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Sapino G, Osinga R, Maruccia M, Guiotto M, Clauss M, Borens O, Guillier D, di Summa PG. Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls. Arch Plast Surg 2023; 50:593-600. [PMID: 38143847 PMCID: PMC10736208 DOI: 10.1055/s-0043-1768644] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 12/26/2023] Open
Abstract
Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee joint mobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.
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Affiliation(s)
- Gianluca Sapino
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Rik Osinga
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery, University Hospital of Bari, Bari, Italy
| | - Martino Guiotto
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Martin Clauss
- Department of Orthopedic and Trauma Surgery, University Hospital of Basel, Basel, Switzerland
| | - Olivier Borens
- Department of Orthopedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - David Guillier
- Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, University Hospital, Dijon, France
| | - Pietro Giovanni di Summa
- Department of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Brügger A, Luthi F, Vuistiner P, Cherix S, Borens O, Steinmetz S. Prosthetic fitting associated with better survival at 5 years after above-knee amputation due to vascular insufficiency. Ann Phys Rehabil Med 2023; 66:101727. [PMID: 36645964 DOI: 10.1016/j.rehab.2022.101727] [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: 12/23/2021] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality. OBJECTIVE To determine survival rate 5 years after Gritti-Stokes and mid-thigh amputation in individuals with vascular insufficiency and to identify the predictors of survival. METHODS We conducted a retrospective observational study including all individuals with vascular insufficiency who underwent amputation from September 2007 to December 2015 in our University Hospital. The indication for amputation was limb necrosis in 86% of cases, infection in 10%, and complications with the stump (discomfort, neuroma or scar dehiscence) in 4%. Medical records were analysed to determine factors and comorbidities. The date of death was retrieved from the national death registry at a minimum of 5 years after amputation. Cox proportional-hazard regression was used to estimate associations between factors and post-amputation survival with hazard ratios (HR) and 95% confidence intervals (CIs). RESULTS We included 126 people with vascular insufficiency (83 men), mean age was 70 years [20; 97]; eighty-nine participants (71%) died during the study period. Survival rate was 68% at 1 year, 48% at 3 years and 37% at 5 years. Survival was associated with prosthetic fitting (HR 0.306 [95% CI 0.180; 0.521], p<0.001) and length of stay (HR 0.992 [95% CI 0.987; 0.997], p = 0.003). Conversely, limb necrosis was associated with a lower survival rate (HR 3.801 [95% CI 1.615; 8.949], p = 0.002). In a secondary multivariable analysis, Gritti-Stokes amputation was the only factor positively associated with prosthetic fitting (odds ratio 7.407 [95% CI 2.439; 22.489], p<0.001). CONCLUSIONS The survival rate at 5 years after Gritti-Stokes and mid-thigh amputation in people with vascular insufficiency was 37%. Prosthetic fitting was independently associated with better survival, and Gritti-Stokes amputation was the only factor positively related to prosthetic fitting.
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Affiliation(s)
- Alexandre Brügger
- Department of Orthopedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - François Luthi
- Department of Medical Research, Clinique Romande de Réadaptation SUVA, avenue du Grand-Champsec 90, 1950 Sion, Switzerland; Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation SUVA, avenue du Grand-Champsec 90, 1950 Sion, Switzerland; Division of Physical Medicine and Rehabiliation, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation SUVA, avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Stéphane Cherix
- Department of Orthopedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopedics and Traumatology, Lausanne University Hospital, rue du Bugnon 46, 1011, Lausanne, Switzerland
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Martineau J, Guillier D, Maruccia M, Guiotto M, Borens O, Raffoul W, di Summa PG. Locoregional anesthesia for post-operative pain management in microsurgical reconstruction of the lower extremities: A retrospective study. J Plast Reconstr Aesthet Surg 2022; 75:3190-3196. [PMID: 35599221 DOI: 10.1016/j.bjps.2022.04.027] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/13/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Opioid-based analgesia is often used in the management of postoperative pain in arthroplasty cases. This article analyses the safety of single-shot peripheral nerve block (PNB) and potential analgesic benefits in patients undergoing lower limb free flap reconstruction. METHODS A retrospective review including all patients undergoing lower limb reconstruction with free flaps between October 2017 and April 2020 was performed. Patients were divided into two groups based on PNB utilization. The use of oral opioids, post-operative pain scores, flap-related outcomes, patient morbidity, and length of hospital stay (LOS) were compared between groups. RESULTS Thirty-one patients who underwent lower limb reconstruction with free flaps, were finally included in the study. Preoperative PNB was performed on 14 patients, while 17 patients received general anesthesia (GA) alone. Pain at rest, measured using the visual analog scale (VAS) score, was significantly lower (2.2 ± 1.7 vs. 4.9 ± 1.7) in the PNB group on postoperative day 1 (POD). The mean [median]±SD amounts of opioids consumed in morphine milligram equivalent (MME) were significantly lower in the PNB group on both POD1 (33.5 [22.5] ± 33.9 vs. 61.6 [48.0] ± 39.0), POD2 (29.0 [15.0] ± 29.2 vs. 58.0 [52.5] ± 37.0) and cumulatively over 7 days (164.0 [197.0] ± 132.8 vs. 315.4 [225] ± 203.2). Complication rates and LOS were not statistically different between groups, although trending toward lower take-back procedures and major complications in the PNB group. CONCLUSION Preoperative single-shot PNB significantly reduced postoperative opioid use and patient-reported pain severity and was not associated with an increase in complication rates.
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Affiliation(s)
- Jérôme Martineau
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Guillier
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland; Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - Dijon University Hospital, France
| | - Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Martino Guiotto
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedic Surgery and Traumatology, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
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Abstract
This study aims to evaluate the effectiveness of an online course to enable orthopaedic surgeons to acquire the core competencies necessary to prevent and treat fracture-related infections (FRI). This study included orthopaedic surgeons and residents from Latin American countries who attended an online course focused on FRI. The online course included: didactic lectures, small-group clinical case discussions, and panel case discussions. The course was delivered using Zoom® platform and designed to address four core competencies: prevention, definition and diagnosis, antimicrobial therapy, and surgical treatment. An online questionnaire was created distributing 16 questions through six clinical scenarios. Participants were invited to answer the questionnaire before and after the course. Sixty of the 78 course participants answered the pre-course, and 42 the post-course assessment. Relative to before the course, the mean post-course assessment score rose significantly for prevention of FRI (4.1 before and 4.5 after; p = 0.014), definition and diagnosis (2.4 before and 3.4 after; p = 0.001), and surgical treatment (2.2 before and 2.8 after; p = 0.011). The final score encompassing all four core competencies also rose significantly (2.7 before and 3.3 after; p = 0.001). The online course on FRI was feasible and effective, significantly increasing course users’ knowledge of overall competency in managing FRI.
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Affiliation(s)
- Matheus Lemos Azi
- Department of Orthopedics, Manoel Victorino Hospital, Secretary of Health for the State of Bahia, Salvador, Brazil
| | - Kodi Edson Kojima
- Department of Orthopedics and Traumatology, Hospital Das Clinicas Hcfmusp, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Pesántez
- Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Guido Carabelli
- Instituto de Ortopedia Y Traumatología "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Argentina
| | - Olivier Borens
- Septic Surgical Unit, Orthopaedic and Trauma Service, University Hospital Lausanne Chuv, University of Lausanne, Lausanne, Switzerland
| | - Iain McFadyen
- Department of Orthopaedic Surgery, University Hospitals of North Midlands, Stoke-on-Trent, UK
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van Sloten M, Gómez-Junyent J, Ferry T, Rossi N, Petersdorf S, Lange J, Corona P, Araújo Abreu M, Borens O, Zlatian O, Soundarrajan D, Rajasekaran S, Wouthuyzen-Bakker M. Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics? : a multicentre observational study. Bone Joint J 2022; 104-B:183-188. [PMID: 34969292 DOI: 10.1302/0301-620x.104b1.bjj-2021-0693.r2] [Citation(s) in RCA: 2] [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] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. METHODS A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. RESULTS None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). CONCLUSION When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183-188.
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Affiliation(s)
- Maxime van Sloten
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joan Gómez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Tristan Ferry
- Department of Infectious and Tropical Diseases, Hospital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolò Rossi
- Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Sabine Petersdorf
- Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Jeppe Lange
- H-HiP, Department of Orthopaedic Surgery, Regional Hospital Horsens, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pablo Corona
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar e Universitário do Porto. GRIP, Porto Bone & Joint infection group, Porto, Portugal
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Septic surgical Unit, University Hospital of Lausanne, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - S Rajasekaran
- Department of Orthopaedics, Ganga Hospital, Coimbatore, India
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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6
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Gilliéron P, Boillat-Blanco N, Nicod Lalonde M, Becce F, Omoumi P, Prior JO, Borens O, Steinmetz S. [Diagnosis and management of chronic osteomyelitis of long bones in adults]. Rev Med Suisse 2021; 17:2194-2200. [PMID: 34910406] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic osteomyelitis is an inflammatory process of the bone caused by an infectious agent. This condition leads to altered bone vascularization and thus to bone destruction and formation of necrotic bone fragments (sequestrum). The treatment of chronic osteomyelitis is primarily based on surgical management, which includes debridement of the sequestrum and sampling of bone tissue for microbiological analysis in order to initiate a targeted antibiotic therapy. A multidisciplinary approach is essential, involving expertise in orthopedic surgery, musculoskeletal imaging and nuclear medicine, infectious diseases, as well as plastic or vascular surgery for complex cases with soft tissue and/or vascular defects.
