No abstract

Prophylactic antibiotics can decrease the risk of wound infection and have been routinely employed in orthopaedic surgery for decades. Despite their widespread use, questions still surround the selection of antibiotics for prophylaxis, timing and duration of administration. The health economic costs associated with wound infections are significant, and the judicious but appropriate use of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics in antibiotic prophylaxis and highlights the uses and advantages of some commonly used antibiotics. Cite this article: Bone Joint J 2016;98-B:1014-19.

This study aimed to evaluate the effect of manipulation under anaesthesia (MUA) and Kirschner wire (K-wire) fixation of displaced, paediatric distal radius fractures on residual radiological angulation, displacement, and shortening, as well as functional outcomes, including complication rates. A retrospective review was conducted of all paediatric patients undergoing MUA and K-wire fixation for an extra-articular distal radius fracture over a period of 5 years. A total of 248 patients were included in the study with a mean age of 9.9 years (3-15). Mean follow-up was 6.6 weeks (4-156). There was a statistically significant increase in median dorsal angulation (p<0.0001) between initial post-operative and follow-up radiographs at the time of K-wire removal. The number of K-wires used did not have a significant effect on dorsal angulation (p=0.9015) at time of K-wire removal, nor did the use of an above or below elbow cast (p=0.3883). Seventeen patients required a further general anaesthetic (5 revision operations, 12 removal of migrated K-wires). Eighty-seven percentage of (215 patients) of patients had normal function at follow-up post-K-wire removal. Angulation at time of K-wire removal of more than 15° was significantly associated with reduced functional outcome (p=0.0377). A total of 41 patients (17%) had complications associated with K-wire use. We conclude that though K-wire fixation is an effective technique, it does not prevent re-angulation of the fracture and is associated with a significant complication rate. Given the remodelling potential and tolerance to deformity in children, surgeons should give careful thought before utilising this technique for all displaced or angulated paediatric distal radius fractures. If used, 1 K-wire with immobilisation in a below elbow cast is sufficient in most cases.

PurposeThe purpose of this study was to assess the accuracy, safety, and survival of distal femoral osteotomy (DFO) surgery for lateral compartment OA of the knee. MethodsA retrospective cohort study was conducted at a single UK centre, using prospectively collected data over an 8‐year period (2009–2017). All patients had pre‐operative radiographic analysis and digital planning of their deformity correction in addition to post‐operative analysis of the achieved correction and yearly face‐to‐face follow‐up. Complications (defined as an undesirable medical or surgical event as a direct result of the operation), reoperations, and failure (defined as conversion to arthroplasty or revision) were recorded. ResultsFrom a total of 83 patients, 81 patients undergoing 86 primary DFOs were included in this study, with a mean follow‐up of 99 months (SD 27 months). The mean pre‐operative percentage Mikulicz point was 78.7% (SD 19.1%) and post‐operative 35.9% (SD 14.8%). The mean accuracy of correction (intended correction − achieved correction) was an 8.2% overcorrection (SD 13.7%). The complication rate was 4.7%. Using Kaplan–Meier analysis, the mean survival was 113 months (95% CI 106–120) with the probability of surviving 10 years 89%. ConclusionDFO for valgus alignment and lateral compartment arthritis is associated with low complications, long‐term joint preservation, and the prevention of arthroplasty surgery. However, the accuracy of correction still requires improvement in intra‐operative technique. Level of evidenceIV.

This study has demonstrated how simple, intensive educational sessions can lead to an improvement in discharge summaries and communication with primary care.