1
|
Coelho A, Alier A, Martínez-Diaz S, Puig-Verdié L, Gómez-Junyent J, García-Bernedo C, Pérez-Prieto D. High rate of undetected infections in failed osteosynthesis of pertrochanteric fractures. J Orthop Trauma 2024:00005131-990000000-00348. [PMID: 38466816 DOI: 10.1097/bot.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The objective of this study was to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. METHODS Design: Retrospective cohort study. SETTING Third-level trauma center. PATIENT SELECTION CRITERIA Patients presenting with a cut-out following proximal femur fracture (PFF) (OTA/AO 31A) osteosynthesis, between January 2007 to December 2020. OUTCOME MEASUREMENTS The primary outcome was infection according to EBJIS criteria. RESULTS Sixty-seven patients presenting with a cut-out were included, with mean age of 83.3 years (range 63-96) and 51 (76.1%) were women. Of all cases, 16 (24.7%) presented a concomitant infection. The presence of concomitant infection was suspected preoperatively in only 3 of the cases. A subgroup analysis was performed between the cases with infection and those without infection, the groups being comparable in terms of demographic data and postoperative radiological criteria. Patients with underlying infection had a higher rate of surgical wound complication (56.3% vs 22%, p = 0.014) and higher rates of leukocytosis (11.560 vs 7.890, p = 0.023). CONCLUSION Faced with a cut-out after osteosynthesis of a proximal femur fracture, underlying infection should be considered as a possible etiological factor. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexandre Coelho
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Albert Alier
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Santos Martínez-Diaz
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lluis Puig-Verdié
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Carlos García-Bernedo
- Department of Anesthesiology, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Daniel Pérez-Prieto
- Department of Orthopaedics, Hospital del Mar, Universitat Autònoma Barcelona, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| |
Collapse
|
2
|
Torrens C, Bellosillo B, Gibert J, Suárez-López A, Santana F, Alier A. Are Cutibacterium acnes delivered from skin to deep tissues in primary reverse shoulder arthroplasty? A prospective study. Arch Orthop Trauma Surg 2024; 144:635-640. [PMID: 37994944 DOI: 10.1007/s00402-023-05125-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION The objective of this study is to determine whether the deep tissues are inoculated during surgery with the Cutibacterium acnes still present in the skin after the surgical preparation in reverse shoulder arthroplasties. MATERIALS AND METHODS Prospective study including patients undergoing surgery with reverse shoulder arthroplasty. All the patients received preoperative antibiotic prophylaxis with cefazolin (2 g IV) and the skin was prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. From all the patients, 9 cultures were obtained after the antibiotic was administrated and the skin surgically prepared. The cultures were sent to isolate C. acnes. DNA was extracted from the C. acnes isolated colonies. Isolate nucleotide distances were calculated using the Genome-based distance matrix calculator from the Enveomics collection toolbox. RESULTS The study included 90 patients. C. acnes was isolated in 24 patients (26.6%) with a total of 61 positive cultures. There were 12 phylotype II, 27 IB and 22 IA. In 9 patients, C. acnes was present in both skin and deep tissues, and they constituted the sample to be studied by means of genomic analysis. In 7 out of the 9 patients, deep tissue samples clustered closer to at least one of its corresponding skin isolates when compared to the other independent bacterial ones. CONCLUSIONS The C. acnes present in the skin at the beginning of the surgery are the same as those found in the deep tissues at the end of the surgery. This result strengthens the possibility that the C. acnes is delivered from the skin to the deep tissues.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Beatriz Bellosillo
- Pathology Department, Hospital del Mar, Barcelona, Spain
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Joan Gibert
- Pathology Department, Hospital del Mar, Barcelona, Spain
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Amaya Suárez-López
- Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| |
Collapse
|
3
|
Coelho A, Parés-Alfonso I, Companys R, Sánchez-Soler JF, Torres-Claramunt R, Alier A, Monllau JC. [Translated article] Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T44-T49. [PMID: 37995815 DOI: 10.1016/j.recot.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/05/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this. MATERIAL AND METHODS Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%). CONCLUSION The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.
