RESUMEN
Objective: We report the unorthodox use of a retrograde intramedullary nail via antegrade technique for the treatment of a subtrochanteric pathological femur fracture in the presence of significant coxa vara. No similar use has been documented previously in literature. Methods: A standard approach to the proximal right femur was performed and standard antegrade technique used to introduce a guide wire into the proximal femur after which the femoral shaft was reamed. A 38-cm long 10 mm diameter retrograde nail was attached to the retrograde insertion and targeting device as if to perform a left sided retrograde femoral nailing. The nail was then inserted antegrade into the proximal right femur and locked. Results: The patient made a good recovery without complications and was followed up regularly at the clinic until complete healing of the fracture. Conclusion: We believe that a retrograde intramedullary nail inserted antegrade, enabling proximal locking with screws passing into the femoral head, provides a mechanically sound fixation of a subtrochanteric fracture, where a reduced neck-shaft angle precludes the use of a standard cephalo-medullary nail.
RESUMEN
AIMS: This pilot study tested the performance of a rapid assay for diagnosing prosthetic joint infection (PJI), which measures synovial fluid calprotectin from total hip and knee revision patients. METHODS: A convenience series of 69 synovial fluid samples from revision patients at the Norfolk and Norwich University Hospital were collected intraoperatively (52 hips, 17 knees) and frozen. Synovial fluid calprotectin was measured retrospectively using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone AS) and compared to International Consensus Meeting (ICM) 2018 criteria and clinical case review (ICM-CR) gold standards. RESULTS: According to ICM, 24 patients were defined as PJI positive and the remaining 45 were negative. The overall accuracy of the lateral flow test compared to ICM was 75.36% (52/69, 95% CI 63.51% to 84.95%), sensitivity and specificity were 75.00% (18/24, 95% CI 53.29% to 90.23%) and 75.56% (34/45, 95% CI 60.46% to 87.12%), respectively, positive predictive value (PPV) was 62.07% (18/29, 95% CI 48.23% to 74.19%) and negative predictive value (NPV) was 85.00% (34/40, 95% CI 73.54% to 92.04%), and area under the receiver operating characteristic (ROC) curve (AUC) was 0.78 (95% CI 0.66 to 0.87). Patient data from discordant cases were reviewed by the clinical team to develop the ICM-CR gold standard. The lateral flow test performance improved significantly when compared to ICM-CR, with accuracy increasing to 82.61% (57/69, 95% CI 71.59% to 90.68%), sensitivity increasing to 94.74% (18/19, 95% CI 73.97% to 99.87%), NPV increasing to 97.50% (39/40, 95% CI 85.20% to 99.62%), and AUC increasing to 0.91 (95% CI 0.81 to 0.96). Test performance was better in knees (100.00% accurate (17/17, 95% CI 80.49% to 100.00%)) compared to hips (76.92% accurate (40/52, 95% CI 63.16% to 87.47%)). CONCLUSION: This study demonstrates that the calprotectin lateral flow assay could be an effective diagnostic test for PJI, however additional prospective studies testing fresh samples are required.Cite this article: Bone Joint Res. 2020;9(5):202-210.
