Best Practices and Evolving Techniques for Preventing Infection After Fracture Surgery
Orthopedic trauma-related infections remain one of the major complications in modern trauma and orthopedic surgery. Despite current preventive practices, infection rates range from ~1% after operative fixation of closed low-energy fractures to>30% in complex open tibia fractures. Fracture-related infections negatively impact clinical outcome with lifelong functional impairment and significantly increase health care expenditure. In addition, the escalating issue of antimicrobial resistance continues to pose a challenge to clinicians. Unfortunately, in orthopedic trauma, only a few preventive measures are strongly supported ...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Will My Fracture Surgery Get Infected? Evidence-based Risk Factors
We present a narrative review of the literature to facilitate evidence-based risk stratification for patients undergoing fracture fixation. Risk factors, including diabetes, hyperglycemia, end-stage renal disease requiring hemodialysis, human immunodeficiency virus, acquired immunodeficiency syndrome, hepatitis C, and alcohol abuse, have consistently been shown to increase infection risk in orthopedic surgery. Other risk factors, including smoking, obesity, and the use of immunomodulatory medications, have been shown to have varying direct impact on postoperative SSI depending on the study and the specific fractures examin...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
Non–culture-based Methods to Aide in the Diagnosis of Implant-associated Infection After Fracture Surgery
Implant-associated infection after fracture surgery is an unfortunate reality for patients and physicians that has long-term, far-reaching implications for treatment, functional recovery, and health care costs. Classically, culture-based methods are used for diagnosis, though “culture-negative” infection is not an uncommon clinical scenario. On the other side, false-positive results can lead to unnecessary antibiotic treatment or surgical intervention. For all parties involved, timely, accurate, and noninvasive diagnostic methods are desirable. It is recognized that bacterial biofilms complicate culture-based diagnosti...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
How to Diagnose Surgical Site Infection After Fracture Surgery: We Have a Problem!
Infections after fracture are often devastating complications and despite widespread efforts to these infections, there are still 100,000 cases of reported fracture-related infection yearly in the United States. Although infection after fracture surgery is common, there is important uncertainty regarding various aspects of diagnosing these infections including a lack of standardization of what the definition of an infection should be in this setting. Most infections after fracture surgery present with obvious clinical signs of infection, but sometimes the signs are more subtle. Furthermore, it is not possible to obtain dia...
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
In Memory of Mark Shirtliff, PhD: Modern Concepts in Diagnosis, Treatment, Prevention, and Cost of Infection After Fracture Surgery
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2020 Category: Orthopaedics Tags: Preface Source Type: research
Radiographic Evaluation of the Distal Radioulnar Joint: Technique to Detect Sigmoid Notch Intra-Articular Screw Breach in Distal Radius Fractures
Conclusions:
The “extended tangential view” and the “sunrise view” improved one's ability to identify DRUJ screw breach and for directing screw repositioning over standard views. We recommend the “sunrise” and “extended tangential” view be obtained intraoperatively to help guide clinical decision-making. Although the “extended tangential view” is more easily obtained with a mini c-arm than the “sunrise view,” both views should be considered to fully evaluate the DRUJ joint.
Clinical Relevance:
Both the “extended tangential” and “sunrise” views help improve sigmoid notch visualization, i...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Total Hip Arthroplasty in Untreated Ankylosing Spondylitis: Tips and Tricks to Avoid Complications
Ankylosing spondylitis (AS) is a seronegative inflammatory disease that progressively affects the spine and sacroiliac joints and is more common in men with the B 27 human leucocyte antigen. This leads to inflammation, synovitis and, eventually, secondary arthritis in the hips of those affected. Hips of those affected are often completely ankylosed at time of presentation to the orthopedic surgeon. Total hip arthroplasty offers a stable mobile hip for patients who are functionally disabled due to their debilitating disease. As disease progresses, the native hip anatomy, which is familiar to orthopedic surgeon in routine to...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
A Comparison of Adjuvant Techniques on Setting Time of Octyl-2-Cyanoacrylate (DERMABOND Advanced)
Octyl-2-cyanoacrylate is a topical skin adhesive (TSA) that has gained popularity over the last decade for wound and incisional wound closure. TSAs have been used with or without suture when closing lacerations or operative incisions. One brand of octyl-2-cyanoacrylate, DERMABOND, was shown to have high wound bursting strength and tensile force, large number of normal tensile loading cycles to failure, long time to failure, and short setting time. Many intraoperative methods have been used by surgical staff in an effort to reduce curing time (ie, time for the tissue adhesive to set), including waving a hand or towels over ...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Trochanteric-sparing Proximal Femoral Resection for Arthritic Spastic Hips
Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisf...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Simple Suction Tube Tensioning Technique for Anterior Cruciate Ligament (ACL) Grafts
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
The Transtrochanteric Approach to the Total Femur Replacement: A Novel Technique
Nononcologic total femur replacement (TFR) secondary to periprosthetic fracture, aseptic loosening or infection has had many surgical approach options provided in the literature. No single approach has been proven to be superior in preventing postoperative complications due to its rare and complex nature, however. Therefore, we believe that a successful outcome following a previously undescribed approach for a TFR is valuable contribution to the current literature. Technique, in the following report, we present is a transtrochanteric approach to a TFR. This approach involved a vertical transtrochanteric osteotomy which all...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
An Easy Positioning Technique for Complex Proximal Tibia Fractures
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Use of a 3D-Printed Custom Reverse Shoulder Arthroplasty
Reverse shoulder arthroplasty is an established treatment for rotator cuff tear arthropathy of the shoulder. In cases of deformity of the glenoid with limited bone stock, implantation of a noncustomized glenoid implant could be challenging. In this technique article, we report 2 cases with severe glenoid deformity. The first case is a 74-year-old woman presenting with rotator cuff tear arthropathy of the shoulder with a severly deformed glenoid. The second case is a 63-year-old woman with deformity of the glenoid after hemiarthroplasty of the shoulder. Both patients were succesfully treated with a 3D-printed customized gle...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Innovative Intraoperative Splints for Tendon Transfer Procedures
Tendon transfers are well accepted treatment modality for managing difficult neurological and musculo tendinous deficits of upper and lower extremities. The most important technical consideration in the final outcome of these procedures are the tension and position with which the donor tendon is attached to the recipient tendon. This technical aspect of the procedure has not been given due importance in the literature. We the authors share our experience of fabricating intra operative splints for various tendon transfer procedures using easily available components of external fixator. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Preoperative Risk Management in Perioperative Medicine and Value-based Care: What the United States Needs to Understand, What the United Kingdom Knows
In the United States, the economics of health has caused us to recognize that a national strategy is needed to quickly and effectively bend the cost curve of a system that is globally noncompetitive with respect to value and is unsustainable in its current form as a health care delivery model. Heretofore, US national policy and health care reform efforts have principally focused on addressing gaps in coverage. Going forward in the United States the drivers of value for health care will most likely come from re-engineering the delivery system itself. In the setting of perioperative medicine, these value gaps maybe unrecogni...
Source: Techniques in Orthopaedics - February 21, 2020 Category: Orthopaedics Tags: Symposium Source Type: research