Collapse
Affiliation(s)
- A Coelho
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - I Parés-Alfonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Companys
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J F Sánchez-Soler
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Torres-Claramunt
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain; ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Alier
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J C Monllau
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain; ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Coelho A, Parés-Alfonso I, Companys R, Sánchez-Soler JF, Torres-Claramunt R, Alier A, Monllau JC. Risk factors for infection of tibial plateau fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:44-49. [PMID: 37451359 DOI: 10.1016/j.recot.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. MATERIAL AND METHODS Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). CONCLUSION The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.
Collapse
Affiliation(s)
- A Coelho
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - I Parés-Alfonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - R Companys
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J F Sánchez-Soler
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - R Torres-Claramunt
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España; ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, España
| | - A Alier
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - J C Monllau
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España; ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
5
|
Torrens C, Marí R, Puig-Verdier L, Santana F, Alier A, García-Jarabo E, Gómez-Sánchez A, Corvec S. Functional outcomes and complications of patients contaminated with Cutibacterium acnes during primary reverse shoulder arthroplasty: study at two- and five-years of follow-up. Int Orthop 2023; 47:2827-2833. [PMID: 37710071 DOI: 10.1007/s00264-023-05971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The objective of the study was to compare the functional outcomes and the complication rate of the patients with C. acnes contamination at the end of the primary reverse shoulder arthroplasty (RSA) surgery to those patients without C. acnes contamination. METHOD A total of 162 patients were included. In all cases, skin and deep tissue cultures were obtained. A molecular typing characterization of the C. acnes strains was performed. Functional outcomes were assessed with the Constant score at the two and five year follow-up and all complications were also recorded. RESULTS A total of 1380 cultures were obtained from the 162 primary RSA surgeries. Of those, 96 turned out to be positive for C. acnes. There were 25 patients with positive cultures for C. acnes. The overall postoperative Constant score was not significantly different between those patients having C. acnes-positive cultures and those with negative cultures at the two and five year follow-up (59.2 vs. 59.6 at two years, p 0.870, and 59.5 vs. 62.4 at five years, p 0.360). Patients with positive cultures presented a higher complication rate (p 0.001) with two infections, one revision surgery, and one dislocation. CONCLUSION Patients ending up with C. acnes-positive cultures after primary shoulder arthroplasty surgery do not have worse clinical outcomes when compared to patients having negative cultures, but a greater number of complications were found in those patients with C. acnes-positive cultures.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Raquel Marí
- Department of Orthopedics, Sant Joan de Déu Hospital Palma Inca, Palma, Mallorca, Spain
| | - Lluís Puig-Verdier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | | | | | - Stèphane Corvec
- Service de Bactériologie et des contrôles microbiologiques, CHU Nantes, Université de Nantes, INSERM, INCIT UMR 1302 F- 44000, Nantes, France
| |
Collapse
|
6
|
Torrens C, Pérez-Prieto D, Puig L, Prim N, Santana F, Alier A. Minimal number of cultures needed to detect Cutibacterium acnes in primary reverse shoulder arthroplasty: a prospective study. J Shoulder Elbow Surg 2023; 32:89-95. [PMID: 35961500 DOI: 10.1016/j.jse.