The open orthopaedics journal
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Metal implants placed during fracture surgery are often removed for various reasons (i.e. pain, prominent material, patients request). The removal of implants is considered a 'clean' procedure and as low risk surgery. The incidence of wound infections following implant removal has received little attention in the literature. The aim of the current study was to assess the incidence and risk factors of postoperative wound infections (POWIs) following implant removal. ⋯ The overall incidence of postoperative wound infection was 11.6% with 10% superficial and 1.6% of deep infections in patients with elective implant removal. A risk factor for POWI following implant removal was a previous wound infection.
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Ipsilateral fracture of the femur and tibia, or floating knee, is a rare injury that is found almost exclusively in polytrauma or high-energy trauma patients. It presents a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligamentous and soft-tissue injuries. The functional outcome and, in some cases, the life, of such polytrauma patients depends largely on a correct therapeutic approach being taken. ⋯ It is essential at all times to take into consideration the associated injuries and complications before deciding upon a treatment strategy. Ligamentous injuries play an important role in these injuries, much more so than when fractures occur singly. Therefore, these injuries require management by an experienced multidisciplinary team.
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Periarticular fractures around the knee are a challenge for the orthopaedic surgeon. When these fractures are presented in the context of a multiple trauma patient, they are even more difficult to manage because the treatment approach depends not only on the fracture itself, but also on the patient's general condition. These fractures, caused by high-energy trauma, present complex fracture patterns with severe comminution and major loss of articular congruity, and are often associated with vascular and nerve complications, particularly in the proximal tibia, due to its anatomical features with poor myocutaneous coverage. ⋯ These fractures are usually addressed sequentially, either according to the general condition of the patient or to the local characteristics of the lesions. In recent decades, various fixation methods have been proposed, but there is still no consensus as to the ideal method for stabilizing these fractures. In this paper, we describe the general characteristics of these fractures, the stabilization methods traditionally used and those that have been developed in recent years, and discuss the treatment sequences proposed as most suitable for the management of these injuries.
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Hemiarthroplasty is the recommended treatment for displaced, intracapsular, femoral neck fractures. This study aimed to evaluate the early complications following insertion of the JRI Furlong cemented hemiarthroplasty, a contemporary, modular, double tapered, polished prosthesis. ⋯ Early surgical outcomes for the JRI hemiarthroplasty prosthesis are equivalent or superior to other major hemiarthroplasty prostheses previously reported however, there was a high intraoperative fracture rate of 3.7%. We recommend using a stem one size smaller than the final broach in fragile, osteoporotic bone. No patients re-presented with aseptic loosening or stem failure.
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Trauma is a major public health problem worldwide. Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. ⋯ We describe a trauma patient with multiple infectious complications caused by multiple micro-organisms leading to prolonged hospital stay with numerous treatments. This patient had multiple single nucleotide polymorphisms (SNPs) in the MBL2, MASP2, FCN2 and TLR2 genes, most likely contributing to increased susceptibility and severity of infectious disease.