The use of the Taylor Spatial Frame (TSF) in the management of tibial fractures and deformity correction is well established in the literature, however the majority of published papers are small in patient number. The aim of the project was to evaluate clinical and radiographic outcomes of patients with tibial fractures treated with a TSF. A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, frame construct, time duration in frame, union rates and complications of treatment.Introduction
Materials and Methods
The COVID-19 pandemic presents an unprecedented burden on global healthcare systems, and existing infrastructures must adapt and evolve to meet the challenge. With health systems reliant on the health of their workforce, the importance of protection against disease transmission in healthcare workers (HCWs) is clear. This study collated responses from several countries, provided by clinicians familiar with practice in each location, to identify areas of best practice and policy so as to build consensus of those measures that might reduce the risk of transmission of COVID-19 to HCWs at work. A cross-sectional descriptive survey was designed with ten open and closed questions and sent to a representative sample. The sample was selected on a convenience basis of 27 senior surgeons, members of an international surgical society, who were all frontline workers in the COVID-19 pandemic. This study was reported according to the Standards for Reporting Qualitative Research (SRQR) checklist.Aims
Methods
This study aimed to evaluate the impact on length of hospital stay from dedicated infectious diseases input for orthopaedic infection patients compared to sporadic infection specialist input. We conducted an observational cohort study of 157 adults with orthopaedic infections at a teaching hospital in the UK. The orthopaedic infections included were: osteomyelitis, septic arthritis, infected metalwork and prosthetic joint infections, and adults were aged 18 years or more. Prior to August 2016, advice on orthopaedic infection patients was adhoc with input principally from the on-call infectious diseases registrar and phone calls to microbiology whereas after August 2016 these patients received regular input from dedicated infectious diseases doctor(s). The dedicated input involved bedside reviews, medical management, correct antimicrobial prescribing, managing adverse drug reactions, increased use of outpatient parenteral antimicrobial therapy (OPAT) services especially self-administration of intravenous antibiotics and shared decision-making for treatment failure, whilst remaining under orthopaedic team care. Orthopaedic patients operated on for management of their infection between 29/8/16 and 15/3/17 were prospectively identified and orthopaedic operation records were used to retrospectively identified patients between 29/8/15 and 15/3/16. The length of stay was compared between the 2 groups.Aim
Method
To demonstrate the use of indium-111 white-cell labelled SPECT CT (In111-WC-SPECT-CT) in bone infection. This novel imaging modality is useful in bone infection. We present three cases of complex osteomyelitis to illustrate this. All were imaged with conventional modalities, but conclusive diagnosis could not be achieved. In111-WC-SPECT-CT was used to provide the definitive imaging that allowed successful treatment.Aim
Method
Ultrasound treatment can be used as an alternative to surgical methods for treating non-union or to enhance healing in a delayed union. This study presents our short-term results of using low intensity pulse ultrasound stimulation in long bone non-union. 18 patients with surgically treated long bone non-union were treated using the Exogen® ultrasound stimulator (Smith & Nephew Inc., UK). The average age of patients was 48 years (20–73 yrs). There were 8 femur fractures, 9 tibial fractures and 1 knee arthrodesis. 5 of these patients had infected non-union. The average follow up after initiation of treatment was 4 months (range 2–8 months). They received 20 minutes stimulation daily at the fracture site with regular follow up in clinic. We reviewed their serial radiographs and clinical progress. The mean interval to initiation of the ultrasound treatment was 7.9 months (2–27 months). Complete bony union was obtained in 6 of the 18 cases (33%) within 4 months of initiation of treatment. In 7 of 18 cases (38%) there was good evidence of progress towards bony union, while in 4/18(22%) patients there was no progress towards union at average of 4 months (range 2–8 months). There were no complications noted with this treatment. Most non-unions are treated by surgical revision, with consolidation rates ranging from 85 to 100% according to previous studies. Our study suggested 72% patients showing progress towards union with 33% achieving bony consolidation at 4 months. Patients with infected non-union also benefitted from this treatment. In summary ultrasound treatment can be a viable option to treat long bone non-unions, which may avoid the morbidity and complications associated with surgery.
Chronic osteomyelitis with intramedullary sequestrum resulting in persistent infection is a challenging orthopaedic problem that often involves multiple surgical operations and unfortunately has a significant recurrence rate. Reasons for this may include difficulty in eradicating all intramedullary microsequestra making subsequent prolonged antibiotic therapy less effective. Use of the Reamer-Irrigator-Aspirator (RIA) has many advantages for management of intramedullary infections in chronic osteomyelitis. The RIA technique allows irrigation of sterile large quantities of saline with simultaneous bony debridement with very sharp reamers that are specially designed to allow simultaneous fluid aspiration. We will illustrate the pearls and pitfalls associated with the RIA technique, based on our experience so far.Background
Purpose
Previous reports have shown the efficacy of muscle interposition grafts in treating recalcitrant infection in the presence of hip arthroplasty. We report our experience with a two stage debridement and rectus femoris pedicled interposition graft technique in chronic severe native hip infection with a persistent draining sinus. During the last 16 months, three paraplegic patients presented with persistently draining sinuses and chronic osteomyelitis of the pelvis, acetabulum and proximal femur, in a total of four hips. The mean patient age was 49 years (range, 40 to 59 years). In all patients there had been previous attempts to control the infection with wound debridement and long-term antibiotics. A two-stage operative treatment was used in all patients. The first stage comprised wound debridement, washout, gentamycin-bead application and temporary vacuum assisted wound coverage. At the second stage, approximately ten days later, through a standard anterior midline incision, the rectus femoris muscle was elevated on its pedicle, rolled, transposed into the acetabulum and sutured to the transverse acetabular ligament. At the second stage, all patients had local administration of antibiotics with genetamycin impregnated absorbable collagen fleece and all wounds were closed by delayed primary closure with a negative pressure dressing placed over the closed wound. All patients were commenced on a 6 week course of intravenous antibiotics, according to sensitivities. No loss of flap occurred in any of the patients. One wound had partial dehiscence and required a split skin graft. At the final follow-up examination all the wounds were healed and there was no recurrence of draining sinuses, pressure sores or systemic sepsis. The two stage technique with a pedicled rectus femoris interposition graft may be a useful technique for the treatment of complex chronic persistent osteomyelitis of the pelvis, acetabulum and proximal femur, with the primary aim of stopping the discharging sinus.