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to determine the minimum number of cultures needed to detect Cutibacterium acnes in primary reverse shoulder arthroplasties (RSAs). METHODS It is a prospective study including 160 primary RSAs. Exclusion criteria included an active infection, an invasive shoulder treatment in the last 6 months before surgery, an Arthro-SCAN or Arthro-MRI in the last 6 months before surgery, previous shoulder surgeries and revision cases. In 90 cases, 11 cultures were obtained. Another 10 cultures were obtained in the other 70 cases (culture 10 was a sterile sponge to detect false positives). To determine the minimum number of cultures needed to detect C acnes, the prevalence of C acnes contamination of the 160 patients included was determined. RESULTS There were 128 females and 32 males, with a mean age of 74 years. There were 1690 cultures obtained from the 160 primary RSA surgeries, and 132 of them turned out to be positive for C acnes. There were 42 patients with positive cultures. Twenty of them were males and 22 females. When considering the skin and the deep tissue cultures altogether, the prevalence of positive cultures for C acnes was of 26.25%. If only deep tissues cultures were considered, the prevalence of positive cultures for C acnes was of 23.13%. When considering the skin and the deep tissue cultures together, the sensitivity to detect the C acnes is 19% if only 1 culture is obtained, 31% if 2 cultures are obtained, 50% if 3 cultures are obtained, 59.5% if 4 cultures are obtained, 66.7% if 5 cultures are obtained, 73.8% if 6 cultures are obtained, 85.7% if 7 cultures are obtained, and 92.9% if 8 cultures are obtained. When considering only the deep tissue cultures, if only 1 culture is obtained, the sensitivity to detect the C acnes is 24.3%, 40.5% if 2 cultures are obtained, 54.1% if 3 cultures are obtained, 73% if 4 cultures are obtained, 89.2% if 5 cultures are obtained, and 97.3% if 6 or 7 cultures are obtained. DISCUSSION A minimum number of 8 cultures are needed to detect C acnes in skin. Moreover, a minimum of 6 cultures are needed to detect it in deep tissues when performing an RSA.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | - Daniel Pérez-Prieto
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Lluís Puig
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Nuria Prim
- Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| |
Collapse
|
7
|
Torrens C, Bellosillo B, Gibert J, Alier A, Santana F, Prim N, Corvec S. Are Cutibacterium acnes present at the end of primary shoulder prosthetic surgeries responsible for infection? Prospective study. Eur J Clin Microbiol Infect Dis 2021; 41:169-173. [PMID: 34535842 DOI: 10.1007/s10096-021-04348-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate if the C. acnes present at the end of a primary shoulder arthroplasty could be responsible for shoulder arthroplasty infection. Prospective study includes patients undergoing primary shoulder arthroplasty from January 2015 until December 2018. From all the patients included, 5 to 12 tissue samples were obtained and were specifically cultured to detect the presence of C. acnes. DNA was extracted from the C acnes isolated colonies and Whole Genome Sequencing (WGS) analysis was done. A cohort of 156 patients was finally included. In twenty-seven patients, the C. acnes was present at the end of the primary surgery. Two of these patients developed a C. acnes periprosthetic shoulder infection at 6 and 4 months after the primary surgery. WGS of C. acnes isolated colonies showed that all the revision-surgery isolates clustered near to the corresponding primary-surgery isolates compared to the other independent bacterial colonies. (99.89% of similarity). C. acnes present at the end of the primary surgery can be the cause of early or delayed periprosthetic joint infections in shoulder arthroplasty.
Collapse
Affiliation(s)
- Carlos Torrens
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Beatriz Bellosillo
- Pathology Department, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Joan Gibert
- Pathology Department, Hospital del Mar, Barcelona, Spain.,Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Albert Alier
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Fernando Santana
- Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Nuria Prim
- Microbiology Service, Laboratori de Referència de Catalunya, Hospital del Mar, Barcelona, Spain
| | - Stéphane Corvec
- Service de Bactériologie Et Des Contrôles Microbiologiques, Université de Nantes, CHU Nantes, CRCINA U1232, 44000, Nantes, France
| |
Collapse
|
8
|
Pérez-Prieto D, Hinarejos P, Alier A, Sorlí L, Martínez S, Puig L, Monllau JC. Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate. BMC Musculoskelet Disord 2021; 22:653. [PMID: 34340666 PMCID: PMC8330036 DOI: 10.1186/s12891-021-04431-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol. Methods This is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons’ discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery). Results Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001). Conclusion A thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures.