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Affiliation(s)
- Paul Gilliéron
- Service d'orthopédie et de traumatologie, Département de l'appareil locomoteur, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Noémie Boillat-Blanco
- Service des maladies infectieuses, Département de médecine, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Nicod Lalonde
- Service de médecine nucléaire et imagerie moléculaire, Département de radiologie médicale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Fabio Becce
- Service de radiodiagnostic et radiologie interventionnelle, Département de radiologie médicale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrick Omoumi
- Service de radiodiagnostic et radiologie interventionnelle, Département de radiologie médicale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - John O Prior
- Service de médecine nucléaire et imagerie moléculaire, Département de radiologie médicale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Borens
- Service d'orthopédie et de traumatologie, Département de l'appareil locomoteur, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Sylvain Steinmetz
- Service d'orthopédie et de traumatologie, Département de l'appareil locomoteur, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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Moerenhout K, Steinmetz S, Vautrin M, Picarra S, Udin G, Borens O. Economic advantage of ‘self-made’ antibiotic-loaded spacer compared to prefabricated antibiotic-loaded spacer and spacer molds in two-staged revision arthroplasty. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infection after total hip or total knee arthroplasty is a serious complication implying great costs for the health care system. Amongst the different treatment options, the two-step exchange using a spacer in the interval is a valid option. We evaluate the economic impact of our self-made antibiotic-loaded hip and knee cement spacers compared with prefabricated spacers and spacer molds.
Costs to prepare self-made cement spacers are detailed for each spacer type. We also assess the intraoperative time spent for fabricating our self-made hip and knee spacers.
The price of these self-made knee spacer is 514 CHF (450 EUR / 505 USD) if non-articulated and 535 CHF (470 EUR / 525 USD) if articulated ; the price for the self-made hip spacer is 749 CHF (760 EUR / 735 USD). Our average preparation time is 14 minutes for our self-made knee spacers and 16 minutes for our self-made hip spacers. While the senior surgeon is fabricating the self-spacers, another surgeon of the team continues intensive irrigation and debridement. Thus, no time is lost waiting for the self-spacer to be fabricated.
In our hands, self-made hip and knee spacers are at least 40-50% cheaper than prefabricated spacers and spacer-molds. This is a serious economic advantage in this already expensive surgery. When done in teamwork, self-spacer fabrication does not increase the surgery time. The economic advantage is added to the main and most important advantage of self- made spacers, which remains the possibility of patient adapted anatomical reconstruction of the joint.
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8
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Guillier D, Sapino G, Schaffer C, Borens O, Thein E, Bramhall RJ, di Summa PG. Lower limb reconstruction involving osteosynthesis material: A retrospective study on propeller flaps outcomes. Injury 2021; 52:3117-3123. [PMID: 33865606 DOI: 10.1016/j.injury.2021.04.003] [Citation(s) in RCA: 3] [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: 12/16/2020] [Revised: 03/02/2021] [Accepted: 04/05/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Reconstruction of soft tissue defects in lower limb fractures requiring internal fixation remains a challenging scenario with the optimal surgical treatment still debated. This study aims to recommend, and eventually redefine, surgical indications for propeller flaps reconstruction in the distal lower limb, with a particular focus on the presence or not of metalwork. METHODS A retrospective study of lower limb soft tissue reconstructions performed between January 2015 and July 2018 was carried out including all patients treated with a propeller perforator flap (PPF) with at least 6-month follow-up. Patients were further divided in 2 groups depending on the presence of metalwork fixation beneath the flap (F group, propeller on Framework; NF group, propeller with No-Framework). RESULTS 21 patients were retained (F group, 11 patients; NF group, 10 patients). There were no significant differences between the two groups in age, BMI, ASA scores, comorbidities or defect size. There was a statistically significant difference between the groups (p<0.05) in the cumulative hospital stay with a mean cumulative hospital stay of 22 ± 9 days in the F group and 12 ± 8 days in NF group. Failures were higher where PPF were used to cover hardware material, with 3 patients requiring a major secondary procedure in F group versus 1 patient in NF group. CONCLUSION The presence of underlying metalwork significantly reduced the margin for small, day-case revision procedures such as flap readvancement or STSG. This study emphasizes clinical intuition that whilst PPF are a useful and elegant tool in lower limb reconstruction, their use should be limited when underlying metalwork is present.
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Affiliation(s)
- D Guillier
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery - University Hospital, Boulevard de Lattre de Tassigny F-21000 Dijon, France
| | - G Sapino
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Department of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - C Schaffer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - O Borens
- Department of Trauma and Orthopedic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - E Thein
- Department of Trauma and Orthopedic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - R J Bramhall
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - P G di Summa
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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9
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Moerenhout K, Steinmetz S, Vautrin M, Picarra S, Udin G, Borens O. Economic advantage of 'self-made' antibiotic-loaded spacer compared to prefabricated antibiotic-loaded spacer and spacer molds in two-staged revision arthroplasty. Acta Orthop Belg 2021; 87:557-562. [PMID: 34808733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Infection after total hip or total knee arthroplasty is a serious complication implying great costs for the health care system. Amongst the different treatment options, the two-step exchange using a spacer in the interval is a valid option. We evaluate the economic impact of our self-made antibiotic-loaded hip and knee cement spacers compared with prefabricated spacers and spacer molds. Costs to prepare self-made cement spacers are detailed for each spacer type. We also assess the intraoperative time spent for fabricating our self-made hip and knee spacers. The price of these self-made knee spacer is 514 CHF (450 EUR / 505 USD) if non-articulated and 535 CHF (470 EUR / 525 USD) if articulated ; the price for the self-made hip spacer is 749 CHF (760 EUR / 735 USD). Our average preparation time is 14 minutes for our self-made knee spacers and 16 minutes for our self-made hip spacers. While the senior surgeon is fabricating the self-spacers, another surgeon of the team continues intensive irrigation and debridement. Thus, no time is lost waiting for the self-spacer to be fabricated. In our hands, self-made hip and knee spacers are at least 40-50% cheaper than prefabricated spacers and spacer-molds. This is a serious economic advantage in this already expensive surgery. When done in teamwork, self-spacer fabrication does not increase the surgery time. The economic advantage is added to the main and most important advantage of self- made spacers, which remains the possibility of patient adapted anatomical reconstruction of the joint.
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10
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Luyet A, Steinmetz S, Gallusser N, Roche D, Fischbacher A, Tissot C, Borens O. Fusion rate of 89% after knee arthrodesis using an intramedullary nail: a mono-centric retrospective review of 48 cases. Knee Surg Sports Traumatol Arthrosc 2021; 31:1299-1306. [PMID: 34458941 PMCID: PMC10050040 DOI: 10.1007/s00167-021-06693-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate. METHODS A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2™ Arthrodesis Nail, 6 OsteoBridge® Knee Arthrodesis and 27 Wichita® fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6-18 years). RESULTS Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita® fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%). CONCLUSION Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita® fusion nail shows a tendency to better results compared to the two other nails. LEVEL OF EVIDENCE Case series, level IV.
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Affiliation(s)
- Anaïs Luyet
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Nicolas Gallusser
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Roche
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Arnaud Fischbacher
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Tissot
- Clinique de la Source, Avenue Bergières 2, 1004, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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11
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Abstract
OBJECTIVE To compare clinical effect of movable external fixation and fusion fixation for the treatment of elbow tuberculosis. METHODS From October 2013 to June 2019, 52 patients with elbow tuberculosis treated with standard antituberculosis therapy were divided into movable external fixation group and fusion fixation group according to treatment methods. In group A, there were 25 patients, including 11 males and 14 females, aged from 24 to 75 years old with an average of (42.81± 9.01) years old; the courses of diseases ranged from 2 to 9 months with an average of (3.96±1.45) months. In group B, there were 27 patients, including 15 males and 12 females, aged from 23 to 77 years old with an averageof (44.08±7.44) years old; the courses of diseases ranged from 2 to 7 months with an average of (3.88±1.67) months. All patients were performed focus debridement. Intraoperative blood loss, operative time were compared between two groups. VAS score before operation, 2 weeks and 12 months after operation were applied to evaluate pain relieve;Mayo elbow performance score (MEPS) before operation, 1 and 12 months after operation were used to evaluate clinical effect;changes of erythrocyte sedimentation rate (ESR) and Creactive protein, CRP) before operation, 3 weeks after antituberculosis therapy, 1 week and 6 months after operation were compared between two groups. RESULTS All patients were followed up from 12 to 20 months with an average of (13.50±4.85) months. No mixed infection and recurrence of tuberculosis occurred. There were no statistical differences in intraoperative blood loss and operative time(P>0.05). There was difference in postoperative VAS score at 2 weeks between movable external fixation group (5.15±0.95) and fusion fixation group (4.04±0.84)(P<0.01);while no difference in postoperative VAS score at 12 months between two groups (P>0.05). No difference in ESR and CRP level between two groups before and after operation (P>0.05). Postoperative Mayo score at 1 and 12 months in movable external fixation group were (78.15±7.83) and (90.19±7.13);in fusion fixation group were (70.40±7.61) and (82.60±8.38);there were differences in Mayo score at different time points between two groups(P<0.01). CONCLUSION For elbow tuberculosis, movable external fixation and fusion fixation have equal effect in operative time, amount of bleeding and control of tuberculosis infection indicator. Movable external fixation need earlier functional exercise, not conducive to pain relief at early stage, which may be better than fusion fixation, it is worth clinical promoting.
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Affiliation(s)
- Tian-Yi Cao
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
| | - Gang Zu
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
| | - Jun Fei
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
| | - Da-Wei Bi
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
| | - Chen-Wei Zhang
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
| | - O Borens
- Department of Orthopaedics, Tuberculosis Diagnosis and Treatment Center, Zhejiang Integrated Traditional Chinese and Western Medicine Hospital, Hangzhou 310003, Zhejiang, China
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12
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Delaune L, Steinmetz S, Heutschi-Öztürk H, Borens O. Traumatic abdominal wall hernias: disruptions of the abdominal wall muscles associated to pelvic bone fractures illustrated by two case reports. BMC Surg 2020; 20:253. [PMID: 33109131 PMCID: PMC7590667 DOI: 10.1186/s12893-020-00909-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blunt abdominal traumas are often associated with intra-abdominal injuries and pelvic fractures. Traumatic abdominal wall hernias due to disruption of the abdominal wall muscles may be overlooked. Delayed diagnosis can lead to hernia related complications. CASE PRESENTATION We present two cases of high kinetic trauma with pelvic fractures and acute traumatic abdominal wall herniation. Both of these cases suffered from a delayed diagnosis and needed surgery to treat the symptomatic herniation. CONCLUSION Clinical reassessment and appropriate medical imaging are mandatory in patients with high kinetic abdominal blunt traumas and associated pelvic fracture, in order to prevent delayed diagnosis and possible complications.
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Affiliation(s)
- Leïlani Delaune
- Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
| | | | - Olivier Borens
- Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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13
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Mahlouly J, Lhopitallier L, Suttels V, Mueller L, Wernly D, Borens O, Steinmetz S. Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report. BMC Infect Dis 2020; 20:767. [PMID: 33069221 PMCID: PMC7568409 DOI: 10.1186/s12879-020-05497-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ureaplasma urealyticum is an intra-cellular bacterium frequently found colonizing the genital tract. Known complications include localized infections, which can result in premature deliveries. Septic arthritis due to U. urealyticum in healthy patients is exceptionally rare, although opportunistic septic arthritis in agammaglobulinemic patients have been reported. However, there are no reports of septic arthritis due to U. urealyticum following caesarean section or in the post-partum period. Case presentation A 38-year-old immunocompetent woman presented with severe right shoulder pain, 1 month following emergency caesarean section at 26 weeks of gestation for pre-eclampsia and spontaneous placental disruption with an uncomplicated post-operative recovery. Our suspicion of septic arthritis was confirmed with abundant pus following arthrotomy by a delto-pectoral approach. Awaiting culture results, empirical antibiotic treatment with intravenous amoxicilline and clavulanic acid was initiated. In spite of sterile cultures, clinical evolution was unfavorable with persistent pain, inflammation and purulent drainage, requiring two additional surgical débridement and lavage procedures. The 16S ribosomal RNA PCR of the purulent liquid was positive for U. urealyticum at 2.95 × 106 copies/ml, specific cultures inoculated a posteriori were positive for U. urealyticum. Levofloxacin and azithromycine antibiotherapy was initiated. Susceptibility testing showed an intermediate sensibility to ciprofloxacin and clarithromycin. The strain was susceptible to doxycycline. Following cessation of breastfeeding, we started antibiotic treatment with doxycycline for 4 weeks. The subsequent course was favorable with an excellent functional and biological outcome. Conclusions We report the first case of septic arthritis due to U. urealyticum after caesarean section. We hypothesize that the breach of the genital mucosal barrier during the caesarean section led to hematogenous spread resulting in purulent septic arthritis. The initial beta-lactam based antibiotic treatment, initiated for a purulent arthritis, did not provide coverage for cell wall deficient organisms. Detection of 16S rRNA allowed for a correct microbiological diagnosis in a patient with an unexpected clinical course.
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Affiliation(s)
- Jaad Mahlouly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Loic Lhopitallier
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Véronique Suttels
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Linda Mueller
- Institute of Microbiology, University of Lausanne, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Diane Wernly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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14
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Lannes X, Moerenhout K, Duong HP, Borens O, Steinmetz S. Outcomes of combined hip procedure with dual mobility cup versus osteosynthesis for acetabular fractures in elderly patients: a retrospective observational cohort study of fifty one patients. Int Orthop 2020; 44:2131-2138. [PMID: 32772320 PMCID: PMC7584544 DOI: 10.1007/s00264-020-04757-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Abstract
Purposes Acetabular fractures are more and more common in the elderly. Open reduction and internal fixation (ORIF) may lead to poor outcomes and high revision rates. Primary total hip arthroplasty (THA) combined with internal fixation, also known as the combined hip procedure (CHP), associated with dual mobility cup (DM-CHP) could be an efficient procedure in selected elderly patients. The aim of this study is to compare functional and radiological outcomes between ORIF and DM-CHP. Methods Between 2007 and 2018, 51 patients older than 65 years were surgically treated for acetabular fractures. Twenty-six patients were treated by DM-CHP and 25 by ORIF. Each group was divided into two subgroups regarding a single or combined approach. Hospital stay, surgical time, intraoperative blood loss, and complications were documented. The Harris Hip Score (HHS) was used for measuring the functional outcome. Radiological analysis was used to assess the centre of rotation in the DM-CHP group. Results Median surgery time and intra-operative blood loss were higher in DM-CHP than those in ORIF. Early medical complication rate was higher for a combined approach as compared with a single posterior approach in DM-CHP (p = 0.003). Dislocation rate was 7.7% in DM-CHP. Revision rate was higher in ORIF (20% versus 7.7%). HHS was similar in both groups. Conclusions DM-CHP leads to similar functional outcomes and less revision than ORIF. This study strengthens the practice of using only the posterior approach for primary THA in the elderly. Dual mobility is a valid therapeutic option for acetabular fractures in elderly patients.
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Affiliation(s)
- Xavier Lannes
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Kevin Moerenhout
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Hong Phuoc Duong
- Institute for Research in Rehabilitation, Clinique romande de réadaptation Sion, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Olivier Borens
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
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15
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Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J, Depypere M, Richards RG, Trampuz A, Verhofstad MHJ, Kates SL, Raschke M, McNally MA, Obremskey WT. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg 2020; 140:1013-1027. [PMID: 31659475 PMCID: PMC7351827 DOI: 10.1007/s00402-019-03287-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Indexed: 12/15/2022]
Abstract
Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients' short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group.Level of evidence: Level V.
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Affiliation(s)
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Olivier Borens
- Orthopedic Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - Geertje A M Govaert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Berlin Institute of Health, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, USA
| | - Michael Raschke
- Department of Trauma Surgery, University Hospital of Münster, Münster, Germany
| | - Martin A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - William T Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Zingg T, Piaget-Rossel R, Steppacher J, Carron PN, Dami F, Borens O, Albrecht R, Darioli V, Taffé P, Maudet L, Pasquier M. Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study. Sci Rep 2020; 10:5106. [PMID: 32198451 PMCID: PMC7083961 DOI: 10.1038/s41598-020-62027-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/06/2020] [Indexed: 11/20/2022] Open
Abstract
Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.
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Affiliation(s)
- Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
| | - Romain Piaget-Rossel
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Julie Steppacher
- School of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Fabrice Dami
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedics and Traumatology, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | | | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Patrick Taffé
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Ludovic Maudet
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
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17
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Abou-Khalil S, Steinmetz S, Mustaki L, Leger B, Thein E, Borens O. Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients. Eur J Orthop Surg Traumatol 2020; 30:877-884. [PMID: 32140838 DOI: 10.1007/s00590-020-02646-x] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. MATERIAL AND METHODS Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. RESULTS The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. CONCLUSION The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques.
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Affiliation(s)
- Sami Abou-Khalil
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Laurent Mustaki
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Leger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950, Sion, Switzerland
| | - Eric Thein
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Luthi F, Praz C, Léger B, Vouilloz A, Favre C, Loiret I, Paysant J, Martinet N, Lacraz A, Suva D, Lambert J, Borens O, Karatzios C, Vuistiner P. Cross-cultural adaptation and measurement properties of the French version of the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R). PLoS One 2020; 15:e0229084. [PMID: 32084223 PMCID: PMC7034834 DOI: 10.1371/journal.pone.0229084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) is a self-administered questionnaire to measure multidimensional adjustment to a prosthetic limb. Our aim was to assess the validity and reliability of the French version of the TAPES-R (TAPES-R-F). MATERIALS AND METHODS The cross-cultural adaptation was performed according to the recommendations. Factor analysis and Rasch analysis were also performed to allow comparison with the original English version. Construct validity was assessed by measuring the correlations between TAPES-R-F subscores and quality of life, pain, body image satisfaction, anxiety and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. RESULTS No major difficulties were encountered throughout the trans-cultural adaptation process. The final version of the TAPES-R-F was well accepted and understood by the patients. According to the factor analysis, the satisfaction scale should be treated as a one-dimensional construct when used by French-speaking people and should not be separated into two separate subscales, functional and aesthetic, as is the case in the original English version. Our study confirmed that there is a strong relationship between biopsychosocial factors and adjustment to amputation. Cronbach's α > 0.8 for all the subscales. Reliability was good to excellent for all the subscales (ICCs between 0.61 and 0.89). The smallest detectable changes were 0.7, 0.8, 1.3, 0.4, and 1.8 (general adjustment, social adjustment, adjustment to limitation, activity restriction, and global satisfaction with the prosthesis). CONCLUSIONS The TAPES-R-F is a valid and reliable instrument to assess multidimensional adjustment of French-speaking lower limb amputees. This questionnaire can be used for both clinical assessment and research purposes.
