Vol 1-3 Review Article

Suction Tip Colonization during Orthopedic Surgery: A Review

Eduardo Gonzalez Edery1, Ximena Rios2, Gerardo Vargas2, Laura Arzuza3, Juan Reatiga Aguilar2*

1Departamento de Ortopedia y Traumatología, Clínica Valle Salud, Cali, Valle del Cauca, Colombia

2Departamento de Ortopedia y Traumatología, Fundación Campbell, Barranquilla, Colombia

3Epidemiología, Grupo Campbell, Barranquilla, Colombia

Surgical site infections are clinically and epidemiologically critical in orthopedic surgery, as they lead to several complications affecting the quality of life of patients. Contamination may occur during the surgery, through instruments directly inserted into the wound acting as reservoirs for microorganisms. This study aimed to review the literature on suction tip colonization during orthopedic surgery, with an aim toward setting guidelines for its management during surgical procedures. Suction tips can be colonized primarily in two ways. The first is through direct contact with a surgical wound or poor handling by surgical staff and the second is through continuous airflow through the tip of the suction. Colonization rate between studies has decreased in the last years reporting in recent papers a 7.3% suction tips colonization rates in clean orthopedic. The most common germs isolated are S. epidermidis, S. aureus and E. cloacae. Suction tip colonization has a direct relationship with the duration of the surgical procedure, with a higher rate of colonization with longer surgeries. Multiple strategies have been proposed to reduce the risk of colonization of the suction tips used during a surgical procedure including systematically changing suction cannula after 1 hour of surgery or strategies to reduce active suction time. It is unclear if suction tip colonization is directly related to surgical site infection rates. Further studies are needed to corelate infection and colonization of the suction canula.

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Vol 1-3 Case Report

Intertrochanteric Hip Fracture in a 4-year child: A Case Report

R. Spagnolo1*, F. Pace2, D. Porreca3

1Department of Orthopaedic Surgery, Asst Hospital Treviglio, Bergamo, Italy

2First Orthopaedic Clinic-Hospital Gaetano Pini, University of Milan, Italy

3Physiotherapist ASST Bergamo, Ovest-Hospital Treviglio Caravaggio, Italy

Hip fractures are rare in children and are less than 1% of all pediatric fractures and less than 1% of all cases of hip fracture. The literature agrees that early treatment, whether surgical or conservative, reduces the risk of complications. The clinical case we present concerns a pertrochanteric fracture with displacement of the greater trochanter in a 4-year-old child. The fracture was a type 4 according to Delbet classification. Clinical evaluation was carried out using the Ratliff scheme. Clinical criteria include pain, movement, activity and X-ray evaluation of the fracture both from the point of view of the formation of the bone callus, and the alteration of the diaphyseal cervical angle (DCA). It was surgically treated with three cannulated screws and a hip spica plaster cast immobilization with a Kirschner wire to avoid secondary displacement. The cast was maintained during the 6 weeks healing period of the fracture. After plaster cast removal, the child begins physiotherapy with an experienced physio in pediatric trauma. The child healed without complications.

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Vol 1-3 Commentary

Commentary: Foot and Ankle Surgery for Chronic Nonhealing Wounds

Kelsey Millonig1*, Christopher Bibbo2

1Foot and Ankle Deformity Correction and Orthoplastics Fellow, Rubin Institute Advanced Orthopedics International Center for Limb Lengthening, Baltimore, USA

2Head of Foot and Ankle Surgery, Reconstructive Plastic and Microsurgery, Orthopaedic Trauma, Musculoskeletal Infections, Rubin Institute Advanced Orthopedics International Center for Limb Lengthening, Baltimore, USA

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Vol 1-3 Research Article

A more accurate method to determine the magnification of radiographs when templating for hip arthroplasty?

Henry Magill1*, Mazin Ibrahim2, Foad Mohamed2, Samuel Grant3, Branavan Rudran4, Warwick Radford5

1Orthopaedic Registrar, Chelsea and Westminster Hospital, London, UK

2Orthopaedic Registrar, University College London Hospital, London, UK

3Orthopaedic Resident, University of Toronto, Toronto, Canada

4Orthopaedic Research Fellow, Chelsea and Westminster Hospital, London, UK

5Orthopaedic Consultant, Chelsea and Westminster Hospital, London, UK

The use of digital templating for Total Hip Arthroplasty (THA) is now the standard approach for pre-operative planning. Digital templating holds potential to reduce operative time and post-op complications however, this often relies on imprecise assumptions. The relationship between the X-ray source, subject and detector alters the perceived magnification. We therefore determine if Body Mass Index (BMI) is positively correlated with true magnification and if a predictive model based these parameters exists. A single surgeon series (n=107) was included in this study. Two independent observers assessed both pre- and post-operative AP pelvis radiographs using TraumaCad™. Post-operative radiographs were assessed to calculate the true magnification by calibrating from a known femoral head prosthesis size. Finally, a scatter plot with regression was used to determine if a predictive model of magnification existed using the Body Mass Index. The mean pre-operative magnification using a scaling marker was 124.2 ± 8.90%. The mean post-operative magnification using a known femoral head prosthesis size (true magnification) was 123.7 ± 3.98%. Significant variability exists in pre-operative marker data. Regression modelling showed no significant correlation between BMI and true magnification (post-op magnification). This study’s suggests that the precision and reliability of the radiographic marker in daily practice is poor. Regression modelling showed no significant correlation between BMI and the true magnification factor. Therefore, a pre-op predictive model cannot be reliably used. The data from this study suggest that a fixed magnification factor of 124% remains the most reliable and accurate method.

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Vol 1-3 Commentary

Commentary: Debridement, antibiotics and implant retention (DAIR) for the management of knee prosthetic joint infection

Shiraz A. Sabah1*, William F. M. Jackson2

1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

2Nuffield Orthopaedic Centre, Oxford, UK

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Vol 1-3 Original Article

The ‘Floating Humeral Head’, A Case Series of Combined Proximal Humeral and Glenoid Fracture Dislocations

Joshua CY Ong*, Mahmoud A Awadallah, Andrew J White, Paul M Robinson

Trauma & Orthopaedic Department, Peterborough City Hospital, Bretton Gate, UK

Background: Fracture of the proximal humerus combined with dislocation of the glenohumeral joint and a soft tissue or bony Bankart lesion are rare. Management options are largely surgical and different approaches to fixation have been described. The reported outcomes are generally poor.

Methods: We present a series of three rare cases of traumatic dislocations of the shoulder associated with combined fractures of the proximal humerus and glenoid that were treated with surgical fixation. We describe the surgical technique and clinical outcomes.

Results: Our patients had multiple medical comorbidities; and coupled with the burden of injury, made a slow post-operative recovery (mean Constant-Murley score of 48 points over a mean follow-up time of 20 months).

Conclusion: A high index of suspicion and appropriate imaging is required to properly diagnose and surgically manage this uncommon pattern of injury. We recommend surgical treatment of these severe injuries, to stabilise the glenohumeral joint, and to achieve optimal clinical outcomes.

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Vol 2-1 Research Article

Joint internal moments in subjects with unilateral transtibial amputation during walking

Francisco Molina-Rueda1, Alicia Cuesta-Gómez1*, María Carratalá-Tejada1, Pilar Fernández-González1, Juan Carlos Miangolarra-Page1,2, Isabel Mª Alguacil-Diego1

1Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Faculty of Health of Sciences. Rey Juan Carlos University, Madrid, Spain

2Physical Medicine and Rehabilitation Service of the University Hospital of Fuenlabrada, Madrid, Spain

Background: Subjects with a unilateral transtibial amputation (UTA) that have used prosthesis for over five years have a higher occurrence rate of osteoarthritis at the knee and hip joints of the intact limb.
Objective: To research the joint internal moments of the hip, knee, and ankle in the sagittal and frontal planes during gait in persons with UTA.
Methods: 25 individuals with UTA (50.26 years ± 13.76) and 25 subjects without amputation (46.71 years ± 13.76) participated in this study. Gait analysis was carried out using a Vicon® Motion System (Oxford Metrics, Oxford, UK) with eight 100 Hz cameras with infrared strobes, two 1000 Hz AMTI® force-plates.
Results: People with UTA walk with a greater hip extensor moment in both intact and prosthetic limbs. The hip abductor moment was lower on the prosthetic limb compared to the intact limb and the control group. At the knee joint, the subjects with UTA walked with a reduced knee extensor and valgus moment on their prosthetic limb compared to the control group. At the ankle joint, the statistical analysis showed that the individuals with UTA walked with a reduced plantarflexor moment during the stance period on the intact limb compared to the people without amputation.
Conclusions: Subjects with UTA walk with a different joint kinetic pattern in the sagittal and frontal planes compared to non-disabled individuals.

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