced Therapies, NO: 9777 and Internal grant of University Hospital Motol, NO 6010

Periprosthetic joint infections (PJIs) and osteosynthesis-associated infections (OSIs) present significant challenges in trauma and orthopaedic surgery, substantially impacting patient morbidity, mortality, and economic burden. This concern is heightened in patients with pre-existing comorbidities, such as diabetes mellitus, which are not always modifiable at presentation. A novel intraoperative strategy to prevent these infections is the use of Defensive Antibacterial Coating (DAC), a bio-absorbable antibiotic-containing hydrogel applied to implant surfaces at implantation, acting as a physical barrier to prevent infection. The purpose of this study is to assess the use of a commercially available hydrogel (DAC), highlighting its characteristics that make it suitable for managing PJIs and OSIs in orthopaedics and traumatology. Twenty-five patients who underwent complex orthopaedic procedures with intraoperative application of DAC between March 2022 and April 2023 at a single hospital site were included. Post-operative assessment encompassed clinical, laboratory, and radiographic examinations. In this study, 25 patients were included, with a mean age of 70 ± 14.77 years and an average ASA grade of 2.46 ± 0.78. The cohort presented an average Charleston Comorbidity score of 5.45 ± 2.24. The procedures included 8 periprosthetic fractures, 8 foot and ankle surgeries, 5 upper limb surgeries, and 4 elective hip and knee surgeries. Follow-up assessments at 6 weeks and 6 months revealed no evidence of PJI or OSI in any patients, nor were any treatments for PJI or OSI required during the interim period. DAC demonstrated efficacy in preventing infections in high-risk patients undergoing complex orthopaedic procedures. Our findings warrant further investigation into the use of DAC in complex hosts with randomized control trials

Aims. The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations. Methods. This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline. Results. Every patient, with and without symptoms, should be screened for COVID-19 before hospital admission. Patients should be assigned to three groups (infection status unknown, confirmed, or negative). Patients with unknown infection status should be considered as infectious. Dependent of the infection status and acuity of the symptoms, patients are assigned to a COVID-19-free or affected zone of the hospital. Isolation, hand hygiene, and personal protective equipment is essential. Hospital personnel directly involved in the care of COVID-19 patients should be tested on a weekly basis independently of the presence of clinical symptoms, staff in the COVID-19-free zone on a biweekly basis. Class 1a operation rooms with laminar air flow and negative pressure are preferred for surgery in COVID-19 patients. Electrocautery should only be utilized with a smoke suction system. In cases of unavoidable elective surgery, a self-imposed quarantine of 14 days is recommended prior to hospital admission. Conclusion. During the current COVID-19 pandemic, orthopaedic patients admitted to the hospital should be treated based on an interdisciplinary algorithm, strictly separating infectious and non-infectious cases. Cite this article: Bone Joint Open 2020;1-6:309–315

Femoroacetabular impingement (FAI) syndrome is one of the significant reasons for hip pain, loss of ROM at hip joint and developing early osteoarthritis at young active adults. FAI is not a new term and it is treated successfully with open surgical techniques. Some disadvantages of open surgical tecniques has lead orthopedists to develop arthroscopic tecniques. At this study, we aimed to assess the effectiveness of arthroscopy at the treatment of FAI. We included 25 patients (19 male, 6 female) and evaluated retrospectively which has gone under arthroscopic surgery for the treatment of FAÄ° at Gulhane Military Medicine Academy, Department of Orthopedics and Traumatology and Ankara Koru Hospital, Department of Orthopedics and Traumatology between January 2009 and May 2012. We have evaluated modified Harris Hip Score and Visual Analogue Score (VAS) preoperatively and postoperatively at all of our patients. Also we have evaluated, hip internal rotation and flexion range of motions clinically. Mean preoperative Harris Hip Score was 68,52 (range 55–76), mean postoperative score was 88,84 (range 72–98). Mean preoperative flexion ROM was 87, 6 (range 80–95) and 108,2 (range 90–120) postoperatively. Also 4,4 (range 0–5) degrees of mean preoperative internal rotation ROM increased to 19,80 range (10–30) degrees postoperatively. Mean preoperative alpha angle was 76,76 (range 60–90) and it was decreased to 41,76 (range 34–48) postoperatively. Mean preoperative visual analog score were decreased from 8, 63 to 2,8 postoperatively. We had to perform o second look arthroscopy to a patient because of inadequate resection. Also femoral neck stres fracture occured at a patient probably due to early weight bearing. Transient sciatic nevre neuropraxy occured at a 3 patients and, transient ankle pain (approximately 6 weeks) had occured at 2 patients due to traction. Loss of sensation has occured at a patient due to lateral femoral cutaneus nevre injury during portal placement. With these results, we assessed that arthroscopic treatment of the FAI syndrome is succesfull with minor complications comperable to open procedures

Aims

The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature.

