Summary

There is little knowledge in surgeons about the guidelines for prophylactic antibiotics in patients with prosthetic joints when undergoing a dental procedure. This study confirms this and there is need for robust and universal guidelines given the disastrous nature of prosthetic infection.

Introduction:

Infection as an indication for revision has increased to 12% of the total revisions (UK NJR 9^th report). However, it is next to impossible to find out the cause for a delayed prosthetic infection. With increasing number of arthroplasty procedures, is there a need for prophylactic antibiotics in patients with prostheses?

Introduction:

The awareness of MoM hips in the general public, one would expect, to be good, given the media coverage. This study aims to look at the perceptions and knowledge of patients who have already got a MoM arthroplasty.

Introduction:

Intraoperative cell salvage involves the collection of blood directly from the operative field. The purpose of this study was to determine if its use reduces the need for postoperative allogenic blood transfusion, assess any adverse events and its effect on duration of postoperative stay in primary hip arthroplasty.

Intraoperative cell salvage involves the collection of blood directly from the operative field. The purpose of this study was to determine if its use reduces the need for postoperative allogenic blood transfusion, assess any adverse events and its effect on duration of postoperative stay in primary hip arthroplasty.

We prospectively examined the effect of intraoperative cell salvage on the need for postoperative allogenic blood transfusion. Between February 2009 and August 2010, a total of 77 patients who underwent primary total hip arthroplasty were included in the study, under the care of the senior author (KB). All patients had a diagnosis of osteoarthritis.

Intraoperative cell salvage was used in 38 patients and not used in 39 patients. We prospectively collected data on patient demographics, ASA grade, preoperative and postoperative haematological features, number of units of packed red cells transfused and the volume of intraoperative reinfused cell salvaged blood was. Total inpatient stay and any postoperative adverse events were recorded.

No patients in the cell salvage group required postoperative allogenic blood transfusion compared to three patients (7.7%) in the conventional group. Postoperative decrease in haemoglobin was less in the cell salvage group (2.57 vs. 3.3 g/dL). The mean length of postoperative inpatient stay was shorter in the cell salvage group (5.1 vs. 6.41 days). Three patients in the cell salvage group had adverse events (1 UTI, 1 hyponatraemia, 1 colonic pseudo-obstruction). Three patients in the conventional group experienced adverse events (2 superficial wound infections, 1 DVT). An average of 361mls of cell salvaged blood was reinfused (110–900mls).

We have found that the use of intraoperative cell salvage in patients undergoing primary total hip arthroplasty reduces the need for post operative allogenic blood transfusion with no increase in adverse events when compared to conventional measures of blood preserving techniques.

Inter-phalangeal (IP) joint fusion of lesser toes has been quite a commonly done procedure using Kirchner wires (K-wire). Infection from the K-wire site has been significant complication. We present a retrospective study of 21 toes of arthrodesis of IP joints of lesser toes using a cannulated screw.

The indications were either claw toe or a hammer toe. All the cases that were done from February 2006 to June 2008 were included. There were 21 toes in 15 patients at an average age of 69 years (range 54 – 80). There were 20 females and only one male. The distribution of second, third and fourth toes were 12, 6 and 3 respectively. Nine toes were right sided and 12 were left sided. They were followed for an average of 14 months (range 2–30).

There was one case of superficial cellulitis (4.8%) which has responded well to antibiotic therapy. There were two cases where the prominent screws had to be removed at 4 and 5 months post-operative period. Good arthrodesis has been achieved by this time.

Clinical arthrodesis was achieved at 4.5 months (range 3–7) and radiological arthrodesis was achieved at 5.2 months (range 4 – 9). All have been discharged at the time of this study.

Good correction of deformities with well healed arthrodesis was achieved. Most patients reported pain free toes. We have found this technique to be very useful alternative with good results and less complications.

We are presenting a prospective study of 25 patients with clavicle fracture treated with Rockwood Intramedullary pin fixation. Operative management is required for open fractures, neurovascular injury or compromise, displaced fractures with impending skin compromise and displaced middle third fractures with 20mm or more shortening. Plate osteosynthesis or intramedullary fixation devices are used for operative management.

Patients and Methods: 25 patients with clavicle fractures underwent fixation of clavicle fractures with threaded intramedullary Rockwood pin. The indications for internal fixation were persistent wide separation of fracture with interposition of soft tissue in 12, symptomatic non-union in 3, associated multiple injuries in 3,one of them had a floating shoulder, impending open fracture with tented skin in 4 and associated acromioclavicular joint injury in 3 and one of whom had bilateral fracture clavicle.. All patients underwent open reduction through an incision centred over the fracture site along the Langer line. Intramedullary pin was inserted in a retrograde manner. Autologous bone grafting from iliac crest was done in all patients with nonunion. Radiographic and functional assessment conducted using DASH scores.

Results: There were 21 male and 4 female patients with a mean age of 34 yrs (range 17 to 64 yrs). Mean follow up was 12 months (range 5 months to 30 months). Radiographic union occurred in all patients within 4 months. In our study the commonest indication for Rockwood pin fixation was displaced middle third clavicle fracture followed by impending open fractures. Commonest complication was skin irritation at the distal end of the pin with formation of a tender bursa occurring in 9 patients, 3 of whom had skin breakdown. Fracture union occurred in all these patients with no further intervention and wounds healed completely after removal of the pin. One patient developed non-union and was later treated with ORIF with DCP and bone-graft. There were no deep infections, pin breakage or migration or re-fractures after pin removal. At the time of last follow up the average DASH score was 25 with a range of 18 to 52.

Conclusion: Open reduction and intramedullary fixation of clavicle fractures with Rockwood pin is a safe and effective method of treatment when surgical fixation of displaced or non-union of middle third clavicle fracture is indicated. This technique has an advantage of minimal soft tissue dissection, compression at the fracture site, less risk of migration and ease of removal, along with early return to daily and sports activities.

Aims: This study reports a retrospective review of notes and x-rays of 45 patients who underwent fixation of inter- and subtrochanteric fractures of the femur with the Intramedullary Hip Screw. Methods: 45 consecutive patients who underwent IMHS fixation between 1998 and 2001. Diagnoses: 24 intertrochanteric- and 15 subtrochanteric fractures, 2 prophylactic nailings for metastases, 4 reoperations for previously failed DHS/DCS. Data collected from patient notes included the intra-operative use of skeletal- vs. ski-boot traction, intra- and postoperative complications. X-ray review included classification of the fractures, grading of osteoporosis, measurement of neck-shaft angle, screw position in the femoral head, and distance from the screw to the nearest cortex. Results: The rate of intraoperative complications was 8,8%, post-operative complications occurred in 13,3% of the patients. The mortality rate within the first 3 months was 15,5%. Re-operations were necessary in 4,4% of the patients. The sliding screw was positioned in the middle sector of the femoral head in the coronal plane in 17 patients and in the sagittal plane in 14. Superior position occurred in 18 cases, inferior in 4, anterior in 4 and posterior in 16 patients. Conclusions: The main complication in our series was screw cut-out from the femoral head. This occurred in 4 patients, 2 of whom were previously failed DHS/DCS fixations. There was no single factor predicting implant failure. The results for primary fixations are comparable to most reported series in the literature and show that the outome is dictated by the original fracture pattern. There is a high failure rate if the implant is used for revision procedures.

Twenty knees, in which a total of 32 previous operations had been performed, were arthrodesed by the Charnley compression technique combined with intramedullary nailing. Patients with previous infection were excluded from the series, but three neuropathic knees were included. Bony union was evident after an average of six months in all but one patient who died three months after operation. One patient developed deep infection that resolved after removing the nail. The combined technique is simple and only limited bone resection is needed; it gives immediate stability and relief of pain with minimal morbidity.