Instant messaging application usage for clinical consultation among orthopedic surgery residents in Turkey: A survey study.

OBJECTIVE: This study aimed to determine the characteristics of instant messaging application (IMA) usage for clinical consultation among orthopedic residents in Turkey and to explore their experiences and opinions concerning potential legal problems. METHODS: A questionnaire titled "Instant messaging for consultation among orthopedic surgeons" consisting of 21 questions was applied to orthopedic surgery residents, and the results were analyzed. The questions were designed to obtain information on 4 categories: 1) demographics and professional experience, 2) attitudes on the use of cellular phones, 3) IMA usage for clinical consultation purposes, and 4) problems and comments on smartphone application usage for clinical consultation purposes. The participants who had no experience with a smartphone or IMA usage were excluded at the final analysis. RESULTS: A total of 860 orthopedic residents (849 males [98.7%]; mean age=28.6 years; age range=22-44 years) participated in the survey (participation rate: 97.3%). The distribution of residency years was as follows: 1st year, 27%; 2nd year, 21.4%; 3rd year, 18.4%; 4th year, 17.4%; and 5th year, 49.9%. The most frequently used IMAs were WhatsApp (99.3%), Facebook Messenger (14.8%), Viber (8%), and Tango (1.3%). The rate of IMA usage for consultation was 95.3%. The most common reasons to prefer IMAs for consultation were being "fast" and "easy," but only 26.3% of the residents reported that they prefer the use of IMAs because they find them "reliable." Moreover, 41.7% of the respondents reported that they had an experience of misdiagnosis owing to the use of IMAs; 81.2% of the participants used the personal information of the patients during the consultation; 57.6% of the respondents considered that legal problems may arise because of the use of IMAs during the consultation; and 51.4% believed that an electronic platform, solely for consultation purposes, is required. CONCLUSION: This survey has shown that it is necessary to make some legal regulations regarding the use of IMAs for consultation purposes and to develop applications only for medical consultation purposes. Most of the trainees make decisions using IMAs without a proper examination, putting the patients at the risk of misdiagnosis. Moreover, the confidentiality of the patient's personal information appears to be in danger when IMAs are used. LEVEL OF EVIDENCE: Level IV, Diagnostic Study.

A novel method to assess intraarticular screw penetration into the joint space.

OBJECTIVES: This study aims to propose a novel method to detect articular penetration of screws by relying on their electrical conductivity properties and control the validity of this method. MATERIALS AND METHODS: In this ex vivo study, conducted between June 2017 and August 2017, we used five fresh sheep shoulder joints. First, the shoulder joint space was filled with saline solution. An insulated cannula was placed in the joint capsule, and a conductive wire was introduced into the joint via this cannula. A single titanium screw was inserted from the tuberculum majus into the posteroinferior quadrant of the humeral head under fluoroscopic observation. Conductivity was continuously measured using a digital multimeter. When a sudden decrease in conduction resistance was detected, fluoroscopic images were obtained in the anteroposterior (AP) and lateral directions. These images were assessed for penetration by a blinded surgeon. Penetration was confirmed by dissection of the joint. RESULTS: There was a significant decrease in electrical resistance when screw penetration occurred (p<0.001). All penetration events were confirmed using our novel method. For all five of the specimens, either AP or lateral images could not be used to confirm penetration. For two of these specimens, penetration was undetectable in both AP and lateral fluoroscopic images, but a decrease in resistance was recorded. CONCLUSION: The described method exhibits greater sensitivity and accuracy for metal penetration to joint, and it is effective in detecting screws in the joints. The novel method described in this paper was applied in a prototype setting, and we believe that this concept can continue to be developed.

Periprosthetic joint infection with streptococcus dysgalactiae subspecies equisimilis: Case report.

Streptococcus dysgalactiae (SD) is a common pathogen among elderly population. However, to our knowledge, there is no periprosthetic joint infection case reported that is infected with Streptococcus dysgalactiae subspecies equisimilis (SDSE) in the English literature. In this article, we report a 77-year-old male patient who had undergone total knee arthroplasty three years ago and had the diagnosis of cellulitis at his leg followed by swelling, pain and hyperemia localized at his knee. Three knee aspirations were performed and the SDSE was identified. There was no direct contact of patient to animals.

The reliability of use of WhatsApp in type 1 and type 2 pediatric supracondylar fractures.