Collapse
Affiliation(s)
- Daniel Pérez-Prieto
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. .,Catalan Institute for Traumatology and Sports Medicine (ICATME), Hospital Universitari Dexeus. - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Pedro Hinarejos
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Albert Alier
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Lluïsa Sorlí
- Department of Infectious Diseases, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Santos Martínez
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Lluís Puig
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Juan C Monllau
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Catalan Institute for Traumatology and Sports Medicine (ICATME), Hospital Universitari Dexeus. - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
9
|
Torrens C, Fraile A, Santana F, Puig L, Alier A. Sonication in shoulder surgery: is it necessary? Int Orthop 2020; 44:1755-1759. [PMID: 32215673 DOI: 10.1007/s00264-020-04543-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The objective of the present study was to determine whether sonication yields greater sensitivity when compared with the traditional tissue culture in detecting peri-implant infections in shoulder surgery. METHODS It is a retrospective study that includes 99 shoulder surgeries with implants explanted. The inclusion criteria required at least four tissue cultures, sonication of the material explanted, and a minimum follow-up of two years. Patients were classified according to the definition of periprosthetic shoulder infection of the 2018 International Consensus Meeting on Orthopedic Infections. The classifications are definitive infection, probable infection, possible infection, and unlikely infection. RESULTS Among the 99 surgical procedures, 31 were considered definitive infections, 11 possible/probable infections, and 57 unlikely infections. Considering the cases with a definitive infection, the sensitivity of the tissue culture was 87.09% and the sensitivity of sonication stood at 80.64% (p = 0.406). Analyzing the cases with a definitive infection and those having a possible/probable infection together and comparing them with those with unlikely infection, the sensitivity of sonication was 80.4% and the sensitivity of the tissue culture came to 91.4%. The specificity of the sonication was 98.1% and the specificity of the tissue culture was 99.6%. CONCLUSION The sensitivity of sonication in shoulder surgery (80.64%) is not superior to the sensitivity of the tissue culture (87.09%). Specificity remains high with both methods, being 98.1% in the sonication group and 99.6% in the tissue culture. Sonication brings no benefit to the detection of shoulder per-implant infections.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Anna Fraile
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lluis Puig
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| |
Collapse
|
10
|
Torrens C, Marí R, Alier A, Puig L, Santana F, Corvec S. Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers. J Shoulder Elbow Surg 2019; 28:839-846. [PMID: 30685278 DOI: 10.1016/j.jse.2018.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/06/2018] [Accepted: 10/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to determine the presence of Cutibacterium acnes (formerly Propionibacterium acnes) on the skin and in deep tissue in a real clinical scenario of primary reverse shoulder arthroplasty. METHODS This prospective study included 90 primary reverse shoulder arthroplasties, and 12 cultures were obtained from each patient. Each sample was homogenized and used to inoculate PolyVitex (bioMérieux, Marcy-l'Etoile, France) agar and Schaedler (bioMérieux) agar plates. The same procedure was also followed with a thioglycolate broth. Culture was considered positive for C acnes when 2 or more colonies were observed. Total DNA from C acnes isolates was extracted using the InstaGene Matrix (Bio-Rad Laboratories, Hercules, CA, USA) method. The phylotype was determined, and single-locus sequence typing was done on all isolates. RESULTS We obtained 1080 tissue cultures from the 90 patients included, and 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes-positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%). We sent 38 positive samples for blinded phylotyping, single-locus sequence typing, and multi-locus sequence typing type determination. Many of the clusters isolated belonged to phylotype IB and clonal complex (CC) 36 or phylotype II and CC53. DISCUSSION In the real scenario of patients undergoing primary reverse shoulder arthroplasty using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine, C acnes was isolated in the deep layers of 18.8% of the patients. The C acnes K1 and K2 subtypes (belonging to phylotype II and CC53), reported to be commonly involved in prosthetic joint infection, were usually isolated.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | - Raquel Marí
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Lluis Puig
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Stephane Corvec
- Bacteriology and Infection Control Unit, Centre Hospitalier Universitaire Nantes, Nantes University Hospital, Nantes, France; Center for Research in Cancerology and Immunology, Univervité de Nantes, Unit 1232, Nantes, France
