Outcomes of nonoperative treatment for developmental dysplasia of the hip were compared between two centres. Eighty children in Centre A underwent staged weaning of the Pavlik harness once three consecutive weekly ultrasounds showed Graf Grade I hips, whereas in 48 children in Centre B, the harness was removed immediately. No statistically significant difference was found in the rate of reintervention (repeat harness treatment, closed or open reduction), avascular necrosis or acetabular index between the two methods, although there was a nonsignificant trend towards higher reintervention rate and lower avascular necrosis rate with immediate harness removal. Age at start of treatment significantly impacted upon initial harness success, reinterventions and avascular necrosis.
Declared competing interests of authors: Saul N Faust was UK chief investigator and University Hospital Southampton NHS Foundation Trust principal investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis. All funds were paid into accounts within the NHS trust or university and not paid as personal fees. He reports consultancy fees for advisory board participation paid into accounts within the NHS trust or university (not personal fees) from vaccine manufacturers and antimicrobial agent manufacturers, including AstraZeneca, Cubist, Merck, GlaxoSmithKline (GSK) and Pfizer, outside the submitted work. He acts as principal investigator for clinical trials and other studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/ University of Southampton that are sponsored by vaccine manufacturers and antimicrobial agents, and has participated in advisory boards for vaccine manufacturers. Adam Finn reports grants and personal fees from Sanofi Pasteur MSD Ltd (SPMSD), and grants and personal fees from GSK, outside the submitted work. In addition, prior to October 2014, the University of Bristol and University Hospitals Bristol NHS Foundation Trust received funding for research conducted by Adam Finn and for consultancy and lectures from Pfizer, GSK, SPMSD and Novartis, who manufacture licensed and developmental meningococcal vaccines. Stuart C Clarke acts as principal investigator for clinical trials and other studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/University of Southampton that are sponsored by vaccine manufacturers but receive no personal payments from them. He has participated in advisory boards for vaccine manufacturers and has received financial assistance from vaccine manufacturers to attend conferences, but receives no personal payments for this work. All grants and honoraria are paid into accounts within the respective NHS trusts or universities. Jethro Herberg reports that he was an investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis; he received no personal payments. Andrew Riordan reports that the trust, but not he, has received funding for research sponsored by vaccine manufacturers and antimicrobial agents. He was lead editor for an e-learning package on meningitis produced by the Royal College of Paediatric and Child Health, funded by an unrestricted grant from Novartis Vaccines. Marieke Emonts was Newcastle upon Tyne Hospitals Foundation Trust's principal investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis. All grants and honoraria are paid into accounts within the NHS trust or university; she received no personal payment of any kind. Marieke Emonts reports acting as site principle investigator on behalf of the Newcastle upon Tyne Hospitals Foundation Trust/Newcastle University for clinical tr...
INTRODUCTION The aim of this study was to investigate the degree of contamination of a surgeon's hand following use of chlorhexidine gluconate or alcohol gel as disinfectants. MATERIALS AND METHODS In this prospective, randomised trial, orthopaedic surgeons were allocated to one of two different hand-washing protocols using a randomisation table. The hand-washing protocol dictated that all surgeons should wash for 5 min with chlorhexidine for their first case. Thereafter, the surgeon was randomised to wash for 3 min with either alcohol gel or chlorhexidine. At the end of each procedure, the gloves of each surgeon were carefully removed and the fingertips from each hand were placed on an agar plate. The number of bacterial colonies present after 24 h and 48 h of incubation were recorded for each agar plate by a microbiologist blinded to the washing protocol used. RESULTS Overall, 41 procedures and 82 episodes of hand washings were included in the study. Two episodes were discarded due to contamination at the time of glove removal. Four hands (8%) were contaminated in the chlorhexidine group compared to 19 (34%) in the alcohol group. Fisher's exact test confirmed a significantly higher risk of contamination using alcohol gel compared to chlorhexidine (P = 0.002). In addition, the average bacterial colony count was substantially higher in the alcohol group (20 colony forming units) compared to the chlorhexidine group (5 colony forming units). There was no relationship between the duration of surgery and the degree of contamination (P = 1.12). CONCLUSIONS Alcohol gel disinfectant is not a suitable alternative to chlorhexidine when hand washing before surgery. This study has identified a higher risk of bacterial contamination of surgeons' hands washed with alcohol. This may lead to higher levels of postoperative infection in the event of glove perforation.
Severely wounded extremities following battlefield injuries present a surgical dilemma to military surgeons of whether to attempt salvage or amputate the limb. There are many considerations to be made, including local and systemic patient factors, other wounded personnel and logistical constraints. Attempts have been made previously to form objective scoring criteria so as to remove possible subjectivity in this decision-making process. Furthermore, paediatric patients present their own particular dilemmas. This paper examines these various matters and, with contemporaneous evidence, presents recommendations for management.
The Girdlestone procedure is an excision arthroplasty of the hip. Rarely used nowadays, it was required in a young patient following discovery of avascular necrosis of the femoral head as a result of septic emboli from infective endocarditis in an intravenous drug user. This procedure was deemed necessary based on poor cardiac function and anaesthetic risk. During this case report we will discuss investigations performed, the procedure and post-procedure course.
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