Introduction. The number of total hip arthroplasties in young patients is continuosly increasing. Nowdays, the study of the materials wear, with the goal of improving the survivorship of implants, represents a fundamental subject in this kind of surgery. The role of ceramic materials in the valutation of types of wear is particularly known. Materials and Methods. We have selected 834 patients, underwent total hip arthroplasty, in which a ceramic head was impalnted with a maximum follow up of ten years. 367 patients were males and 467 were females, operated by 14 surgeons of the same equipe of Orthopaedic and Traumatology Department. A postero-lateral approach, according to Gibson Moore, and an extrarotator tendons transosseal repair was performed. Results. 446 ceramic liners, 354 polyethylene liners and 34 metallic liners were used. 18 types of stems, 5 of which stemless, were implanted. The mean survivorship of all cohrt of patients was 92% at 10 years. No ceramic heads and liners breakage occurred. In particular, of 69 total hip arthroplasties, implanted in 2005, only 3 were revised. Discussion. In our cohort review no major failures of ceramic components were observed. These datas suggested the importance of design and up grading of new materials, in order to achieve better long term results. Therefore, the ceramic components represent the gold standard, specifically in young active patients with good long term results reguarding functional outcomes and wear of implants. Conclusions. The use of ceramic head, assembled with ceramic or polyethylene liners, also demonstrated good results at 10 years follow up. Ceramic-on- polyethylene is a valid alternative to ceramic-on-ceramic in consideration of the lower cost and theoretical lower risk of breakage

Introduction. Various anti-infective agents can be added to the surface of orthopaedic implants to actively kill bacteria and prevent infection. Silver (Ag) is a commonly used agent in various anti-infective applications. Silver disrupts bacterial membranes and binds to bacterial DNA and to the sulfhydryl groups of metabolic enzymes in the bacterial electron transport chain, thus inactivating bacterial replication and key metabolic processes. Recently we are implanting Silver coated megaprosthesis for the treatment of post-traumatic septic non unions/bone defects and for infected hip or knee prosthesis revision. We treat these complications utilizing a two steps procedure: 1° step: devices removal, resection, debridment and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. This technique produce a reactive pseudosynovial membrane, well known in traumatology (Masquelet technique), following the Chamber Induction Technique principles. This chamber creates the perfect environment in which implant the prosthesis with safety. We are nowadays investigating if this membrane could optimize the Silver antimicrobical effects reducing the Silver ions dispersion and reducing toxicity on the human body. Objectives. The aim of this study is to perform a review of the literature about Silver coated implants in Orthopaedics and Trauma and to analyze our cases treated with this implants in order to measure their efficacy and the ion dispersion in urine and blood. Methods. We performed a literature review using the universally validated search engines in the biomedical field: PubMed / Medline, Google Scholar, Scopus, EMBASE. The keywords used were: “Silver”, “Silver coating”, “Silver surface”, “were crossed with “Prosthesis”, “Megaprosthesis”, “Infection”, “Sepsis”, “Revision”. We also analized all our patients treated with Silver coated implants measuring Silver dose in blood and urine before implantation, 1 day after implantation and then after 15 days, 3,6,12,24,36 months. Results. The search led to 468 items, of these were considered only article in English with full text available. We found 1 in vitro study, 1 animal study and 2 human studies. The animal study showed a reduction in periprosthetic infection from 47% to 7%, 1 human study in Oncology application of megaprosthesis showed a reduction of septic complications from 17,6% to 5,9%. Te other human study demonstrated that Silver surface implants don't have toxicity cause the blood level of silver Ions were only 56,4 parts per billion. The analysis of our casuistry is giving good results with low level of Silver in the blood and urine, lower concentrations are observed in patients treated with the 2 steps-CIT technique. Conclusions. The use of silver-coated prosthesis can reduce the infection rate in the medium-long term with no toxicity for the patients. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results most of all in the patients treated with the 2 steps procedure in order to better understand the role of the membrane and of the Chamber Induction Technique in Silver ions dispersions