OBJECTIVES: This study aims to evaluate the reliability of the assessment of radiological X-ray images of traumatic injuries in the elbows of children using WhatsApp application, compared to true-size images on a Picture Archiving and Communication System (PACS) screen. PATIENTS AND METHODS: Between November 2017 and March 2018, X-ray images of a total of 90 pediatric patients (53 males, 37 females; mean age 6.2 years; range, 2 to 10 years) with an elbow injury were retrospectively evaluated. The images were captured and sent to three orthopedic surgeons via the WhatsApp instant messaging application on an iPhone 7S smartphone. Observers were asked to diagnose and classify for each case over their personal smartphones. The three observers independently assessed the images with a seven-day interval. Following one-week interval, revaluation was conducted using the PACS. Intra- and interobserver reliability were calculated by Cohen Kappa statistics. RESULTS: There was a good agreement between the first and second evaluations by the physicians via WhatsApp (k=0.74). The intraobserver reliability was very good (k=0.8), moderate (k=0.55), and good (k=0.67). There was no significant difference in the intra- and interobserver reliability between the groups. CONCLUSION: Using WhatsApp for consulting is a reliable method which can be used in the emergency setting for decision-making. Using WhatsApp can improve the efficacy of medical assessment and reduce waiting time in emergency admissions, although this method is not a substitution for evaluation of the images using computer-based PACS.

A meta-analysis comparing the direct anterior with other approaches in primary total hip arthroplasty.

BACKGROUND: Proponents of the direct anterior approach (DAA) for THAs suggest earlier recovery with no increased complications whereas opponents suggest higher complication rates. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of the DAA versus other surgical approaches in primary THAs. RESULTS: We identified 18 RCTs suitable for detailed extraction of the data. The RCTs included a total of 1661 patients with a mean age of 62 years (range 55-69). Using the DAA led to a significant improvement in the Harris Hip score by a mean of 5.6 points (95% confidence interval (CI) 4.3 to 6.8, p < 0.01, heterogeneity I2 18%) and the WOMAC score by a mean of -3.1 points (95% CI -4.1 to -2.1, p < 0.001, I2 0%) at 6 weeks postoperatively, reduction in the analgesic requirements on the day of surgery (Morphine Equivalents -3.6 95% CI -6.5 to -0.7, p = 0.02, I2 50%) and pain scores on day one postoperatively (VAS -1.3 95% CI -1.5 to -1.1, p < 0.01, I2 91%). DAA was associated with a smaller incision (-3.2 cm 95% CI -3.3 to -3.1, p < 0.01, I2 99%) and there was no significant difference in complication rates (P = 0.20) among the study groups. CONCLUSION: Based on the available studies, the DAA offers superior functional outcomes over other approaches in the immediate postoperative period after primary THA with no increased risk of complications. However, there was no evidence to support the superiority of any approach beyond 6 weeks postoperatively.

Comparison of Cytotoxic Effects of Intra-Articular Use of Tranexamic Acid versus Epinephrine on Rat Cartilage.

BACKGROUND Adequate visualization is known to be essential to perform arthroscopic procedures effectively and efficiently. We hypothesized that tranexamic acid may be considered as an alternative agent to reduce intra-articular bleeding during arthroscopic procedures, after comparing its potential chondrotoxicity with that of epinephrine. MATERIAL AND METHODS Seventy-two rats were randomized into 3 groups with 24 rats each. The injections were performed in the right knees, as follows: Group 1: 0.25 mL of tranexamic acid solution, Group 2: 0.25 mL of epinephrine solution, and Group 3: 0.25 mL of 0.9% saline, serving as control. One week after the injections, the animals were euthanized. Samples were evaluated histologically based on the Osteoarthritis Research Society International (OARSI) Histopathology Grading and Staging System and the "live/dead" staining technique to determine chondrocyte viability. RESULTS Comparison of epinephrine and tranexamic acid revealed significantly higher OARSI scores in the epinephrine group (epinephrine: 3.42±1.31, TA: 0.92±0.90; P<0.001). The most significant difference between the 2 groups was in the number of joints diagnosed with OARSI grade III. The percentage of viability was significantly higher in the tranexamic acid group when compared with the epinephrine group (tranexamic acid: 79.74±3.343; epinephrine: 63.81±1.914; P<0.05). CONCLUSIONS Based on the histologic parameters and chondrocyte viability, tranexamic acid is less cytotoxic than epinephrine in rat chondrocytes at the doses typically used in irrigation fluid, and may be a good alternative to epinephrine in arthroscopic surgery.

The effect of platelet-rich plasma in bone-tendon integration.