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Affiliation(s)
- François Luthi
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Sion, Switzerland
| | - Caroline Praz
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Aurélie Vouilloz
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Christine Favre
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Isabelle Loiret
- Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Nancy, France
| | - Jean Paysant
- Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Nancy, France
| | - Noel Martinet
- Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Nancy, France
| | - Alain Lacraz
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital (HUG), Genève, Switzerland
| | - Domizio Suva
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital (HUG), Genève, Switzerland
| | - Jean Lambert
- Department of Musculoskeletal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Christos Karatzios
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Sion, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
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Steinmetz S, Brügger A, Chauveau J, Chevalley F, Borens O, Thein E. Practical guidelines for the treatment of patellar fractures in adults. Swiss Med Wkly 2020; 150:w20165. [PMID: 31940427 DOI: 10.4414/smw.2020.20165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The role of the patella is paramount in the transmission of the quadriceps muscle forces, the increase of the lever arm, the distribution of the forces on the trochlea and the centring of the extensor apparatus. Despite the low incidence of patellar factures in comparison with other lower limb fractures, the painful and functional complications, such as knee stiffness, loss of extension and patellofemoral osteoarthritis, can be very disabling and will often compromise the return to a professional or recreational activity and induce falls in the elderly population. Treatment can be conservative or surgical, provided that it is adapted to the type of fracture. Undisplaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique. In most cases, hardware has to be removed after fracture healing because of implant-related pain. Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons. Failure to restore the articular surface contour results in posttraumatic arthritis. Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis. Typically, fracture classification and thus treatment choice are based on anteroposterior and lateral radiographs of the knee, but when computed tomography of the knee was performed pre-operatively, both the classification and treatment were modified thanks to a better understanding of the fracture complexity. The purpose of this article is to review current treatment strategies and optimise the management of adult patients with patellar fractures.
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Affiliation(s)
| | | | - Jules Chauveau
- Service de Traumatologie, Service OTR, CHUV, Lausanne, Switzerland
| | | | - Olivier Borens
- Service de Traumatologie, Service OTR, CHUV, Lausanne, Switzerland
| | - Eric Thein
- Service de Traumatologie, Service OTR, CHUV, Lausanne, Switzerland
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Goetti P, Gallusser N, Antoniadis A, Wernly D, Vauclair F, Borens O. Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty. World J Orthop 2019; 10:356-363. [PMID: 31754606 PMCID: PMC6854056 DOI: 10.5312/wjo.v10.i10.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/01/2019] [Revised: 09/03/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.
AIM To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.
METHODS We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.
RESULTS Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.
CONCLUSION Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.
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Affiliation(s)
- Patrick Goetti
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Nicolas Gallusser
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Alexander Antoniadis
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Diane Wernly
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Frédéric Vauclair
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Olivier Borens
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
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21
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Abstract
Background: There is a constant increase of joint arthroplasties to improve the quality of life of an ever-aging population. Although prosthetic-joint infections are rare, with an incidence of 1-2%, they represent a serious complication in terms of morbidity and mortality. Infection related mortality is known to be approaching 8% at one year. The aim of this retrospective study is to reassess the one and two-year mortality over the last ten years. Methods: Patients treated for prosthetic joint infection at the University Hospital of Lausanne (Switzerland) between 2006 and 2016 were included. The one and two-year cumulative mortality depending on sex, age, type of prosthesis, infecting organism and type of surgical treatment were computed. Results: 363 patients (60% hips, 40% knees) were identified with a median age of 70 years. The one-year cumulative mortality was 5.5% and it was 7.3% after two years. No difference was seen between hip and knee prostheses, but the mortality was higher in men than in women and increased with age. Furthermore, there was a significant difference depending of the germ with enterococci infections associated with a higher risk of death. Finally, patients treated with a one-stage or two-stage exchange had a lower mortality than those treated with debridement and retention. Conclusion: The mortality is still high and differs according to sex, age, infecting organism and type of surgical treatment. There is a need of studies to improve the management of patients at risk of increased mortality.
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Affiliation(s)
- Arnaud Fischbacher
- Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Olivier Borens
- Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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22
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Abdel MP, Akgün D, George A, Akinola B, Alencar P, Amanatullah DF, Babazadeh S, Borens O, Vicente Cabral RM, Cichos KH, Deirmengian C, de Steiger R, Ghanem E, Radtke Gonçalves JR, Goodman S, Hamlin B, Hwang K, Klatt BA, Lee GC, Manrique J, Moon AS, Ogedegbe F, Salib CG, Tian S, Winkler T. Erratum to "Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections" [The Journal of Arthroplasty 34 (2019) S361-S367]. J Arthroplasty 2019; 34:1863. [PMID: 31155458 DOI: 10.1016/j.arth.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abstract
Periprosthetic joint infection (PJI) is a serious complication occurring in 1% to 2% of primary arthroplasties, which is associated with high morbidity and need for complex interdisciplinary treatment strategies. The challenge in the management of PJI is the persistence of micro-organisms on the implant surface in the form of biofilm. Understanding this ability, the phases of biofilm formation, antimicrobial susceptibility and the limitations of host local immune response allows an individual choice of the most suitable treatment. By using diagnostic methods for biofilm detection such as sonication, the sensitivity for diagnosing PJI is increasing, especially in chronic infections caused by low-virulence pathogens. The use of biofilm-active antibiotics enables eradication of micro-organisms in the presence of a foreign body. The total duration of antibiotic treatment following revision surgery should not exceed 12 weeks.
Cite this article: EFORT Open Rev 2019;4:482-494. DOI: 10.1302/2058-5241.4.180092
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Affiliation(s)
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Corporate Member of Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
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24
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Abstract
Infection after fracture fixation is a feared complication in orthopaedic surgery leading to poor bone healing and loss of function.Early detection is essential and interdisciplinary care is mandatory.Eradication of infection is only possible through combined surgical and antibiotic treatment.Intraoperative tissue samples must be taken and are effective for guidance of the antibiotic regimen.Infection after fracture fixation is different from prosthetic joint infection (PJI) and needs a specific strategy.In this review, we define infection after fracture fixation, and outline the clinical, radiological and laboratory signs of these infections, as well as a treatment algorithm for optimal patient care. Cite this article: EFORT Open Rev 2019;4:468-475. DOI: 10.1302/2058-5241.4.180093.
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Affiliation(s)
- Sylvain Steinmetz
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Diane Wernly
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Kevin Moerenhout
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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Pasquier M, Taffé P, Hugli O, Borens O, Kirkham KR, Albrecht E. Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial. BMC Geriatr 2019; 19:180. [PMID: 31262265 PMCID: PMC6604210 DOI: 10.1186/s12877-019-1193-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/23/2019] [Indexed: 02/08/2023] Open
Abstract
Background Hip fracture causes moderate to severe pain and while fascia iliaca block has been reported to provide analgesic benefit, most previous trials were unblinded, with subsequent high risks of performance, selection and detection biases. In this randomized, control double-blind trial, we tested the hypothesis that a fascia iliaca block provides effective analgesia for patients suffering from hip fracture. Methods Thirty ASA I-III hip fracture patients over 70 years old, who received prehospital morphine, were randomized to receive either a fascia iliaca block using 30 ml of bupivacaine 0.5% with epinephrine 1:200,000 or a sham injection with normal saline. The fascia iliaca block was administered by emergency medicine physicians trained to perform an anatomic landmark-based technique. The primary outcome was the comparison between groups of the longitudinal pain score profiles at rest over the first 45 min following the procedure (numeric rating scale, 0–10). Secondary outcomes included the longitudinal pain score profiles on movement and the comparison over 4 h, 8 h, 12 h, and 24 h after the procedure, along with cumulative intravenous morphine consumption at 24 h. Results At baseline, the fascia iliaca group had a lower mean pain score than the sham injection group, both at rest (difference = − 0.9, 95%CI [− 2.4, 0.5]) and on movement (difference = − 0.9, 95%CI [− 2.7; 0.9]). These differences remained 45 min after the procedure and the two longitudinal pain score profiles were parallel both for patients at rest and on movement (test of parallelism for patients at rest p = 0.53 and on movement p = 0.45). The same parallel change in pain scores over time was observed over 24 h of follow-up (test of parallelism for patients at rest p = 0.82 and on movement p = 0.12). These results were confirmed after adjustment for gender, ASA score, and cumulative sums of intravenous morphine received pre-procedure and during-follow-up. In addition, there was no difference between the two groups in total cumulative intravenous morphine consumption at 24 h. Conclusion Fascia iliaca block following anatomic landmarks may not provide supplementary analgesia for patients suffering from hip fracture, when low pain scores are reported after prehospital morphine. Additional larger trials will help reach definitive conclusion. Trial registration number Clinicaltrials.gov – NCT02433548. The study was registered retrospectively.
