ImportanceSeptic arthritis of the native knee joint is the most common bacterial joint infection. The management involves prompt surgical debridement and joint irrigation by arthroscopy or arthrotomy. This is the first systematic review and meta-analysis to compare arthroscopic debridement with arthrotomy for septic arthritis of native knee joint.ObjectiveThe purpose of this systematic review and meta-analysis is to compare re-operation rates, length of inpatient hospital stay (LOS) and functional outcome between arthroscopy and arthrotomy in the treatment of acute septic arthritis of the native knee joint.Evidence reviewThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched from database inception to 31 May 2019. All original studies that compared re-operation rates and LOS between arthroscopy and arthrotomy for septic arthritis of knee were included. The research question and eligibility criteria were established a priori. Pertinent data were extracted and random-effects model was used to pool the data where possible.FindingsA total of seven studies with 1089 knees were included, of which 723 underwent arthroscopic surgery and 366 knees underwent arthrotomy. The relative risk of re-operation was significantly lower in the arthroscopy group with a pooled relative risk of 0.69 (95% CI 0.56 to 0.86; p=0.0006). All studies reported shorter LOS and one study reported better functional outcomes in the arthroscopy group as compared with arthrotomy. However, the data could not be quantitatively synthesised due to variation in reporting among the studies included.Conclusions and relevanceBased on the available evidence, we conclude that arthroscopy for the treatment of septic arthritis of the knee results in a lower re-operation rate than arthrotomy. It cannot be concluded whether arthroscopic treatment results in shorter LOS or better functional outcome as compared with arthrotomy.Level of evidenceIV

Purpose Fractures of the femoral shaft in children are common. The rates of bone growth and remodeling in children vary according to their ages, which affect their respective management. Methods This paper evaluates the incidence and patterns of pediatric femoral shaft fracture and the current concepts of treatments available. ResultsThe type of fracture-closed or open; stable or unstable-needs to be taken into account. Child abuse should be suspected in fractures sustained by infants. For younger children, non-surgical management is preferred, which include Pavlik harness (< 6 months old) and early spica casting (6 months to 6 years old). Older children (> 6 years old) usually benefit from surgical treatments as outcomes of non-surgical alternatives are worse and are associated with prolonged recovery times. These operative measures for older children that are 6-12 years old include elastic stable intramedullary nailing and submuscular plating. Factors to be considered when devising an appropriate intervention include body mass, location of injury, and nature of fracture. For adolescent and skeletally mature teenagers (> 12 years old), rigid antegrade entry intramedullary fixation is indicated. In the event of open fractures or polytrauma, external fixation should be considered as a temporary treatment method for initial fracture stabilization. Conclusion An age-based and evidence-based algorithm has been proposed to guide surgeons in the process of evaluating an appropriate treatment.

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Purpose This study aims to analyze the correlation between the incidence rate of hand injuries and various construction and manufacturing indicators in Singapore. We hypothesize that the number of hand injuries is correlated to activity in the construction and manufacturing industries in Singapore. Methods 20,764 patients who underwent hand surgeries in a tertiary institution between 2012 to 2018 were reviewed. Two independent, blinded observers extracted the frequency of hand surgeries performed from Electronic Medical Records. Economic indicators pertinent to Singapore’s labor force, construction and manufacturing industries were collected and smoothed by simple moving average of the prior 3 months. Results were analyzed using IBM SPSS v25.0. Results Significant independent univariate variables were Purchasing Manager Index for Manufacturing and Industrial Production Index. Multivariate regression of quarterly reported figures showed that Purchasing Manager Index for Manufacturing, Construction Index, Labor Productivity Change for Gross Domestic Product and Labor Productivity Change for Manufacturing were significantly correlated with hand injuries, with r square = 60.9%. Conclusion Quarterly economic indicators from construction and manufacturing industries can be used to predict the incidence of hand injuries with a 60.9% correlation. These findings may be useful for anticipating healthcare resource allocation to treat hand injuries. Type of Study and Level of Evidence Economic and decision, Level II.