Sterilization of Biofilm on a Titanium Surface Using a Combination of Nonthermal Plasma and Chlorhexidine Digluconate.

Nosocomial infections caused by opportunistic bacteria pose major healthcare problem worldwide. Out of the many microorganisms responsible for such infections, Pseudomonas aeruginosa is a ubiquitous bacterium that accounts for 10-20% of hospital-acquired infections. These infections have mortality rates ranging from 18 to 60% and the cost of treatment ranges from $20,000 to $80,000 per infection. The formation of biofilms on medical devices and implants is responsible for the majority of those infections. Only limited progress has been made to prevent this issue in a safe and cost-effective manner. To address this, we propose employing jet plasma to break down and inactivate biofilms in vitro. Moreover, to improve the antimicrobial effect on the biofilm, a treatment method using a combination of jet plasma and a biocide known as chlorhexidine (CHX) digluconate was investigated. We found that complete sterilization of P. aeruginosa biofilms can be achieved after combinatorial treatment using plasma and CHX. A decrease in biofilm viability was also observed using confocal laser scanning electron microscopy (CLSM). This treatment method sterilized biofilm-contaminated surfaces in a short treatment time, indicating it to be a potential tool for the removal of biofilms present on medical devices and implants.

Orthopedic complications in diabetes.

Diabetes is associated with a number of lower extremity orthopedic conditions and complications including fractures, Charcot neuroarthropathy, plantar ulcers, and infection. These complications are of significant clinical concern in terms of morbidity, mortality, and socioeconomic costs. A review of each condition is discussed, with particular emphasis on the clinical importance, diagnostic considerations, and orthopedic treatment recommendations. The goal of the article is to provide a clinical picture of the challenges that orthopedic surgeons confront, and highlight the need for specific clinical guidelines in diabetic patients.

Oxford hip scores at 6 months and 5 years are associated with total hip revision within the subsequent 2 years.

BACKGROUND: The Oxford hip score (OHS) is commonly reported in research studies as a reflection of pain and function but it is unclear whether it predicts subsequent prosthesis failure. QUESTIONS/PURPOSES: We determined whether OHS obtained at 6 months and 5 years after surgery predicts risk of revision within the subsequent 2 years. METHODS: We reviewed data from the New Zealand Joint Registry between January 1999 and December 2010. OHS at 6 months was available for 17,831 total hip patients. Patients were separated into four categories based on their OHS: 10,458 (59%) scored 42-48, 4726 (26%) scored 34-41, 1592 (9%) scored 27-33, and 1028 (6%) scored 0-26. Five-year OHSs were available for 3665 patients. Of these patients, 2619 (72%) scored 42-48, 657 (18%) scored 34-41, 225 (6%) scored 27-33, and 164 (4%) scored 0-26. RESULTS: For patients with a 6-month OHS, revision risk within 2 years was 0.4% in the 42-48 group, 1.0% in the 34-41 group, 1.7% in the 27-33 group, and 6.2% in the 0-27 group. For patients with 5-year OHS, revision risk within 2 years was 0.3%, 1.1%, 3.6%, and 6.1%, respectively. Increase in revision risk for the 0-27 versus the 42-48 OHS group was 15-fold at 6 months and 18-fold at 5 years. CONCLUSIONS: Our data suggest patients with an OHS of 42-48 at 6 months need a 5-year postoperative appointment. Those patients with a 5-year OHS of 42-48 need not be followed up for a further 5 years.

Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus.

A fracture of the posteromedial talar tubercle is also referred to as the Cedell fracture and is an infrequently described injury. Failure to recognize this injury may lead to posteromedial ankle pain and tarsal tunnel syndrome. It is therefore important to diagnose these fractures at the time of the initial presentation to avoid future morbidity. Although plain radiography forms the mainstay of initial radiological evaluation of the ankle, these fractures are commonly missed and misdiagnosed because of poor visualization on routine ankle radiographs. Computed tomography helps for better visualization of this fracture at the higher risk of radiation. We evaluated the use of the 30-degree external rotation view for the diagnosis of fractures of the posteromedial tubercle of the talus using cadaver specimens. On the 30-degree external rotation view of the ankle, all fractures of the posteromedial tubercle of the talus were revealed. In contrast, the fracture was visualized in only 2 cases using the standard lateral radiograph of the ankle, and not once in the anteroposterior or mortise views. In conclusion, a 30-degree external rotation view is likely to show a fracture of the posteromedial tubercle of the talus in contrast to the 3 routine trauma views of the ankle, aiding in diagnosis and treatment strategy at time of initial presentation.