Examining the Efficacy of Drain Tip Cultures in Predicting Postoperative Surgical Site Infections in Hip Arthroplasty: A 15-Year Retrospective Study.

Background Postoperative surgical site infections (SSIs) are a significant complication of surgical procedures, leading to increased morbidity, prolonged hospital stays, and substantial healthcare costs; however, the use of drain tip cultures to diagnose SSIs in patients is controversial. The objective of this study was to evaluate the efficacy of drain tip cultures for the prediction of postoperative SSIs in patients recovering from hip arthroplasty. Methodology The data were collected from 1204 patients who underwent hip arthroplasty procedures over 15 years, and statistical analysis was performed to evaluate the diagnostic value of drain tip culture in determining surgical site infection. We also used these data to evaluate whether preexisting conditions such as hypertension or diabetes affected the probability of a patient getting an SSI. Results Drain tip cultures were positive in 12 of 1,112 cases of primary hip arthroplasty, but only one of these 12 patients was ultimately diagnosed with an SSI (sensitivity, 12.5%; specificity, 99.0%; p = 0.0834). Results from postoperative drain tip cultures performed in patients undergoing revision arthroplasty included two false positives and three false negatives; interestingly, no true positives were detected in any of the revision arthroplasty cases we evaluated (sensitivity, 0％; specificity, 97.8％; p = 0.9355). Conclusion Our results indicate that drain tip cultures have no statistically significant predictive value for the diagnosis of postoperative SSIs and thus should not be used as a primary diagnostic or predictive tool for SSIs. We recommend exploring other diagnostic tools for the postoperative diagnosis of SSIs. Standardized guidelines should therefore be established to improve the predictive value of the different methods.

Reinstrumentation for progressive hyper-kyphotic deformity after implant removal despite obtaining physiological alignment by posterior corrective surgery for adolescent idiopathic scoliosis with flat back: a case report.

This case report describes a 13-year-old female patient with adolescent idiopathic scoliosis (AIS) and flat back who experienced progressive kyphotic deformity after implant removal despite obtaining physiological alignment postoperatively. The patient underwent multiple surgeries, and a late-developing infection complicated her treatment course. Despite hard bracing to prevent kyphotic change, the kyphosis progressed to 74° within a year after implant removal, leading to a decrease in patient height and back pain. Revision surgery was eventually necessary. Possible factors for the kyphotic progression include injury to paraspinal back muscles due to multiple surgeries or insufficient bony fusion from late-developing infection. This case highlights the importance of thorough evaluation and follow-up for optimal patient outcomes after implant removal in AIS patients, particularly those with flat back.

Combined Femoral Osteotomy and Contralateral Hip Arthroplasty to Correct Limb Alignment and Arthritis in a Scoliosis and Polio Patient: A Case Report.

We describe the first case of a 62-year-old female symptomatic patient with multiple comorbidities presenting with coronal limb malalignment due to scoliosis and osteoarthritis who underwent a combined total hip arthroplasty and biplane opening wedge osteotomy of the distal femur in one procedure. It is essential to realize that in patients who present with multiple comorbidities, combining different established procedures should be considered as a therapeutic option. We detail the operative procedure, preoperative considerations, and postoperative rehabilitation. By reviewing the literature on operative techniques, we highlight how our findings can be applied to similar cases with multiple comorbidities. Our report underscores the importance of considering combined procedures as a viable therapeutic option for patients with complex medical histories.

Major Amputation Needed to Treat Purulent Tenosynovitis and Necrotizing Fasciitis in a Patient with a Human Bite and Severe COVID-19.