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Affiliation(s)
- Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Taffé
- Statistician, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Hugli
- Department of Emergency Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedic surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Eric Albrecht
- Department of Anaesthesia, Lausanne University Hospital, Rue du Bugnon 46, BH 05.311, 1011, Lausanne, Switzerland.
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26
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Sconfienza LM, Signore A, Cassar-Pullicino V, Cataldo MA, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Vanhoenacker FMHM, Jutte PC, Glaudemans AWJM. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol 2019; 29:6425-6438. [PMID: 31250170 DOI: 10.1007/s00330-019-06326-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/07/2019] [Revised: 05/27/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement). METHODS AND RESULTS After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging. CONCLUSIONS Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics. KEY POINTS • For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities. • Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel. • Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Victor Cassar-Pullicino
- Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire, UK
| | - Maria Adriana Cataldo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Septic surgical unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Nicola Petrosillo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Filip M H M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.,AZ Sint-Maarten, Belgium, Mechelen, Belgium.,University of Ghent, Ghent, Belgium
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Vautrin M, Moerenhout K, Udin G, Borens O. Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review. J Bone Jt Infect 2019; 4:65-71. [PMID: 31011510 PMCID: PMC6470652 DOI: 10.7150/jbji.30613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/12/2018] [Accepted: 01/26/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt. Methods Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those “sterility mistake” situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope. Results When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: ”putting a definitive PE one size smaller or bigger with balance adjustment” (31%); and “leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives” (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error. Conclusions There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.
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Affiliation(s)
- Matthias Vautrin
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Kevin Moerenhout
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Gilles Udin
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Olivier Borens
- Orthopaedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne. University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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28
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Signore A, Sconfienza LM, Borens O, Glaudemans AWJM, Cassar-Pullicino VN, Trampuz A, Winkler H, Gheysens O, Vanhoenacker FMHM, Petrosillo N, Jutte PC. Correction to: Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46:1203. [PMID: 30737519 DOI: 10.1007/s00259-019-04281-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors regret to inform the readers that one of the author's name in the original publication of this article was spelled incorrectly as Victor Casar-Pullicino. The correct spelling is Victor N. Cassar-Pullicino and is now presented correctly in this article.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy. .,Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Victor N Cassar-Pullicino
- Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital - Oswestry, Shropshire, UK
| | - Andrej Trampuz
- Department of Internal Medicine, University Hospital "Charitè", Berlin, Germany
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Olivier Gheysens
- Department of Nuclear Medicine, University Hospital Leuven, Leuven, Belgium
| | - Filip M H M Vanhoenacker
- Department of Radiology, University Hospital Antwerp, AZ Sint-Maarten Duffel-Mechelen, and University of Ghent, Edegem, Belgium
| | - Nicola Petrosillo
- Division of Infective Diseases, National Institute for Infective Diseases "L. Spallanzani", Rome, Italy
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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29
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Brouze IF, Steinmetz S, McManus J, Borens O. Well leg compartment syndrome in trauma surgery - femoral shaft fracture treated by femoral intramedullary nailing in the hemilithotomy position: case series and review of the literature. Ther Clin Risk Manag 2019; 15:241-250. [PMID: 30799923 PMCID: PMC6371926 DOI: 10.2147/tcrm.s177530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Well leg compartment syndrome (WLCS) is a rare complication which can occur following urological, gynecological, general surgical or orthopedic surgeries carried out with the lower limb in the hemilithotomy position. WLCS is associated with significant morbidity and mortality because delay in diagnosis and treatment can lead to loss of function and even life-threatening complications. During orthopedic surgeries on a traction table, such as femoral nailing, the contralateral “well leg” is often placed in the hemilithotomy position, thus facilitating the use of fluoroscopy. This position (also named the Lloyd-Davis position) consists of hip flexion, abduction, external rotation and knee flexion. We present the cases of two teenaged patients who underwent femoral nailing on an extension table of a femoral fracture and developed WLCS. We also present a review of the literature and a discussion of the pathophysiology, risk factors and treatment of this condition. Clinicians need to be aware of the risk factors for WLCS and have high index of suspicion. Further studies looking at the risks, benefits and feasibility of ways to reduce this risk are required.
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Affiliation(s)
- Iris F Brouze
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - Sylvain Steinmetz
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - John McManus
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
| | - Olivier Borens
- Orthopedics and Traumatology Service, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,
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30
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Abdel MP, Akgün D, Akin G, Akinola B, Alencar P, Amanatullah DF, Babazadeh S, Borens O, Vicente Cabral RM, Cichos KH, Deirmengian C, de Steiger R, Ghanem E, Radtke Gonçalves JR, Goodman S, Hamlin B, Hwang K, Klatt BA, Lee GC, Manrique J, Moon AS, Ogedegbe F, Salib CG, Tian S, Winkler T. Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S361-S367. [PMID: 30343972 DOI: 10.1016/j.arth.2018.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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31
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Vautrin M, Kaminski G, Barimani B, Elmers J, Philippe V, Cherix S, Thein E, Borens O, Vauclair F. Does candidate for plate fixation selection improve the functional outcome after midshaft clavicle fracture? A systematic review of 1348 patients. Shoulder Elbow 2019; 11:9-16. [PMID: 30719093 PMCID: PMC6348584 DOI: 10.1177/1758573218777996] [Citation(s) in RCA: 5] [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: 10/31/2017] [Accepted: 04/25/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate versus conservative) would give better functional outcome than random treatment allocation. METHODS We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included. RESULTS Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial). DISCUSSION This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.
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Affiliation(s)
- M Vautrin
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland,M Vautrin, Centre Hospitalier Universitaire
Vaudois, BH 10-40, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - G Kaminski
- UMR 5263, Laboratoire CLLE-LTC,
Toulouse, France
| | - B Barimani
- Faculty of Medicine, Imperial College
London, London, UK,Division of Orthopedic Surgery,
Department of Surgery, McGill University, Montreal, Canada
| | - J Elmers
- Faculty of Biology and Medicine Library,
Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - V Philippe
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland
| | - S Cherix
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland
| | - E Thein
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland
| | - O Borens
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland
| | - F Vauclair
- Orthopedic Trauma Surgery Unit,
Department of the Locomotor Apparatus, Lausanne University Hospital, University of
Lausanne, Lausanne, Switzerland
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Glaudemans AWJM, Jutte PC, Cataldo MA, Cassar-Pullicino V, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Signore A, Sconfienza LM. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46:957-970. [PMID: 30675635 PMCID: PMC6450853 DOI: 10.1007/s00259-019-4262-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 01/15/2023]
Abstract
Introduction In adults with a suspicion of peripheral bone infection, evidence-based guidelines in choosing the most accurate diagnostic strategy are lacking. Aim and methods To provide an evidence-based, multidisciplinary consensus document on the diagnostic management of adult patients with PBIs, we performed a systematic review of relevant infectious, microbiological, orthopedic, radiological, and nuclear medicine literature. Delegates from four European societies (European Bone and Joint Infection Society, European Society of Microbiology and Infectious Diseases, European Society or Radiology, and European Association of Nuclear Medicine) defined clinical questions to be addressed, thoroughly reviewed the literature pertinent to each of the questions, and thereby evaluated the diagnostic accuracy of each diagnostic technique. Inclusion of the papers per statement was based on a PICO (Population/problem – Intervention/indicator – Comparator – Outcome) question following the strategy reported by the Oxford Centre for Evidence-based Medicine. For each statement, the level of evidence was graded according to the 2011 review of the Oxford Centre for Evidence-based Medicine. All approved statements were addressed taking into consideration the available diagnostic procedures, patient acceptance, tolerability, complications, and costs in Europe. Finally, a commonly agreed-upon diagnostic flowchart was developed. Electronic supplementary material The online version of this article (10.1007/s00259-019-4262-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Adriana Cataldo
- Clinical and Research Department on of Infectious Diseases, "L. Spallanzani", IRCCS-Rome, Rome, Italy
| | - Victor Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, Shropshire, UK
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Muskuloskeletal Surgery, Charité - Universitätsmedicin Berlin, Berlin, Germany
| | - Klaus Wörtler
- 69 Division Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicola Petrosillo
- Clinical and Research Department on of Infectious Diseases, "L. Spallanzani", IRCCS-Rome, Rome, Italy
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Steinmetz S, Goetti P, Mustaki L, Mariaux S, Borens O, Vauclair F. [Olecranon fractures]. Rev Med Suisse 2018; 14:2264-2267. [PMID: 30550023] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Olecranon fractures represent 5 % of all adult fractures. Management is most often surgical. Conservative treatment is recommended for non-displaced fractures or patients who would be poor surgical candidates. Prolonged immobilization of the elbow may cause joint stiffness, whereas surgical treatment can be complicated by loss of reduction or wound issues with secondary infection of the material. In this article, we discuss the pathology and the principles of treatment based on the literature, to allow the general practitioner to guide the patient towards the most suitable treatment.
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Affiliation(s)
- Sylvain Steinmetz
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Patrick Goetti
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Laurent Mustaki
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Sandrine Mariaux
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Olivier Borens
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Frédéric Vauclair
- Service de chirurgie orthopédique et traumatologique, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
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34
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Wernly D, Steinmetz S, Cherix S, Borens O. [Hypersensitivity to metal : myth or reality ?]. Rev Med Suisse 2018; 14:2243-2247. [PMID: 30550019] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
So-called metal allergy is a new interesting subject in orthopedics. Two different ways of thinking prevail in the literature. In the German orthopaedic literature, the diagnosis of metal allergy is often described and considered a real pathology, while we can find a more skeptical approach to this entity in Anglo-Saxons literature. Being an exclusion diagnostic, without any universal consensus on how to diagnose or on the treatment, the aim of this article is to clarify what we know about metal allergy today.
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Affiliation(s)
- Diane Wernly
- Service d'orthopédie et traumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Sylvain Steinmetz
- Service d'orthopédie et traumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Stéphane Cherix
- Service d'orthopédie et traumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Olivier Borens
- Service d'orthopédie et traumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
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Fischbacher A, Peltier K, Borens O. Economic Analysis in a Diagnosis Related Groups System for Two-stage Exchange of Prosthetic-joint Infections. J Bone Jt Infect 2018; 3:249-254. [PMID: 30533346 PMCID: PMC6284098 DOI: 10.7150/jbji.26146] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background: There is a constant increase of joint arthroplasties performed, with an infectious risk of 1-2%. Different therapeutic options for prosthetic-joint infections exist, but surgery remains essential. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective. Methods: 21 patients who have undergone a two-stage exchange of a hip or knee prosthetic-joint infection at the University Hospital of Lausanne (Switzerland) from 2012 to 2013 were included. The revenues earned according to the Swiss Diagnosis Related Groups (SwissDRG) system introduced in 2012 and the costs were compared for each hospital stay. Results: The remuneration ranged from 26'806 to 42'978 Swiss francs (CHF) (~ 22'905-36'723 EUR, median 36'338 CHF, ~ 31'049 EUR). The median total cost per patient was 76'000 CHF (~ 65'000 EUR) (51'151 to 118'263; hip median 79'744, knee median 66'708). The main determinant of the costs was the length of the hospital stay. Revenues never covered all the costs, even with a short-interval procedure. The hospital lost a median of 35'000 CHF per patient (~ 30'000 EUR) (22'280 to 64'666). Conclusion: The current DRG system may not be specific enough for rewarding prosthetic-joint infections. Several options could be considered to act on the length of the hospital stay. In order to cover costs in complicated cases, such as prosthetic-joint infections, more specific DRGs are needed.
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Affiliation(s)
- Arnaud Fischbacher
- Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Karine Peltier
- Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Olivier Borens
- Centre hospitalier universitaire vaudois (CHUV), Service d'orthopédie et de traumatologie, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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36
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Sapino G, Zaugg P, Cherix S, Borens O, Lo SJ, Raffoul W, di Summa PG. ALT flap with vascularized fascia lata for one-stage functional patellar tendon reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:467-476. [PMID: 30579912 DOI: 10.1016/j.bjps.2018.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/22/2018] [Revised: 09/18/2018] [Accepted: 11/03/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Composite anterolateral thigh (ALT) flap with vascularized fascia lata can reconstitute patellar tendon integrity and knee soft tissue coverage in one stage. However, long-term evidence of outcomes is lacking. This work analyzes long-term functional results, compares subtotal and total reconstruction of patellar tendon, and assesses the respective function of the extensor apparatus. PATIENTS AND METHODS Outcomes of reconstruction using 10 ALT flaps in 9 patients (age range 21-87 years) were analyzed (mean follow-up 30 ± 6 months). Knee Society Scores, isometric knee extensor strength (M1-M5), and sensory recovery were evaluated, together with active range of motion and extensor lag of the reconstructed limb, compared to contralateral. RESULTS Ten flaps were used for tendon replacement in 9 patients. Eight (80%) free flaps and 2 (20%) propeller distally based flaps were used. Complications requiring the harvest of a second flap were seen in 2 patients. All patients could return to their daily activities without the use of walking supports. Mean active ROM was 94.4° with an extensor lag of 9.4°, without a significant difference between partial and total patellar tendon reconstruction. The mean knee and functional scores of the Knee Society were 81/100 and 77/100, respectively. CONCLUSION Composite ALT flap with fascia lata can satisfy the twofold needs of functional restoration and soft tissue coverage, thus ensuring stable results in total and subtotal knee extensor mechanism reconstruction. Distally based flaps should be carefully considered, as they lead to higher complication rates.
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Affiliation(s)
- G Sapino
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland; Department of Plastic and Reconstructive Surgery, Policlinico Universitario di Modena, Modena, IT, Italy
| | - P Zaugg
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - S Cherix
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - O Borens
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - S J Lo
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - W Raffoul
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - P G di Summa
- Department of Plastic and Reconstructive Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland; Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK.
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Abstract
INTRODUCTION Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. METHOD We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections. RESULTS Of the 796 patients in the PA group, there were 6 wound complications leading to reoperation and 6 infections; 4 early and 2 delayed onset. Among the infected cases, one was obese (body mass index [BMI] >30 kg/m2). Two procedures were teaching-based. Of the 399 patients in the DAA group, there were three dehiscences leading to reoperation, two of which were in obese patients. 6 infections were also found; 4 with early and 2 with delayed onset. Of the infected cases, three were obese. 4 procedures were teaching-based. CONCLUSION In our series of patients undergoing THA, the DAA did not increase the rates of either wound complications leading to reoperation nor early or delayed infection compared to the PA.
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Affiliation(s)
- Christophe Tissot
- 1 Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Vautrin
- 1 Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Anais Luyet
- 2 Department of Orthopaedics and Traumatology, Ensemble Hospitalier du Nord Vaudois, Yverdon Hospital, Yverdon, Switzerland
| | - Olivier Borens
- 1 Department of Orthopaedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
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38
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Grolimund Berset D, Guex E, Valentinuzzi N, Borens O, Wild P, Coti Bertrand P. Improving nutritional care quality in the orthopedic ward of a Septic Surgery Center by implementing a preventive nutritional policy using the Nutritional Risk Score: a pilot study. Eur J Clin Nutr 2018; 73:276-283. [PMID: 30337712 DOI: 10.1038/s41430-018-0345-1] [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] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/12/2018] [Accepted: 09/30/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Septic Surgery Center (SSC) patients are at a particularly high risk of protein-energy malnutrition (PEM), with a prevalence of 35-85% found in various studies. Previous collaboration between our hospital's SSC and its Clinical Nutrition Team (CNT) only focussed on patients with severe PEM. This study aimed to determine whether it was possible to improve the quality of nutritional care in septic surgery patients with help of a nutritional policy using the Nutritional Risk Score (NRS). SUBJECTS/METHODS Nutritional practices in the SSC were observed over three separate periods: in the 3 months leading up to the implementation baseline, 6 months after implementation of preventive nutritional practices, and at 3 years. The nutritional care quality indicator was the percentage of patients whose nutritional care, as prescribed by the SSC, was adapted to their specific requirements. We determined the septic surgery team's NRS completion rate and calculated the nutritional policy's impact on SSC length of stay. Data before (T0) and after (T1 + T2) implementation of the nutritional policy were compared. RESULTS Ninety-eight patients were included. The nutritional care-quality indicator improved from 26 to 81% between T0 and T2. During the T1 and T2 audits, septic surgery nurses calculated NRS for 100% and 97% of patients, respectively. Excluding patients with severe PEM, SSC length of stay was significantly reduced by 23 days (p = 0.005). CONCLUSIONS These findings showed that implementing a nutritional policy in an SSC is possible with the help of an algorithm including an easy-to-use tool like the NRS.
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Affiliation(s)
| | - Esther Guex
- Clinical Nutrition, Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Valentinuzzi
- Septic Surgery Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Borens
- Septic Surgery Center, Lausanne University Hospital, Lausanne, Switzerland.,Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Wild
- Institute for Work and Health, University of Lausanne and Geneva, Lausanne, Switzerland
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Vouilloz A, Favre C, Luthi F, Loiret I, Paysant J, Martinet N, Lacraz A, Suva D, Lambert J, Borens O, Vuistiner P. Cross-cultural adaptation and validation of the ABIS questionnaire for French speaking amputees. Disabil Rehabil 2018; 42:730-736. [PMID: 30278793 DOI: 10.1080/09638288.2018.1506511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F).Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability.Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach's α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was -3.90 with limits of agreement from -18.71 to 10.92. For ABIS-R-F, the mean difference was -2.12 with limits of agreement from -8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F).Conclusions: The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible.Implications for rehabilitationThe quality of life of amputees is impacted by their satisfaction with body imageThe Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputeesThe Standard Errors of Measurement proposed could be useful for clinical and research purposesBoth ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliabilityThe shortened version has a better response structure and is more readily feasible.