Developmental hip displasia (DHD) still presents as an important problem in our country. Latency in diagnosis and inaccurate treatment causes seconder osteoarthritis in young adults and elder patients. Variable reconstructive surgical procedures as proximal femoral and acetabular osteotomies can be performed, but the most satisfactory functional results are achieved by total hip arthroplasty (THA). In this study, we analyzed the results of the cementless total hip arthroplasties performed in coxarthrosis secondary to developmental hip displasia. Between January 2006 and October 2009, 53 patients diagnosed with hip osteoarthritis secondary to DHD, whom performed 59 total hip arthroplasties in GATA Orthopaedics and Traumatology Clinic were included in the study. 10 of the patients were male (%19), and 43 of them were female (%81). Age of the patients varied between 29 and 78 years and the mean age was 48,7. In 23 patients (%44), THA procedure was performed at the right hip and in 24 patients (%45) at the left hip. 6 patients operadted bilaterally. All patients were followed up 8–38 months (mean 20, 6 months) with clinical and radiological evaluation. The hospitalization period varied between 7–14 days, mean 8,3 days. Posterolateral incision was used at all of the patients. Totally 10 (%17) complications were observed. 5 (%8,5) of them was intraoperative and 5(%8,5) was postoperative. Patients evaluated preoperatively and postoperatively with modified Harris Hip Score. While preoperative mean Harris score was 39,1, the postoperative mean score measured as 90,3. The results were excellent in 52 cases (%88,1), and very good in 7 cases (%11,9). Appropriate implementation of cementless total hip prosthesis in patients with hip osteoarthritis secondary to DHD, who have good bone quality and surgical indicaton; clinical and radiological short term results were satisfactory

Introduction:. Tuberosity healing is strongly correlated with functional results in all series of three- and four-part fractures of the proximal humerus treated by hemiarthroplasty. We formed a working group to improve position of the implant and fixation of the tuberosities on an implant specifically intended for traumatology. Material and Methods:. An anatomic study on 11 cadavers and a prospective multicentre clinical study of 32 cases were performed to validate extrapolable original solutions at the patient scale: placement of the stem at a height indicated in relation to the insertion of the clavicular bundle of the pectoralis major, locking of the stem, placement (based on bone quality) of a variable volume metaphyseal frame (offset modular system® OMS®), avoiding medialisation of the tuberosities, and fixation of the tuberosities using strong looped sutures, brightly coloured so that they can be located more easily. Evaluation by Dash score and Constant score was correlated with positioning of the tuberosities using radiographs. Results:. The clinical study enabled a distance of the top of the head to pectoralis major of 5.5 cm +/− 5 mm to be determined, confirming the results of the anatomic study and data from the literature. The distal double-locking ancillary device and the suturing technique for the tuberosities using looped sutures was judged to be effective by all of the surgeons. 23 patients (5 males, 9 CT4 and 8 CT3) with an mean age 69,6 (33–90) were operated on by 3 senior surgeons and reviewed at a mean follow-up of 17,3 months (6–24). All patients were seen again at 3 months and 6 months and the average motion at last follow was abduction of 90,7° (140–40), active anterior elevation of 113,25° (160–60), and external rotation of 43,2°(55–30). One complication was noted: inadequate position of a locking screw. In the 17 patients operated without oms® 50% had adequate initial positioning of the tuberosities and 10% secondary displacement. In comparison the 6 patients operated with the oms® 100% had adequate initial positioning of the tuberosities and no secondary displacement occurred. Discussion:. The series from Sofcot, Boileau, and more recently Reuther yielded results of 40 to 66% malposition or nonunion of the tuberosities. The initial clinical results from our series are encouraging and demonstrate that using a variable volume metaphyseal frame in synthesis of the tuberosities with control of the height of the implant is reliable. This multicentre study should be extended by a more long-term analysis

