How Can Negative Pressure Wound Therapy Pay for Itself?-Reducing Complications Is Important.

INTRODUCTION: Orthopaedic trauma demonstrates a relatively high rate of surgical site infections (SSI) as compared with other surgical specialties. SSIs provide significant clinical challenges and create significant health care costs. Incisional negative pressure wound therapy (iNPWT) has reduced the risk of SSI in orthopaedic surgery and other surgical specialties. PURPOSE: The purpose of this study is to investigate potential cost savings with the use of iNPWT (3M Prevena Therapy, 3M, St. Paul, MN) in high-risk orthopaedic trauma patients with closed OTA/AO 41C and 43C fractures. METHODS: This is a retrospective cohort study performed at a single, level-1 trauma center using data from a lower extremity fracture registry. Using the results from the registry and baseline infection rates derived from the literature, a health economic model was developed to evaluate the potential cost savings. RESULTS: A total of 79 patients included in the registry underwent open reduction and internal fixation of OTA/AO 41C and 43C fractures. A total of 10.1% developed a SSI. For those who received iNPWT, the rate of SSI was 7.4%. A health economic model suggests that the use of iNPWT may reduce the costs per patient by approximately $1381 to $4436 per patient. CONCLUSIONS: This health economic assessment and model suggests that judicious use of iNPWT may reduce health care costs in patients undergoing open reduction and internal fixation of OTA/AO 41C and 43C fractures. LEVEL OF EVIDENCE: Economic Level IV.

Impact of Short- and Long-Term Exposure to Elevated Seawater Pco2 on Metabolic Rate and Hypoxia Tolerance in Octopus rubescens.

AbstractMuch of the CO2 released by human activity into the atmosphere is dissolving into the oceans, making them more acidic. In this study we provide the first data on the short- and long-term impacts of ocean acidification on octopuses. We measured routine metabolic rate (RMR) of Octopus rubescens at elevated CO2 pressure (Pco2) with no prior acclimation and 1 or 5 wk of acclimation and critical oxygen pressure (Pcrit) after 5 wk of acclimation. Our results show that with no prior acclimation, octopuses had significantly higher RMRs in 1,500-µatm Pco2 environments than octopuses in 700- or 360-µatm environments. However, after both 1 and 5 wk of acclimation there was no significant difference in RMRs between octopuses at differing Pco2, indicating that octopuses acclimated rapidly to elevated Pco2. In octopuses acclimated for 5 wk at 1,500 µatm Pco2, we observed impaired hypoxia tolerance, as demonstrated by a significantly higher Pcrit than those acclimated to 700 µatm Pco2. Our findings suggest that O. rubescens experiences short-term stress in elevated Pco2 but is able to acclimate over time. However, while this species may be able to acclimate to near-term ocean acidification, compounding environmental effects of acidification and hypoxia may present a physiological challenge for this species.

Oxidized Zirconium Total Knee Arthroplasty Implant Failure in a Patient With Knee Instability.

Oxidized zirconium was introduced as an alternative bearing surface to decrease polyethylene wear and reduce aseptic mechanical failure of hip and knee arthroplasties. Oxidized zirconium combines the strength of a metal with wear properties of ceramic, proposing increased survivorship of implant components, and possible decreased rate of revision. Despite a harder surface than cobalt-chromium, the substrate of zirconium is a softer metal. Although uncommon, prior reports have described accelerated wear and severe metallosis after femoral head dislocation in oxidized zirconium total hip arthroplasty; however, this has not been described in total knee arthroplasty. We report a case of an oxidized zirconium total knee arthroplasty failure in a patient with knee instability. This is the first report of catastrophic failure of an oxidized zirconium total knee arthroplasty implant.

Subarachnoid Hemorrhage-Related Epilepsy.

Epilepsy is a significant worldwide public health problem that leads to reduced quality of life and negative psychosocial consequences and significantly increases mortality rates in those who are affected. The development of epilepsy from subarachnoid hemorrhage (SAH) has an important negative impact on long-term survival, functional status, and cognitive recovery in patients following aneurysmal rupture. Anticonvulsant medication (AED) administration to prevent the development of epilepsy following SAH is controversial, and studies to date have not shown effectiveness of AED use as prophylaxis. This paper reviews the pathophysiology of SAH in the development of epilepsy, the scope of the problem of epilepsy related to SAH, and the studies that have evaluated AED administration as prophylaxis for seizures and epilepsy.

Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space.

BACKGROUND: Surgical resection of lesions in the posterior incisural space presents a significant surgical challenge, which may result in postoperative visual complications and other neurological deficits. We, therefore, describe a retractorless interhemispheric transtentorial approach that avoids surrounding brain structures with positive outcomes and no complications or visual damage. CASE DESCRIPTION: We present four cases of lesions in the posterior incisural space that was treated with a retractorless interhemispheric transtentorial approach. Two patients were previously seen at another institution for a falcotentorial meningioma. We resected the meningiomas with a parietal-occipital interhemispheric transtentorial approach with no neurological deficits. A third patient presented with a large superior vermian hemangioblastoma with a steep angle of the tentorium. The fourth patient had a large upper vermian metastatic lesion with progressive enlargement, which was refractory to radiation treatments and chemotherapy, and we achieved partial resection. Postoperative visual function was completely preserved in all patients. CONCLUSION: A carefully executed retractorless interhemispheric approach in select cases is an effective option to reduce morbidity and prevent visual complications when removing lesions in the posterior tentorial incisure.