Background: Peripheral human bite wounds are rarely serious and are typically treated medically, with the most complex cases requiring only minor amputation or excision of the infected site. There are few to no reports documenting the development of purulent tenosynovitis, necrotizing fasciitis, and osteomyelitis from these lesions. Major amputations are required only rarely in these cases. Case Presentation: A 71-year-old woman presented with an uncontrolled infection following a self-inflicted bite wound to her left middle finger. A bacterial culture of the lesion revealed methicillin-resistant Staphylococcus aureus (MRSA). The infection could not be controlled with antibiotics or additional interventions, including debridement and minor amputation. She contracted severe COVID-19 while in the hospital which limited the available treatment options. In an attempt to control the infection, the patient ultimately underwent a major amputation of the distal left forearm. While recovering from the procedure, the patient succumbed to septic shock and cardiopulmonary arrest. Conclusion: The unusual progression of this case may be attributed to the interventions required to treat acute COVID-19 as well as a variety of confounding factors. For example, vasopressors and steroids used to treat severely-ill patients compromise the local and systemic physiologic responses to acute bacterial infection. It is important to reconsider clinical expectations during the pandemic and intervene as early as possible to prevent ongoing damage and clinical deterioration.

Unicompartmental Knee Arthroplasty for Severe Osteoarthritis and Pseudarthrosis in a Patient with Neurofibromatosis.

We describe the case of a 76-year-old Asian female patient who presented with severe pain and a valgus deformity of the right knee. Her past medical history included neurofibromatosis, which resulted in a severe anterior slope of the right knee, limb shortening, and congenital pseudarthrosis. She was diagnosed with severe anterolateral osteoarthritis and eburnation of the right knee that was treated surgically with a lateral unicompartmental knee arthroplasty (UKA). Bone and cartilage fragments were removed from the joint space and a UKA implant (Zimmer®) with dimensions of 29 mm × 50 mm was inserted. Perioperative imaging revealed that the procedure resulted in the correction of the valgus deformity. Pain was reduced and the patient was able to walk for 10 meters with support during the immediate postoperative period. One week post-surgery, the patient sustained an oblique tibial fracture that extended from the medial edge of the implant to the medial slope of the proximal tibia. This complication may have been attributed to large implant size or sagittal overcutting. The fracture was treated surgically with a rotated anterolateral locking plate (A.L.P.S®) inserted into the distal tibia. The patient was capable of ambulation at full weight load at two months after the second procedure. It is critical to recognize that there are no standard protocols that can be used to guide the treatment of neurofibromatosis-induced osteoarthritis. The specific preoperative condition of the individual patient plays a large role in determining the appropriate treatment option. In this case, the availability of custom-fitted UKA implants might have improved outlook, we understand that these devices are costly and may not be available at all hospitals. However, we strongly believe that the "gold standard" in these cases is patient-specific treatment that addresses the issues of the highest concern using the resources that are available at that time.

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report.

Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable. Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers. Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries. Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

Gorham-Stout Disease Resulting in Spinal Deformity Treated by Fusion Surgery Combined With Everolimus Therapy: A Case Report.

CASE: Gorham-Stout disease (GSD) is a rare disorder characterized by progressive localized osteolysis and lymphatic malformation. A 26-year-old woman with GSD presented to our hospital with a Cobb angle of 100° and a kyphosis angle of 88°. Everolimus therapy was initiated to control the disease prior to surgery. After halo-gravity traction for 4 weeks, we performed anterior and posterior spinal fusion. Postoperative computed tomography revealed satisfactory bone union and no significant loss of correction 1 year post-surgery. CONCLUSION: This case suggests that anterior and posterior spinal fusion combined with everolimus therapy can be a therapeutic option for GSD.

Flexor Tendon Entrapment of the Index Finger After Monteggia Fracture in a Pediatric Patient.

The present case report describes a pediatric patient who presented with flexor digitorum profundus (FDP) entrapment after a forearm fracture. The patient was diagnosed with a Bado type I Monteggia fracture. The fracture was reduced using closed reduction under fluoroscopy followed by Kirschner's wire fixation. This case is unique because the FDP was found entrapped in the fracture site 2 weeks post-operation and was managed using conservative therapy. FDP entrapment is typically managed by surgical intervention, and there have been no previous reports of conservative management. The FDP was released using passive extension of the index finger under general anesthesia, and no irreversible damage to the tendon or muscle was found. This case report demonstrates the potential for conservative therapy in the management of FDP entrapment after forearm fractures.