| |
Collapse
|
11
|
Torrens C, Santana F, Puig L, Sorli L, Alier A. Results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection. J Orthop Surg Res 2018; 13:58. [PMID: 29554935 PMCID: PMC5859682 DOI: 10.1186/s13018-018-0763-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/10/2018] [Indexed: 02/07/2023] Open
Abstract
Background The objective of this study is to present the results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection and to determine the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning. Methods Twenty-one patients (22 cement spacers) treated with two-stage surgery because of a shoulder arthroplasty infection were included. In the second stage, the cement spacer was sent for sonication and at least four tissue cultures were obtained. Epidemiological data, comorbidities, sensitivity of the microorganisms to the antibiotic loaded in the cement spacer in the first revision surgery, time elapsed since an antibiotic was last administered until second revision procedure, functional shoulder status at last follow-up, and any complication were recorded. Results Three out of the 22 cases (13.6%) presented positive cultures at the second-stage surgery. Periprosthetic tissue culturing detected the three positive culture cases in the second stage while the cement spacer sonication detected two and missed one. Considering periprosthetic tissue culturing as the standard procedure, the cement spacer sonication showed sensitivity at 66.6%. Recurrent infection over time was considered present in 3 patients; two of them had been previously diagnosed with a positive culture at the second stage (66.6%). Conclusions A good number of patients (13.6%) present a positive culture at the second stage of the two-stage surgical procedure for infected shoulder arthroplasty, and those patients seem to be at high risk for recurrent infection. Periprosthetic tissue cultures have a higher sensitivity to detecting a positive culture at the second stage than cement spacer sonication.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lluis Puig
- Department of Orthopedics, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Luisa Sorli
- Service of Internal Medicine and Infectious Diseases, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| |
Collapse
|
12
|
Torrens C, Santana F, Marí R, Puig L, Alier A. Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study. J Orthop Sci 2017; 22:858-861. [PMID: 28689929 DOI: 10.1016/j.jos.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/22/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty. METHODS A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery. RESULTS Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day. CONCLUSIONS Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty.
Collapse
Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain.
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Raquel Marí
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Lluis Puig
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Albert Alier
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Universitat Autonoma de Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain
| |
Collapse
|
13
|
Pérez-Prieto D, Portillo ME, Puig-Verdié L, Alier A, Gamba C, Guirro P, Martínez-Díaz S, Horcajada JP, Trampuz A, Monllau JC. Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures. Diagn Microbiol Infect Dis 2016; 86:442-445. [DOI: 10.1016/j.diagmicrobio.2016.09.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/20/2016] [Indexed: 10/21/2022]
|
14
|
Portillo ME, Salvadó M, Alier A, Martínez S, Sorli L, Horcajada JP, Puig L. Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect 2014; 69:35-41. [DOI: 10.1016/j.jinf.2014.03.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/25/2014] [Accepted: 03/01/2014] [Indexed: 12/18/2022]
|
15
|
Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, Puig L. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res 2013; 471:3672-8. [PMID: 23904245 PMCID: PMC3792275 DOI: 10.1007/s11999-013-3200-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 07/19/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). QUESTIONS/PURPOSES We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis. METHODS All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards regression analysis were performed. RESULTS The median time from primary to revision surgery was (p < 0.001) longer for patients with aseptic loosening (7.8 years) than for patients with mechanical failure (1.6 years) or PJI (2 years). No difference in the time to revision was observed for patients with aseptic loosening with positive or negative microbiological cultures (p = 0.594). Propionibacterium acnes was cultured below the established microbiological criteria for positivity in 12 (19%) procedures that had been presumed to have been revisions for aseptic loosening. CONCLUSIONS PJI should be considered in all revisions performed within 2 years of implantation even in the absence of clinical or laboratory findings suggestive for infection. However, the growth of low-virulence microorganisms below the cut-off in revisions for apparent aseptic loosening is not associated with early prosthesis failure.
