Purpose Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacteria living in the fluids as biofilm-aggregates. The antibiofilm pre-treatment of synovial fluids with dithiotreitol (DTT) could improve bacterial counts and microbiological early stage diagnosis in patients with suspected PJI. Methods Synovial fluids collected from 57 subjects, affected by painful total hip or knee replacement, were divided into two aliquots, one pre-treated with DTT and one with normal saline. All samples were plated for microbial counts. Sensitivity of cultural examination and bacterial counts of pre-treated and control samples were then calculated and statistically compared. Results Dithiothreitol pre-treatment led to a higher number of positive samples, compared to controls (27 vs 19), leading to a statistically significant increase in the sensitivity of the microbiological count examination from 54.3 to 77.1% and in colony-forming units count from 1884 ± 2.129 CFU/mL with saline pre-treatment to 20.442 ± 19.270 with DTT pre-treatment (P = 0.02). Conclusions To our knowledge, this is the first report showing the ability of a chemical antibiofilm pre-treatment to increase the sensitivity of microbiological examination in the synovial fluid of patients with peri-prosthetic joint infection. If confirmed by larger studies, this finding may have a significant impact on routine microbiological procedures applied to synovial fluids and brings further support to the key role of bacteria living in biofilm-formed aggregates in joint infections.
Traumatic dislocation of the pisiform bone (PB) is a rare injury of the carpal bones, especially in pediatric patients. A few cases were reported, and there is no consensus about the treatment. Each author supports his own method, such as an open reduction internal fixation (ORIF) approach or a closed reduction. However, failures of both techniques with recurrent dislocation of the PB have been reported in the literature. In this article, a fracture dislocation of the PB was treated with ORIF in an 11-year-old boy with a greenstick radial fracture. In addition, a review of the literature about pisiform fracture dislocation in children has been made.
Objective. The evolution of new prosthetic and osteosynthesis devices has led to better outcomes and therefore more frequent surgical indications. As a consequence, an increased incidence of complications such as infections or aseptic loosening in orthopedic and trauma surgery are being recorded in general population. MicroDTTect is a quick and simple system that is useful to detect low grade or bio-film related infections. The aim of this study was to evaluate the reliability of MicroDTTect in detection of orthopedic infections compared to conventional culture of tissue samples. Methods. The population enrolled was composed of 13 patients undergoing surgery for prosthesis or osteosynthetic device failure or loosening. The MicroDTTect system and traditional culture of tissue samples were applied to identify the pathogens and compared with each other. Results. MicroDTTect had a higher sensitivity compared to conventional culture of tissue samples. Two cases resulted positive while the traditional culture sample showed a false negative result. In addition, with MicroDTTect a polymicrobial infection was identified, while with traditional methods was misdiagnosed. Conclusions. We showed that treatment of suspected implant infections using the MicroD-TTect device improves microbiological diagnosis with more sensitive results, leading to a more accurate treatment.
In the last few years, as the COVID-19 pandemic put in the spotlight the flaws of the Italian National Health System (INHS), the Italian National Residency Program (NRP) has aroused more and more interest among several stakeholders. The persistent burden on the Welfare System, caused by the systemic shortage of Specialized Practitioners, inevitably influenced the recent major reforms of the NRP, eventually affecting its quality. Within this emergency scenario, the urge to critically analyze the post-graduate educational program and its methods, became impellent. As the Orthopedics and Traumatology Italian Residents Association (AISOT) showed, despite the newly introduced DL Calabria, in 2020, almost 50% of the Orthopedic Residents would not feel comfortable to be challenged as independent specialists. However, the lack of methodological involvement of Residents in daily practice activities, from their Mentors, if matched with the positive feedback provided from residents who, conversely, experienced the DL Calabria conveniences, raised some concerns about the standard of quality of future Orthopedics. Modern times and technologies may allow a more efficient redesign and less nebulous educational methods and goals, and eventually guarantee a Nationwide equality among each Orthopedic School. A shared future with exhaustive objectives and fair opportunities between all Italian Orthopedic Residents is the key to build a righteous collective intelligentsia and harmony between practitioners of a glorious discipline, with ancient roots, such as Italian Orthopedics.
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