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Affiliation(s)
| | | | - François Luthi
- Clinique Romande de Réadaptation, Sion, Switzerland.,Institute for Research in Rehabilitation, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Jean Paysant
- Institut Régional de Réadaptation, Nancy, France
| | | | - Alain Lacraz
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital (HUG), Genève, Switzerland
| | - Domizio Suva
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital (HUG), Genève, Switzerland
| | - Jean Lambert
- Department of Musculoskeletal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Vuistiner
- Clinique Romande de Réadaptation, Sion, Switzerland.,Institute for Research in Rehabilitation, Sion, Switzerland
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Mariaux S, Furustrand Tafin U, Borens O. Diagnosis of Persistent Infection in Prosthetic Two-Stage Exchange: Evaluation of the Effect of Sonication on Antibiotic Release from Bone Cement Spacers. J Bone Jt Infect 2018; 3:37-42. [PMID: 29545994 PMCID: PMC5852846 DOI: 10.7150/jbji.23668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/05/2017] [Accepted: 01/31/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction: When treating periprosthetic joint infection with a two-stage procedure, antibiotic-impregnated spacers can be used in the interval between prosthetic removal and reimplantation. In our experience, cultures of sonicated spacers are most often negative. The objective of the study was to assess whether that sonication causes an elution of antibiotics, leading to elevated antibiotic concentrations in the sonication fluid inhibiting bacterial growth and thus causing false-negative cultures. Methods: A prospective monocentric study was performed from September 2014 to March 2016. Inclusion criteria were a two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Spacers were made of gentamicin-containing cement to which tobramycin and vancomycin were added. Antibiotic concentrations in the sonication fluid were determined by mass-spectometry (LC-MS). Results: 30 patients were identified (15 hip and 14 knee and 1 ankle arthroplasties). No cases of culture positive sonicated spacer fluid were observed in our serie. In the sonication fluid median concentrations of 13.2µg/ml, 392 µg/ml and 16.6 µg/ml were detected for vancomycin, tobramycin and gentamicin, respectively. According to the European Committee on antimicrobial susceptibility testing (EUCAST), these concentrations released from cement spacer during sonication are higher than the minimal inhibitory concentrations (MICs) for most bacteria relevant in prosthetic joint infections. Conclusion:Spacer sonication cultures remained sterile in all of our cases. Elevated concentrations of antibiotics released during sonication could explain partly negative-cultured sonicated spacers. Indeed, the absence of antibiotic free interval during the two-stages can also contribute to false-negative spacers sonicated cultures.
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Affiliation(s)
- Sandrine Mariaux
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Ulrika Furustrand Tafin
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
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Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad MHJ, Borens O, Kates S, Morgenstern M. Infection after fracture fixation: Current surgical and microbiological concepts. Injury 2018; 49:511-522. [PMID: 27639601 DOI: 10.1016/j.injury.2016.09.019] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [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: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 02/02/2023]
Abstract
One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF. Although IAFF shares many similarities with PJI, there are numerous critical differences in many facets including prevention, diagnosis and treatment. Admittedly, extrapolating data from PJI research to IAFF has been of value to the trauma surgeon, but we should also be aware of the unique challenges posed by IAFF that may not be accounted for in the PJI literature. This review summarizes the clinical approaches towards the diagnosis and treatment of IAFF with an emphasis on the unique aspects of fracture care that distinguish IAFF from PJI. Finally, recent developments in anti-infective technologies that may be particularly suitable or applicable for trauma patients in the future will be briefly discussed.
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Affiliation(s)
- W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
| | - R Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | | | | | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands, The Netherlands
| | - O Borens
- Orthopedic Septic Surgical Unit, Department of the Locomotor Apparatus and Department of Surgery and Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - S Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, USA
| | - M Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital of Basel, Switzerland
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Metsemakers WJ, Kortram K, Morgenstern M, Moriarty TF, Meex I, Kuehl R, Nijs S, Richards RG, Raschke M, Borens O, Kates SL, Zalavras C, Giannoudis PV, Verhofstad MHJ. Definition of infection after fracture fixation: A systematic review of randomized controlled trials to evaluate current practice. Injury 2018; 49:497-504. [PMID: 28245906 DOI: 10.1016/j.injury.2017.02.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 11/19/2016] [Revised: 02/08/2017] [Accepted: 02/17/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION One of the most challenging musculoskeletal complications in modern trauma surgery is infection after fracture fixation (IAFF). Although infections are clinically obvious in many cases, a clear definition of the term IAFF is crucial, not only for the evaluation of published research data but also for the establishment of uniform treatment concepts. The aim of this systematic review was to identify the definitions used in the scientific literature to describe infectious complications after internal fixation of fractures. The hypothesis of this study was that the majority of fracture-related literature do not define IAFF. MATERIAL AND METHODS A comprehensive search was performed in Embase, Cochrane, Google Scholar, Medline (OvidSP), PubMed publisher and Web-of-Science for randomized controlled trials (RCTs) on fracture fixation. Data were collected on the definition of infectious complications after fracture fixation used in each study. Study selection was accomplished through two phases. During the first phase, titles and abstracts were reviewed for relevance, and the full texts of relevant articles were obtained. During the second phase, full-text articles were reviewed. All definitions were literally extracted and collected in a database. Then, a classification was designed to rate the quality of the description of IAFF. RESULTS A total of 100 RCT's were identified in the search. Of 100 studies, only two (2%) cited a validated definition to describe IAFF. In 28 (28%) RCTs, the authors used a self-designed definition. In the other 70 RCTs, (70%) there was no description of a definition in the Methods section, although all of the articles described infections as an outcome parameter in the Results section. CONCLUSION This systematic review shows that IAFF is not defined in a large majority of the fracture-related literature. To our knowledge, this is the first study conducted with the objective to explore this important issue. The lack of a consensus definition remains a problem in current orthopedic trauma research and treatment and this void should be addressed in the near future.
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Affiliation(s)
- W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
| | - K Kortram
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital of Basel, Switzerland
| | | | - I Meex
- Department of Trauma Surgery, University Hospitals Leuven, Belgium
| | - R Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | - S Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Belgium
| | | | - M Raschke
- Department of Orthopaedic and Trauma Surgery, University Hospital of Münster, Germany
| | - O Borens
- Orthopedic Septic Surgical Unit, Department of the Locomotor Apparatus and Department of Surgery and Anaesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - S L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, USA
| | - C Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - P V Giannoudis
- Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, United Kingdom and NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, Athanasou NA, Ochsner PE, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates SL, Zalavras C, Giannoudis PV, Richards RG, Verhofstad MHJ. Fracture-related infection: A consensus on definition from an international expert group. Injury 2018; 49:505-510. [PMID: 28867644 DOI: 10.1016/j.injury.2017.08.040] [Citation(s) in RCA: 376] [Impact Index Per Article: 62.7] [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: 05/02/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 02/02/2023]
Abstract
Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.
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Affiliation(s)
- W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium; KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium.
| | - M Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland
| | - M A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - I McFadyen
- Department of Orthopaedic Surgery, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
| | - M Scarborough
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - N A Athanasou
- Department of Osteoarticular Pathology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, United Kingdom
| | | | - R Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | - M Raschke
- Department of Trauma and Reconstructive Surgery, University Hospital of Münster, Germany
| | - O Borens
- Orthopedic Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - Z Xie
- Department of Orthopaedic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - S Velkes
- Department of Orthopedic and Trauma Surgery, Rabin Medical Center, University of Tel Aviv Medical School, Israel
| | - S Hungerer
- Department of Joint Surgery, Trauma Center Murnau, Germany and Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - S L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, USA
| | - C Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - P V Giannoudis
- Department of Trauma and Orthopaedic Surgery, University Hospital of Leeds, United Kingdom; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | | | - M H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Morgenstern M, Moriarty TF, Kuehl R, Richards RG, McNally MA, Verhofstad MHJ, Borens O, Zalavras C, Raschke M, Kates SL, Metsemakers WJ. International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection. Injury 2018; 49:491-496. [PMID: 29433799 DOI: 10.1016/j.injury.2018.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 10/30/2017] [Accepted: 02/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI. METHODS An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland). RESULTS Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI. CONCLUSION This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI.
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Affiliation(s)
- M Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland
| | | | - R Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Switzerland
| | | | - M A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - O Borens
- Department of Septic Surgery, Orthopaedic-Trauma Unit, Department for the Musculoskeletal System, CHUV, Lausanne, Switzerland
| | - C Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - M Raschke
- Department of Orthopaedic and Trauma Surgery, University Hospital of Münster, Germany
| | - S L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, USA
| | - W J Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Belgium.
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Abstract
BACKGROUND Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches. MATERIAL AND METHODS The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature. RESULTS With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible. DISCUSSION With adequate local wound débridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.
