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Background: Contamination of the surgeon during gowning is a possible risk factor for prosthetic joint infection in arthroplasty surgery. Surgical helmets are a common form of personal protective equipment used during this type of surgery. Increasingly, there is a focus on the methods of application of the surgical hood and gown while wearing these helmets. Methods: Ultraviolet fluorescent powder was used to represent air-borne contaminant and applied through the airflow inlet of the surgical helmet. Seven methods of helmet and surgical gown application methods were examined. A ultraviolet torch was used to determine the level of contamination across 11 body regions. A single body region with less than 10 particles was classified as minor contamination, and over 10 particles as major contamination. Results: Early activation of the surgical helmet resulted in significant level of contamination across the majority of body regions. Major contamination also affected the scrub nurse when applying the surgical hood to the surgeon's helmet. Late activation of helmet system resulted in only minor level of contamination to the surgeon's shoulders and forearms. Adhesive wrist wraps over the inner gloves did not decrease contamination when added to late activation of the helmet. Conclusion: It is our recommendation that the surgical hood should be applied by an unsterile theater assistant and that the surgical helmet system should be activated after the surgeon has applied inner gloves to minimize the level of contamination to the surgeon's gown.

This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.

Background: Although differentiating between transient synovitis and septic hip arthritis is challenging, clinical prediction rules such as the Kocher criteria (KC) have been shown to help with the diagnosis of septic hip arthritis in children. Their performance in septic arthritis due to less virulent pathogens such as Kingella Kingae, however is unknown. We aimed to describe the performance of these clinical prediction rules in pre-school children with septic hip arthritis due to different pathogens. We hypothesised that the number of KC or modified KC met would be lower in children with septic hip arthritis caused by K. kingae, compared to those caused by Staphylococcus aureus. Methods: In this retrospective multicentre study conducted in Australia and New Zealand between 2012-2016, we included children with confirmed septic hip arthritis due to S. aureus (n=29), K. kingae (n=20), other pathogens (n=32), and no pathogen identified (n=48). We applied the KC (temperature, weight-bearing, erythrocyte sedimentation rate, white blood cell count) and the modified KC (C-reactive protein added) and assessed their sensitivity for septic hip arthritis, using cut offs of KC ≥ 3 and modified KC ≥ 4. Results: The score of the KC and the modified KC was not lower in K. kingae compared to S. aureus (P=0.27, P=0.21). In addition, both the sensitivity for the KC (S. aureus 18/29 (62.1%); K. kingae 12/20 (60.0%)), and for the modified KC (S. aureus 18/29 (62.1%); K. kingae 12/20 (60.0%)) did not differ between K. kingae and S. aureus. Of all children with septic hip arthritis, the sensitivity of both the KC and modified KC were 56.6% (95%CI 47.6-65.3). Conclusions: The clinical prediction rules had comparable performance in K. kingae infections to those caused by S. aureus. Concerningly, less than 60% of the children with confirmed septic hip arthritis met the cut-off values. These prediction rules lack sensitivity to rule-out septic hip arthritis in the early assessment of pre-school aged children with acute hip pain. Level of Evidence: Level III Diagnostic.

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