Today TKA belongs to a standard care in orthopaedics and traumatology. The number of the annual implantations has clearly increased during the last years and also in the future an increasing rate to be expected. Also the number of Revision TKA and the treatment of complicated pathologies in the primary care will increase in the same way. Therefore the requirements of the surgeon rised as well as a suitable and accurate systems will be needed. Beside revision cases, traumatic-, post-traumatic- and RA-patients demonstrate partly distinctive bone and ligamentous pathologies. Beside the primary implant components and instrumentation-systems, modern knee systems must include also modular revision systems compatible with the primary systems to be able to carry out complicated primary as well as light to moderately severe recision cases. Besides, also the possibility should be able to change within the system (with constant bone-cuttings) on higher degrees of the constrain. With the TC-Primary and TC-Revision system fulfils the above mentioned criteria so that nearly every situation can be handled. We present our experience using this system in cases of revisions, traumatic, post-traumatic and RA-cases The handling of bone and ligamentous defects will be demonstrated. In particular the possibility the use of the TC-Revision also in primary TKA as P a so named “extension primary system” will be emphasized. By the Modulary and compatibility of the TC-Primary and TC-Revision systems, the use of Wedges and Stems as well as the possibility of the different degrees of the constrain a knee family permits us to treat complicated primary as well as mild to moderate revision cases

Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and clavicle fractures, and shoulder instability. The majority of proximal humerus fractures can be managed non-operatively with surgery reserved for approximately 10–20% of patients. The choice of surgical treatment is usually between a humeral head head-conserving fracture reduction and internal fixation and humeral head sacrifice hemiarthroplasty. Current indications for primary hemiarthroplasty include a displaced four-part fracture (with or without associated dislocation of the humeral head) and a head-splitting fracture (with involvement of >40% of the articular surface), due to the high associated risk of avascular necrosis. However, the indications for internal fixation of proximal humerus fractures have expanded over the last decade, and many fractures which have previously been considered unsalvageable and treated either non-operatively or with hemiarthroplasty are now deemed reconstructable. This is partially as a result of improved appreciation of sub-groups of fractures which have a better prognosis from head-salvage, the possibility that subsequent development of osteonecrosis may be relatively asymptomatic and the realisation that functional results after hemiarthroplasty are often sub-optimal. The purpose of this talk is to discuss the current concepts in fracture classification and the indications for operative treatment for these fractures. The novel surgical approaches, techniques and implants which have renewed interest in their treatment are also highlighted. None of the authors have received any payment or consideration from any source for the conduct of this study

Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and clavicle fractures, and shoulder instability. The traditional view that the vast majority clavicle fractures heal with non- operative treatment with consistently good functional outcomes is no longer valid. Recent studies have identified a higher rate of nonunion and specific defects of shoulder function in sub-groups of patients with these injuries. These fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualised treatment. This talk provides an overview of the current knowledge regarding their epidemiology, classification, clinical assessment and treatment in adults. The following key points will be highlighted:. Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union and good functional outcomes after non-operative treatment. Non-operative treatment of displaced shaft fractures may be associated with a higher rate of non-union and functional deficit than previously reported. However, it remains difficult to predict which patients will develop these complications. Since satisfactory functional outcome may be regained from operative treatment for clavicular nonunion or malunion, there is currently considerable debate about the benefits of primary operative treatment for these injuries. Displaced lateral-end fractures have a higher risk of nonunion after non-operative treatment than shaft fractures. However, nonunion is difficult to predict and may be asymptomatic in the elderly. The results of operative treatment are more unpredictable than for shaft fractures. None of the authors have received any payment or consideration from any source for the conduct of this study

Michael Robinson has been a Consultant Orthopaedic Surgeon and Senior Lecturer in the Department of Orthopaedics and Traumatology in Edinburgh, Scotland, United Kingdom for 10 years. His special interests include the treatment of proximal humeral and clavicle fractures, and shoulder instability. Primary traumatic anterior dislocations of the glenohumeral joint in young adults are common injuries, which are associated with persistent deficits of shoulder function and a high risk of recurrent instability. Although several risk factors have been implicated, a younger age at the time of the primary dislocation, and male gender, are the factors that have been most consistently associated with a higher risk of recurrence. Recent studies have suggested that primary arthroscopic repair of the anteroinferior detachment of the glenoid labrum (Bankart repair) may reduce the risk of subsequent recurrent instability and improve function, when compared with non-operative treatment. However, the unblinded or single-blind design of these studies fails to eliminate the potential for error due to observer or subject bias, and the therapeutic effects of the Bankart repair cannot be distinguished from those of the arthroscopic examination and washout alone. The latter may reduce the rate of subsequent instability, by promoting healing of the labral detachment, or by altering the patient's subsequent level of physical activity and compliance with rehabilitation protocols. A clinical trial conducted recently in our Institution assessed the efficacy of a primary arthroscopic stabilisation after a first-time dislcoation, whilst controlling for the therapeutic effects of the arthroscopic examination and washout alone. We aimed to specifically test the null hypothesis, that an arthroscopic Bankart repair (ABR) would not produce an improvement in the rate of recurrent instability, functional outcome, range of movement, levels of patient satisfaction or total cost of treatment, when compared with an arthroscopic examination and washout (AWO) alone. The results of this study will be presented, together with an overview of the advantages and disadvantages of primary arthroscopic stabilisation. None of the authors have received any payment or consideration from any source for the conduct of this study

Arthroplasty is a successfulsurgical procedure which provides returning daily activities by relieving pain, correcting deformity, and regaining the loss of ROM which is caused by many diseases such as degenerative arthritis when conservative and other surgical techniques fail to achieve. Successful outcomes depend on many variables at arthroplasty. Proper indication, careful selection of patient, adequate surgical technique and postoperative rehabilitation plays a major role. Despite successful outcomes achieved at arthroplasty, undesired complications can be frustrating for the patient and the surgeon. These complications can be minimized by careful preoperative planning, meticulous surgical procedure and rigorius postoperative care. Infection is the most frequent and most effective complication on outcomes after arthroplasty. Because of that, risk factors for infection must be researched carefully and minimized preoperatively. Antibiotic prophylaxis is routinely suggested before the surgery. Using routine irrigation as well as the standard surgical technique is effective for decreasing postoperative infection rates. Antibiotic impregenated cement is used especially at revision arthroplasties and should be used at primary surgery at high risk groups. In this study we evaluated 19 patients which admitted to Gulhane Military Academy of Medicine, Department of Orthopedics and Traumatology betwen 2007 and 2012. 5 patients had total hip arthroplasty (26.32%), 11 patients had total knee arthroplasty (57.89%) and 3 patients had hip hemiarthroplasty after femoral neck fractures. 14 of the patiens were female (73.68%) and 5 were (26,32%). Mean age was 69.74 (53–83). Primary surgery was held at our institution at 14 of the patients and 5 patients were referred from other instutitions because of their complaints.6 of the knees were right-sided and 5 of them was left-sided. 3 of the totap hips were left-sided and 2 of them was right-sided. 1 of the hip hemiarthroplasties were left-sided and 2 of them was right-sided. 42.11%of the patients were treated medically and 47.37%were treated with two staged surgery. 42.11%of the surgically treated group were healed completely and 5.26%of the patients passed away due to other comorbidities. Wound debridement was applied 10.53%of the patients which were admitted at early phase and resection arthroplasty was applied 5.26%of these patients because of the lack of response to medical and surgical debridement. With these results, patients with infected prosthesis can present with many different symptoms and infection risk must always be considered. It must be remembered that the onset time of infection is very important during diagnosis and treatment. Follow ups and treatment protocols must be standardized by clinics as algorithms. During the treatment the surgeon must be in close contact with infectious diseases and microbiology departments. Especially by new developing techniques during the recent years, spesific agents of the infection can be determined and spesific antibiotics can be used for the treatment

Introduction. Stryker computer navigation system has been used for total knee arthroplasty (TKA) procedures since October 2008 at the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics. Material and methods. There have been 126 computer assisted TKA that accounted for 11.5 % of primary TKA within this period (1096 procedures). Arthritis of the knee joints with evident pain syndrome was an indication to TKA surgery. Arthritis of the knee joint of 27 patients (21.4 %) was accompanied by femoral deformity of various etiology with debris found in the medullary canal in several cases. The rest 99 patients (78.6 %) were regular cases of primary TKA. Results. We compared the results of correction of lower limb biomechanical axis with TKA employing navigation and without computer assistance. Regular TKA procedures showed no substantial difference in the correction of biomechanical axis. Complete correction using computer navigation was achieved in 85 % of the cases versus 79 % of the patients without navigation. The deformity up to 3° developed in 14 % of navigated cases and in 17 % of the cases without computer assistance. An error of deformity correction was 3–5° in 4 % of the cases without computer navigation. Those were cases of challenging primary TKA. So the advantages of computer navigation have become evident with greater deformities, and in the cases when intramedullary guide can hardly be used due to severe deformities in the femoral metaphysis and diaphysis, after several operative procedures of osteosynthesis with deformed, obliterating bone marrow canal or presence of debris. Complete correction using computer navigation was achieved in 85.2 % cases versus 42.8 % patients without navigation. Postoperative varus of 2° was observed in 14.8 % cases (valgus or varus deformity of 3° developed in 28.6 % of the cases without computer assistance). Conclusion. What is better: special instrumentation or navigation?. Current instrumentation can provide regular mechanical control of the limb axis and is based on the principles of intramedullary, extramedullary and even double guide placement. Image-free navigation and standard surgical techniques can equally be used for simple cases of primary TKA. Same landmarks are used. These landmarks are determined by a surgeon quite subjectively and can lead to inadequate usage of special instrumentation and computer navigation. However, computer navigation should be used in the cases when intramedullary guide can hardly be used, not desirable or possible. Special instrumentation can fail in setting a valgus angle needed with extraarticular femoral deformity. Navigation allows determining rotation more precisely in the cases when posterior femoral condyles contour (posttraumatic condition, hypoplastic condyles) is distorted. Assessment of ligament balance can be rather subjective when special instrumentation is used. Application of computer navigation is helpful for measurements of flexion and extension gaps sixe and regularity. Computer navigation is contraindicated for contractures and ankyloses of the hip joint. For the rest of the cases the choice of instrumentation is a surgeon's decision

In orthopaedic surgery, as in many other surgical fields, there is a clear tendency towards the use of minimally invasive procedures. These techniques are increasingly being implemented almost routinely for procedures such as spine and pelvis surgery. However, for fracture treatment and for applications involving small bones, such as hand and foot surgery, these systems are hardly ever used. We introduce a new system for image based guidance in traumatology. We included 20 patients with a fracture of the fifth metatarsal. They were randomised on admission into two groups. Ten patients in the metatarsal group were operated conventionally and ten were operated with the assistance of a new image guidance system. This system is based on 2D-fluoro images which are acquired with a conventional c-arm and are transferred to the system workstation. After detecting marked tools, it can be used to display trajectories for K-wire guidance in the c-arm shot. The average duration of surgery (time from incision to suture) in the image-based group was 12.7 minutes ± 5.5 (min. 6, max. 23), in the conventional group it was 17 minutes ± 6.5 (min. 7, max. 28) (p=0.086). The average duration of radiation was 18 seconds ± 8.5 (min. 6, max 36) in the image-based group vs. 32.4 seconds ± 19.4 (min. 12, max. 66) in the conventional group (p=0.057). An average of 4.7 C-arm shots ± 2 (min 2, max 9) were necessary in the image-based group to position the K-wire. For the conventional group, 8.2 shots ± 2.3 (min 4, max 12) were used (p=0.0073). It took 1.6 trials ± 0.7 (min.1, max. 3) to position the K-wire for the image-based procedures, in the conventional group 2.7 trials ± 0.9 (min. 1, max 4) were necessary (p=0.0084). There were no malfunctions or adverse events in any of the image-based navigational cases. No screws needed to be replaced in the image-based group. In the conventional group, two screws were replaced intra-operatively because they were too short in the control c-arm shot, and the screw threads did not bridge the fracture gap completely, leading to insufficient compression. In this pilot study with only a small sample size, the image-based guidance system could be integrated into the existing surgical workflow and was used for applications, where existing navigation systems are not commonly used. The technology gives the surgeon additional information and can reduce the number of trials for perfect implant positioning. This potentially increases the safety of the surgical procedure and spares intact bone substance which is essential for the footing of implants in small bones and fragment fixation. Whether these factors contribute to a reduction in complications or revision rate must be confirmed in larger prospective studies

Aims

The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality.