Risk assessment of accidental exposure of surgeons to blood during orthopedic surgery. Are we safe in surgical gloves?

AIM: To analyze tears in sterile surgical gloves used by surgeons in the operating theatre of the Trauma and Orthopedic Surgery Department, Copernicus Memorial Hospital, Lódz, Poland. MATERIALS AND METHOD: This study analyzes tears in sterile surgical gloves used by surgeons by ICD-9 and ICD-10 codes. 1,404 gloves were collected from 581 surgical procedures. All gloves were tested immediately following surgery using the test method described in Standard EN455-1 (each glove was inflated with 1,000 ± 50 ml of water and observed for leaks for 2-3 min.). RESULTS: Analysis of tears took into consideration the role of medical personnel (operator, first assistant, second assistant) during surgical procedure, the type of procedure according to ICD-9 and ICD-10 codes, and the elective or emergency nature of the procedure. The results of the study show that these factors have a significant influence on the risk of glove tears. Significant differences were observed in tear frequency and tear location depending on the function performed by the surgeon during the procedure. CONCLUSION: The study proved that the role performed by the surgeon during the procedure (operator, first assistant, second assistant) has a significant influence on the risk of glove tearing. The role in the procedure determines exposure to glove tears. Implementing a double gloving procedure in surgical procedures or using single gloves characterized by higher tear resistance should be considered.

Fatigue fracture of the femur after navigated total knee replacement.

We present a case of fatigue fracture of the femur after navigated total knee arthroplasty with the Orthopilot system. A 60-year-old woman with rheumatoid arthritis and osteoporosis (T-score = -3.1) reported increasing pain of the thigh 8 weeks after the surgery. A fatigue fracture of the right femur through the pinholes was diagnosed and stabilized with an intramedullary nail, achieving union and a good functional result. To our knowledge, this is the first described fracture through the pinholes after Orthopilot-assisted surgery with 4.5 mm threaded pins for tracker fixation. We believe that the number of such complications is underestimated because reports are not published. Patients with osteoporosis should be informed about the possibility of this complicating fracture if they are undergoing navigated surgery.

[Evaluation of bone metabolism in patients after total hip replacement based on bone turnover markers]. / Ocena zmian w tkance kostnej u pacjentów po calkowitej cementowej endoprotezoplastyce stawu biodrowego na podstawie markerów obrotu kostnego.

Serum bone markers: N-mid osteocalcin (OCN-Mid) and Cross-Laps were evaluated in 51 patients (15 men and 36 women), age 50-81y. (mean 69) with OA undergoing elective cemented THR. Samples were collected at the day before operation and 3 days, 1, 2, 6 weeks, 3, 6, 12 months after the operation and markers measured by direct chemoluminescency using Modular E-170. Lowest values of both markers were noted at the 3-rd day after operation. Cross-Laps levels rose rapidly reaching highest levels 2 weeks after operation and still were significantly (alpha = 0,05) elevated after 6 weeks. The highest but not statistically significant levels of OCN-Mid were noted after 6 months. After 12 months both markers returned to preoperative values. OCN-Mid/Cross-Laps ratio were lowest after 2 weeks (maximal resorption), then rose over the preoperative value after 3 months, being still significantly elevated after 12 months, indicating that bone formation still occurred. No significant differences were found according to sex, radiolucencies around the endoprosthesis (14 patients) and periarticular ossification (9 patients). Serum bone markers can show the process of bone healing around endoprosthesis, but because of different basic levels of bone metabolism, evaluation of this process can be achieved only with comparison to preoperative values.

[Serum bone markers in patients with loosening of cemented total hip endoprosthesis]. / Markery metabolizmu kostnego w surowicy pacjentów z aseptycznym obluzowaniem cementowej endoprotezy stawu biodrowego.

Serum levels of bone markers N-mid osteocalcin (OCN-Mid) and Cross-Laps in 20 patients (8 men and 12 women) with loosening of at least one element of total hip endoprosthesis confirmed during operation were compared with age and sex matched group with OA. Marker levels were measured by direct chemoluminescency using Modular E-170. Statistical analysis were done with t-Student test (alpha = 0.05). There were no significant differences in OCN-Mid, Cross-Laps levels and OCN-Mid/Cross-Laps ratio between both groups. Implant loosening is a slow process taking place on a relatively small surface in comparison to whole skeleton, so bone markers have no clinical value in diagnostics of total hip loosening.