Quality of life, functional and radiological outcomes of treatment of three-part and four-part proximal humerus fractures with locking plates and comparison in young versus older than 70 years: a retrospective cohort study.

PURPOSE: Verify if the use of locking plates in displaced three- and four-part proximal humerus fractures has meant an improvement even in patients over 70 years of age. MATERIAL AND METHODS: We performed surgery with locking plate fixation in 56 consecutive patients with three- and four-part proximal humerus fractures according to Neer's classification between 1/1/15 and 12/31/20 at our Hospital. Patient satisfaction, quality of life, functionality and radiological variables, as well as the comparison between patients older and younger than 70 years were the main outcomes. Likewise, factors and complications that may have influenced these variables were analyzed as secondary outcomes. The analysis of all these variables was performed after a minimum follow-up time of 24 months after surgery. RESULTS: 51 patients (92%) ended up satisfied or very satisfied according to the SF-36 test and with no disability or mild disability according to the DASH Score questionnaire. 46 patients (82%) obtained a satisfactory or excellent result according to the Neer scale modified by Cofield and 38 (68%) a good or excellent function according to the Constant Murley questionnaire. In 47 cases (84%) good radiological alignment was observed. Complications occurred in 20 patients (36%). The complications and the results of the SF-36, DASH Score, Neer scale modified by Cofield and Constant Murley tests depended on the radiological alignment (p = 0.009, p = 0.006, p = 0.025, p = 0.0008 and p = 0.0004). There were 37 patients younger than 70 years and 19 older than 70 years with no statistically significant differences when comparing the two groups. CONCLUSIONS: This study demonstrates that satisfactory results can be obtained with osteosynthesis with locking plates in displaced proximal humerus fractures even in patients older than 70 years of age. LEVEL OF EVIDENCE III: Retrospective Cohort, Treatment Study.

Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection.

INTRODUCTION: The risk of knee arthroplasty infection and appropriateness of antibiotic treatment are not clearly established in patients with preoperative asymptomatic bacteriuria. It has been the purpose to analyze the prevalence of preoperative asymptomatic bacteriuria in knee arthroplasty patients, as well as the incidence of prosthetic joint infection in those with asymptomatic bacteriuria treated and not with specific antibiotics. PATIENTS AND METHODS: This prospective study included 215 consecutive knee arthroplasty patients (73 ± 6 years, 168 females) with neither urinary symptoms nor perioperative urethral catheterization. A "clean-catch" urinalysis was obtained from all patients before surgery and an urine culture if urinalysis was abnormal. Asymptomatic bacteriuria was diagnosed if >100,000 colony-forming units/ml were cultured. Patients were treated (Group A) or not (Group B) with additional specific antibiotics for urine bacteria according to surgeon criteria. Minimum follow-up reached 48 months. No patient was lost to follow-up. RESULTS: Asymptomatic bacteriuria was diagnosed in 11/215 patients (5.1 %) (11/11 females), and four of these 11 were treated with specific antibiotics (Group A). Only one patient in Group A suffered a prosthesis infection along the first 3 months (1/125, 0.5 %), but bacteria cultured from the wound were absolutely different to those in urine culture. No patient in Group B suffered a prosthesis infection. CONCLUSIONS: Asymptomatic bacteriuria presents a low prevalence. We have not found any case of arthroplasty infection from urinary focus in patients with asymptomatic bacteriuria whether they received or not specific antibiotics.

Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with/without treatment.

BACKGROUND: In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear. QUESTIONS/PURPOSES: We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics. METHODS: We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1-12 months). RESULTS: Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery. CONCLUSIONS: We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics.