Surgical-site infection (SSI) is a common complication in orthopedic surgery; however, SSI after surgically managed distal femur fractures was not well studied. The aim of this study was to investigate the incidence of SSI and identify some modifiable and nonmodifiable risk factors. The patients’ electronic medical records (EMRs) were reviewed to identify those who sustained a distal femur fracture and treated by open reduction and internal fixation (ORIF) between March 2014 and February 2018. SSI was defined based on the Centers for Disease Control criteria and confirmed according to the descriptions in EMR. Univariate and multivariate logistic regression models were used to determine the independent risk factors associated with SSI. Totally, EMRs of 665 patients who underwent ORIF of distal femur fractures were reviewed and 24 SSIs were found, indicating the overall incidence of SSI was 3.6%. The rate of deep SSI was 1.2% and superficial SSI was 2.4%. Staphylococcus aureus was the most common causative pathogen, either alone (7/15, 46.7%) or as a mixed infection (3/15, 20%), followed by mixed bacterial (4/15, 26.7%) and S epidermidis (2/15, 13.3%) and others. Patients with SSI had approximately twice the length of hospital stay as those without SSIs (29.0 vs 16.0 days, P < .001). Open fracture, temporary use of external fixation, obesity, smoking, diabetes mellitus, and preoperative reduced albumin level were identified as independent risk factors associated with SSI, and current smoking and preoperative reduced albumin level were the true modifiable factors. Patients should be encouraged to cease smoking as early as possible and increase the good-quality protein intake to reduce or prevent the occurrence of SSI. An explanation of the nonmodifiable risk factors should be included when patients are counseled about their increased risk of SSI.
Purpose This study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF). Methods It was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12 months. Gartland–Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0. Results The mean follow-up time was 17.1 months. At final visit, VLP performed better in wrist flexion (69.7° vs 62.3°, p < 0.001), forearm pronation (73.1° vs 64.8°, p = 0.027) and supination (70.6° vs 63.1°, p = 0.033) than EF, but not different with regard to other kinematic parameters. No significant difference was found between two groups, in term of Gartland-Werley or DASH score ( p > 0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6 mm ( p = 0.002) and 0.5 vs 1.2 mm ( p = 0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) ( p = 0.587). Conclusions Compared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.
Distal radius fracture involving the lunate facet is a tough issue for surgeons, but currently there is scarcity of data on these injuries. This study aims to evaluate results of volar locking plate (VLP) for treatment of die-punch fractures of the distal radius.Between January 2013 and June 2017, a total of 37 patients with die-punch fractures of the distal radius were admitted and underwent VLP fixation. Clinical and radiographic data on these patients were extracted from their electronic medical records. Preoperative radiographs, CT scanning and 3D reconstruction were used to definitely diagnose this injury. Radiographs taken at immediate postoperation and at last follow-up were analyzed. Data on radial subsidence, articular step-off status, volar tilt, radial inclination, wrist motion range, grip strength and related complications at the final follow-up were documented for analysis. The overall outcomes of the injured limb were evaluated, based on the Gartland and Werley scoring system.The mean radial subsidence was 0.8 mm (0–3.3 mm), and articular step-off finally occurred in 4 patients (10.8%). The mean volar tilt was 9.5° (6°–15°), radial inclination 21° (12°–27°). The mean wrist was 84.2% in flexion of the contralateral uninjured wrist, 87.0% in extension, 92.2% in pronation and 94.5% in supination, respectively. The mean grip strength was 86% (range 56%–108%) of the contralateral un-injured upper limb. Gartland and Werley score demonstrated the excellent and good rate of 83.8%, with excellent result in 21 patients, good in 10, fair in 4 and poor in 2. Incidence of overall complications was 27.0% (10/37), with one requiring surgical intervention.VLP demonstrated its efficacy and safety for treatment of die-punch fractures. Prospective comparative studies with larger sample are required to compare the outcomes among different fixation methods, with expectation of precise and individualized treatment for every patient. Type of study/level of evidence: Therapeutic III.
Purpose This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. Methods This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. Results The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. Conclusion Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. Level of evidence III
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