Collapse
Affiliation(s)
- María Eugenia Portillo
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Margarita Salvadó
- />Microbiology Laboratory, Laboratori de Referència de Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis Mas Blau, 08820 El Prat de Llobregat, Barcelona, Spain
| | - Albert Alier
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Lluisa Sorli
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Santos Martínez
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| | - Juan Pablo Horcajada
- />Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluis Puig
- />Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
| |
Collapse
|
16
|
Puig-Verdié L, Alentorn-Geli E, González-Cuevas A, Sorlí L, Salvadó M, Alier A, Pelfort X, Portillo ME, Horcajada JP. Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure. Bone Joint J 2013; 95-B:244-9. [DOI: 10.1302/0301-620x.95b2.30486] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to compare the diagnostic accuracy for the detection of infection between the culture of fluid obtained by sonication (SFC) and the culture of peri-implant tissues (PITC) in patients with early and delayed implant failure, and those with unsuspected and suspected septic failure. It was hypothesised that SFC increases the diagnostic accuracy for infection in delayed, but not early, implant failure, and in unsuspected septic failure. The diagnostic accuracy for infection of all consecutive implants (hardware or prostheses) that were removed for failure was compared between SFC and PITC. This prospective study included 317 patients with a mean age of 62.7 years (9 to 97). The sensitivity for detection of infection using SFC was higher than using PITC in an overall comparison (89.9% versus 67%, respectively; p < 0.001), in unsuspected septic failure (100% versus 48.5%, respectively; p < 0.001), and in delayed implant failure (88% versus 58%, respectively; p < 0.001). PITC sensitivity dropped significantly in unsuspected compared with suspected septic failure (p = 0.007), and in delayed compared with early failure (p = 0.013). There were no differences in specificity. Sonication is mainly recommended when there is implant failure with no clear signs of infection and in patients with delayed implant failure. In early failure, SFC is not superior to PITC for the diagnosis of infection and, therefore, is not recommended as a routine diagnostic test in these patients. Cite this article: Bone Joint J 2013;95-B:244–9.
Collapse
Affiliation(s)
- L. Puig-Verdié
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - E. Alentorn-Geli
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - A. González-Cuevas
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - L. Sorlí
- Hospital del Mar – Parc de Salut Mar, Service
of Internal Medicine and Infectious Diseases, Passeig
Marítim 25-29, E-08003 Barcelona, Spain
| | - M. Salvadó
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - A. Alier
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - X. Pelfort
- Hospital del Mar – Parc de Salut Mar, Department
of Orthopaedic Surgery, Passeig Marítim 25-29, E-08003
Barcelona, Spain
| | - M. E. Portillo
- Laboratori de Referència de Catalunya, C/
de la Selva, 10, E-08820
El Prat de Llobregat, Spain
| | - J. P. Horcajada
- Hospital del Mar – Parc de Salut Mar, Service
of Internal Medicine and Infectious Diseases, Passeig
Marítim 25-29, E-08003 Barcelona, Spain
| |
Collapse
|
17
|
Piñol I, Alier A, Hinarejos P, Sorli ML, Puig L. [Septic arthritis of the knee by Stenotrophomonas maltophilia]. Rev Esp Quimioter 2012; 25:218-219. [PMID: 22987269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
18
|
Navallas M, Díaz-Ledo F, Ares J, Sánchez-Buenavida A, López-Vilchez MA, Solano A, García García J, Maiques JM, Mur-Sierra A, Alier A. Distal humeral epiphysiolysis in the newborn: utility of sonography and differential diagnosis. Clin Imaging 2012. [PMID: 23206631 DOI: 10.1016/j.clinimag.2012.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the result of a traumatic delivery. It can mimic elbow dislocation and, due to the absence of ossification of the epiphysis at that time, cannot be diagnosed radiographically. However, ultrasound is an important diagnostic tool for this purpose because it is able to clearly visualize the cartilaginous epiphysis. In addition, it allows the differential diagnosis with posterior elbow dislocation whose therapeutic management and prognosis are different. We report the case of a preterm newborn in which a fracture-separation of the distal humeral epiphysis was diagnosed with the help of sonography. The purpose of this report is to emphasize the utility of echography as a cheap, available, and noninvasive tool for the evaluation of the nonossified epiphysis in the newborn elbow.
Collapse
Affiliation(s)
- María Navallas
- Department of Radiology, IDIMAR CRC Mar-Hospital del Mar, Paseo Marítimo 25-29, 08003 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sorlí L, Puig L, Torres-Claramunt R, González A, Alier A, Knobel H, Salvadó M, Horcajada JP. The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. ACTA ACUST UNITED AC 2012; 94:249-53. [PMID: 22323695 DOI: 10.1302/0301-620x.94b2.27779] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with infected arthroplasties are normally treated with a two-stage exchange procedure using polymethylmethacrylate bone cement spacers impregnated with antibiotics. However, spacers may act as a foreign body to which micro-organisms may adhere and grow. In this study it was hypothesised that subclinical infection may be diagnosed with sonication of the surface biofilm of the spacer. The aims were to assess the presence of subclinical infection through sonication of the spacer at the time of a second-stage procedure, and to determine the relationship between subclinical infection and the clinical outcome. Of 55 patients studied, 11 (20%) were diagnosed with subclinical infection. At a mean follow-up of 12 months (interquartile range 6 to 18), clinical failure was found in 18 (32.7%) patients. Of the patients previously diagnosed with subclinical infection, 63% (7 of 11) had failed compared with 25% (11 of 44) of those without subclinical infection (odds ratio 5.25, 95% confidence interval 1.29 to 21.4, p = 0.021). Sonication of the biofilm of the surface of the spacer is useful in order to exclude subclinical infection and therefore contributes to improving the outcome after two-stage procedures.
Collapse
Affiliation(s)
- L Sorlí
- Parc de Salut Mar, Service of Internal Medicine and Infectious Diseases, Passeig Marítim 25-29, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Knobel H, Díez A, Arnau D, Alier A, Ibáñez J, Campodarve I, Supervía A, Nogués X. [The sequelae of osteoporotic femoral fracture in Barcelona]. Med Clin (Barc) 1992; 98:441-4. [PMID: 1573908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of the present was to study the long term sequelae of osteoporotic fracture of the femur in a general hospital of 300 beds in Barcelona, analyzing 1) mortality; 2) degree of functional capacity; 3) care requirements; 4) familial repercussion, and 5) psychic repercussion. METHODS Structured telephone interviews were carried out between 1990-1991 with the patients attended for osteoporotic fracture of the femur in our center from 1988-1989. Of a total of 145 patients, 12 died within 1 month. Among the remaining patients the interview was performed with 100 patients--25 of whom were males of 78 +/- 8 years of age and 75 females of 82 +/- 10 years of age. The degree of functional capacity was evaluated by the index of independence in daily activities (DA). RESULTS Mortality within one month was 8.3%; at one year 30% and at 2 years 38%. Factors associated with the highest mortality were: age of over 80 years (p less than 0.004), deterioration of post fracture functional capacity (p less than 0.0004) and pre-fracture dementia (p less than 0.01). Important deterioration in post fracture functional capacity was seen in 45% of the cases. Seventeen percent of the patients required transfer to a center for chronic care and 34% resided in a center for chronic care prior to the fracture. Familial repercussion was observed in 43% of the cases and post fracture psychologic repercussion was seen in 28%. CONCLUSIONS Osteoporotic fracture of the femur presents the following sequelae: mortality, intense deterioration of functional capacity and important health care requirements in addition to considerable familial and psychological repercussion.
Collapse
Affiliation(s)
- H Knobel
- Servicio de Medicina Interna, Hospital de la Esperanza, Barcelona
| | | | | | | | | | | | | | | |
Collapse
|