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Affiliation(s)
- O Borens
- Abteilung für Traumatologie und Abteilung für Septische Chirurgie, Klinik für Orthopaedie und Traumtologie, Universitätsspital Lausanne - CHUV, Universität Lausanne, Rue du Bugnon 46, 1011, Lausanne, Schweiz.
| | - N Helmy
- Abteilung für Orthopaedie und Traumtologie des Bewegungsapparates, Bürgerspital Solothurn, Solothurn, Schweiz
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Mariaux S, Tafin UF, Borens O. Diagnosis Of Persistent Infection In Prosthetic Two-Stage Exchange: PCR analysis of Sonication fluid From Bone Cement Spacers. J Bone Jt Infect 2017; 2:218-223. [PMID: 29188174 PMCID: PMC5704004 DOI: 10.7150/jbji.23078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/28/2017] [Accepted: 10/26/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction: When treating periprosthetic joint infections with a two-stage procedure, antibiotic-impregnated spacers are used in the interval between removal of prosthesis and reimplantation. According to our experience, cultures of sonicated spacers are most often negative. The objective of our study was to investigate whether PCR analysis would improve the detection of bacteria in the spacer sonication fluid. Methods: A prospective monocentric study was performed from September 2014 to January 2016. Inclusion criteria were two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Beside tissues samples and sonication, broad range bacterial PCRs, specific S. aureus PCRs and Unyvero-multiplex PCRs were performed on the sonicated spacer fluid. Results: 30 patients were identified (15 hip, 14 knee and 1 ankle replacements). At reimplantation, cultures of tissue samples and spacer sonication fluid were all negative. Broad range PCRs were all negative. Specific S. aureus PCRs were positive in 5 cases. We had two persistent infections and four cases of infection recurrence were observed, with bacteria different than for the initial infection in three cases. Conclusion: The three different types of PCRs did not detect any bacteria in spacer sonication fluid that was culture-negative. In our study, PCR did not improve the bacterial detection and did not help to predict whether the patient will present a persistent or recurrent infection. Prosthetic 2-stage exchange with short interval and antibiotic-impregnated spacer is an efficient treatment to eradicate infection as both culture- and molecular-based methods were unable to detect bacteria in spacer sonication fluid after reimplantation.
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Affiliation(s)
- Sandrine Mariaux
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Ulrika Furustrand Tafin
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
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Kummer A, Tafin UF, Borens O. Effect of Sonication on the Elution of Antibiotics from Polymethyl Methacrylate (PMMA). J Bone Jt Infect 2017; 2:208-212. [PMID: 29188172 PMCID: PMC5704002 DOI: 10.7150/jbji.22443] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/19/2017] [Accepted: 10/11/2017] [Indexed: 11/12/2022] Open
Abstract
Background: In the setting of prosthetic joint infections treated with a two-stage procedure, spacers can be sonicated after removal. We hypothesize that the sonication process may cause an increased elution of antibiotics from the spacer, leading to elevated concentrations of antibiotics in the sonication fluid inhibiting bacterial growth. We aimed to evaluate in vitro the influence of sonication on the elution of antibiotics from polymethyl methacrylate (PMMA) over time and to determine whether these concentrations are above the minimum inhibitory concentrations (MIC) for microorganisms relevant in prosthetic joint infections. Methods: PMMA blocks impregnated with vancomycin, fosfomycin, gentamicin or daptomycin were incubated in phosphate-buffered saline (PBS) at 37°C for up to 6 weeks. PBS was changed once a week. Concentrations were determined from samples of each antibiotic every week, and after 5 minutes of sonication at 2, 4 and 6 weeks. Results: With sonication there was a trend toward an increase of the elution of antibiotics. This increase was significant for vancomycin at 2 and 4 weeks (p=0.008 and 0.002 respectively) and for fosfomycin at 2 weeks (p=0.01). Conclusion: The effect of sonication could play a role in clinical results, especially for daptomycin and gentamicin for which the MIC is close to the concentration of antibiotics at 4 and 6 weeks. We conclude that elution of antibiotics from PMMA along with the effect of sonication could inhibit bacterial growth from spacers, resulting in false negative results in the setting of two-stage exchange procedures for prosthetic joint infections.
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Affiliation(s)
- Anne Kummer
- University Hospital Lausanne (CHUV), Service of Orthopedics and Traumatology, University of Lausanne, Lausanne, Switzerland
| | - Ulrika Furustrand Tafin
- University Hospital Lausanne (CHUV), Service of Orthopedics and Traumatology, University of Lausanne, Lausanne, Switzerland
| | - Olivier Borens
- University Hospital Lausanne (CHUV), Service of Orthopedics and Traumatology, University of Lausanne, Lausanne, Switzerland
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Agri F, Bourgeat M, Becce F, Moerenhout K, Pasquier M, Borens O, Yersin B, Demartines N, Zingg T. Association of pelvic fracture patterns, pelvic binder use and arterial angio-embolization with transfusion requirements and mortality rates; a 7-year retrospective cohort study. BMC Surg 2017; 17:104. [PMID: 29121893 PMCID: PMC5680776 DOI: 10.1186/s12893-017-0299-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures. Methods Single-center retrospective cohort study including all consecutive patients with a pelvic fracture from January 2008 to June 2015. All radiological fracture patterns were independently reviewed and grouped according to the Tile classification system. Data on patient demographics, use of pelvic binders and arterial angio-embolization, transfusion requirements and mortality were extracted from the institutional trauma registry and analyzed. Results The present study included 228 patients. Median patient age was 43.5 years and 68.9% were male. The two independent observers identified 105 Tile C (46.1%), 71 Tile B (31.1%) and 52 Tile A (22.8%) fractures, with substantial to almost perfect interobserver agreement (Kappa 0.70-0.83). Tile C fractures were associated with a higher mortality rate (p = 0.001) and higher transfusion requirements (p < 0.0001) than Tile A or B fractures. Arterial angio-embolization for pelvic bleeding (p = 0.05) and prehospital pelvic binder placement (p = 0.5) were not associated with differences in mortality rates. Conclusions Tile C pelvic fractures are associated with higher transfusion requirements and a higher mortality rate than Tile A or B fractures. No association between the use of pelvic binders or arterial angio-embolization and survival was observed in this cohort of patients with pelvic fractures.
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Affiliation(s)
- Fabio Agri
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Mylène Bourgeat
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Kevin Moerenhout
- Department of Orthopedic Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedic Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Department of Emergency Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Lacraz A, Armand S, Turcot K, Carmona G, Stern R, Borens O, Assal M. Comparison of the Otto Bock solid ankle cushion heel foot with wooden keel to the low-cost CR-Equipements ™ solid ankle cushion heel foot with polypropylene keel: A randomized prospective double-blind crossover study assessing patient satisfaction and energy expenditure. Prosthet Orthot Int 2017; 41:258-265. [PMID: 27881551 DOI: 10.1177/0309364616677649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND The International Committee of the Red Cross supports a worldwide program of prosthetic fitting and rehabilitation. In this context, a prosthetic foot was developed and widely distributed in least developed countries. STUDY DESIGN Prospective, randomized, double-blind, controlled study. OBJECTIVE To compare patient satisfaction and energy expenditure during ambulation between a low-cost prosthetic foot designed with a polypropylene keel (CR-Equipements™ solid ankle cushion heel, International Committee of the Red Cross) to a well-recognized solid ankle cushion heel foot with a wooden keel (solid ankle cushion heel foot, Otto Bock). METHODS A total of 15 participants with unilateral transtibial amputation were evaluated using the two prosthetic feet in a randomized prospective double-blind crossover study. Main outcomes were patient satisfaction questionnaires (Satisfaction with Prosthesis Questionnaire and prosthetic foot satisfaction) and energy expenditure (oxygen consumption-mL/kg/min, oxygen cost-mL/kg/m, and heart rate-bpm). RESULTS There were no significant differences between the two prosthetic feet for satisfaction and energy expenditure. CONCLUSION The low-cost solid ankle cushion heel foot with polypropylene keel provides comparable satisfaction and similar energy expenditure as the solid ankle cushion heel foot with wooden keel. Clinical relevance The results of this study support the application and widespread use of the CR-Equipements™ solid ankle cushion heel foot. From a cost-effectiveness standpoint, patients are well satisfied and exhibit similar outcomes at a substantially lower cost.
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Affiliation(s)
- Alain Lacraz
- 1 University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- 1 University Hospitals of Geneva, Geneva, Switzerland.,3 University of Geneva, Geneva, Switzerland
| | - Katia Turcot
- 2 Faculty of Medicine, Laval University, Laval, QC, Canada
| | - Gorki Carmona
- 1 University Hospitals of Geneva, Geneva, Switzerland.,3 University of Geneva, Geneva, Switzerland
| | | | - Olivier Borens
- 5 Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Sendi P, Borens O, Wahl P, Clauss M, Uçkay I. Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics. J Bone Jt Infect 2017; 2:154-159. [PMID: 28894690 PMCID: PMC5592375 DOI: 10.7150/jbji.20425] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 12/31/2022] Open
Abstract
In this position paper, we review definitions related to this subject and the corresponding literature. Our recommendations include the following statements. Asymptomatic bacteriuria, asymptomatic leukocyturia, urine discolouration, odd smell or positive nitrite sediments are not an indication for antimicrobial treatment. Antimicrobial treatment of asymptomatic bacteriuria does not prevent periprosthetic joint infection, but is associated with adverse events, costs and antibiotic resistance development. Urine analyses or urine cultures in asymptomatic patients undergoing orthopaedic implants should be avoided. Indwelling urinary catheters are the most frequent reason for healthcare-associated urinary tract infections and should be avoided or removed as soon as possible.
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Affiliation(s)
- Parham Sendi
- Department of Infectious Diseases, Bern University Hospital, University of Bern.,Institute for Infectious Diseases, University of Bern
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anaesthesiology, Lausanne University Hospital, Lausanne
| | - Peter Wahl
- Division for Orthopaedic and Trauma Surgery, Cantonal Hospital Winterthur, Switzerland
| | - Martin Clauss
- Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland Liestal, Switzerland
| | - Ilker Uçkay
- Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva.,Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland
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