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3.

Although simultaneous infection can occur, aseptic periprosthetic gout should be considered in individuals with a known history of gout, in those with a good response to anti-gout medication, and when there is an otherwise negative workup for infection.

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We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.

Objectives This study was performed to determine 1) the incidence of humeral shaft fractures within the Medicare non-cancer population, 2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, 3) differences in procedure times, and 4) the outcomes of individuals as measured by rate of secondary operations and one-year mortality. Design/Setting Retrospective comparative cohort analysis. A cancer-free Medicare Part B claims sample derived from a 5% sample from the years 1993-2007 was analyzed. Patients/Intervention Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures. Main Outcome Measurement The incidence of humeral shaft fracture and trend in operative fixation was evaluated for all years of data. Surgical times were assessed by anesthesia CPT codes. Outcomes and complications were assessed by CPT codes. The proportion of individuals experiencing complications and one-year mortality were compared by proportion hazards. Results We identified 1,385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete one-year follow-up data. Nail fixation was more prevalent than plate fixation most years, and had shorter anesthesia time by 27.1 minutes (P<0.0001). There were no significant differences in the complication rates between the two groups as measured by incidence of secondary operations and one-year mortality. Conclusions Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The two surgical techniques had no significant differences in terms of risk of secondary procedures and one-year mortality.

These results demonstrate that adequate endplate preparation for interbody fusion can be achieved utilizing various minimally invasive approach techniques (mini-ALIF, MAS TLIF, MAS PLIF, XLIF), however, XLIF appears to provide a greater area of and more complete endplate preparation.

The radiographs of patients on long term bisphosphonates with atypical femur fractures demonstrate markedly thick cortices at the site of the fracture. We conducted a prospective clinical study to determine if cortical thickening is increased in long term bisphosphonate users. We recruited 43 patients who had taken bisphosphonates for more than 5 years. A group of 45 healthy volunteers and 12 patients recently diagnosed with osteoporosis served as controls. We measured the cortical thickening as the ratio of femoral cortical thickness to diameter of the femur, and looked for cortical beaking. No difference in the cortical thickness ratio was observed between long term bisphosphonate users and osteoporotic controls (0.53 vs. 0.54, p= 0.659). No cases of cortical beaking were seen and no increase in thigh pain was observed. The power of the study was 95% to detect a 10% difference in cortical thickness ratio. We conclude that long term bisphosphonate use does not produce a generalized increase in subtrochanteric femoral cortical thickening in the majority of patients.