BACKGROUND: The operative reconstruction of a torn or insufficient anterior cruciate ligament has become a routine surgical procedure in orthopedics. The long-term success of an anterior cruciate ligament reconstruction depends on the ability of the graft to heal adequately in a bone tunnel. Investigators studying reconstructions described healing within a tunnel as osseous ingrowth and incorporation. In particular, helping the healing using autologous material for the best integration process was a new idea that helped us to set up this study. OBJECTIVES: The purpose of this study is to show the effect of platelet-rich plasma on bone-tendon healing. MATERIAL AND METHODS: Ten New Zealand rabbits were used. The study had 2 groups: (1) a study group including the right extremities of rabbits in which tendon-bone integration was strengthened by plateletrich plasma and (2) a control group including the left extremities of rabbits in which tendon-bone integration was without platelet-rich plasma. On the 56th day postoperatively, the portion of the distal femur containing the tunnel was amputated following the euthanization process for histological evaluation. RESULTS: In the histological evaluation of the tendon-integrated bone segments with platelet-rich plasma, the integration of tendon in the bone was successful without any necrosis formation in most of the tissues. However, in the control group without platelet-rich plasma, the integration was distorted in many zones and some cystic morphologies were present. CONCLUSIONS: The findings of this study showed that using platelet-rich plasma during tendon-to-bone implantation has positive effects histologically. In the literature, many studies are available that have investigated the effect of platelet-rich plasma on anterior cruciate surgery radiologically. However, the histological findings are more reliable than radiological findings because bone-tendon integration is a biological process.

A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases.

INTRODUCTION: The fractures around the supramalleolar region are difficult to manage and deformities may occur following insufficient or inadequate treatment attempts. The treatment of those deformities is even more challenging. The available options for surgical fixation have inherent problems considering the soft tissue problems, infection and compliance of the patients. In this study, we report the preliminary outcome of new IMN system in use of supramalleolar deformities. PATIENTS AND METHODS: Three patients with supramalleolar deformities were recruited for this study. Two patients had periarticular distal tibia malunions and one patient had nonunion in same region. All patients were operated with using newly designed intramedullary nail system with a unique distal interlocking bolt screw. The outcome for each patient was followed-up and evaluated with using AOFAS score. RESULTS: The patients were followed up for 3 years, 3 months, and 6 months, respectively. The AOFAS scores were 36, 33, and 21 preoperatively; and 75, 68, and 75 postoperatively in Patients 1, 2 and 3, respectively. CONCLUSION: In our patient series, adequate fixation following correction of the deformity was seen. Although the number of the cases are limited this study provides encouraging results regarding the outcome of new IMN system in use of supramalleolar deformities.

Anthropometric measurements of tibial plateau and correlation with the current tibial implants.

PURPOSE: The aim of the study was to make an anthropometric analysis at the resected surfaces of the proximal tibia in the Turkish population and to compare the data with the dimensions of tibial components in current use. We hypothesized that tibial components currently available on the market do not fulfil the requirements of this population and a new tibial component design may be required, especially for female patients with small stature. METHODS: Anthropometric data from the proximal tibia of 226 knees in 226 Turkish subjects were measured using magnetic resonance imaging. We measured the mediolateral, middle anteroposterior, medial and lateral anteroposterior dimensions and the aspect ratio of the resected proximal tibial surface. All morphological data were compared with the dimensions of five contemporary tibial implants, including asymmetric and symmetric design types. RESULTS: The dimensions of the tibial plateau of Turkish knees demonstrated significant differences according to gender (P < 0.05). Among the different tibial implants reviewed, neither asymmetric nor symmetric designs exhibited a perfect conformity to proximal tibial morphology in size and shape. The vast majority of tibial implants involved in this study tend to overhang anteroposteriorly, and a statistically significant number of women (21 %, P < 0.05) had tibial anteroposterior diameters smaller than the smallest available tibial component. CONCLUSION: Tibial components designed according to anthropometric measurements of Western populations do not perfectly meet the requirements of Turkish population. These data could provide the basis for designing the optimal and smaller tibial component for this population, especially for women, is required for best fit. LEVEL OF EVIDENCE: II.

The Prevention of Periprosthetic Joint Infections.

Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

Closure of round cutaneous defects progressively with the purse string suture technique.

INTRODUCTION: There are many closure techniques available to cutaneous surgeons. One of them is the purse-string suture which is used to provide complete or partial closure of round skin defects. In our animal study; we closed skin defects with using subcuticular purse string suture technique by progressively cinching wound and we aim to more rapidly healing according to secondary healing. METHODS: After anaesthetize, we created a 4 cm diameter circular full thickness skin defect on dorsal area of rats. In group 1, subcuticular purse string suture was applied by using a nonabsorbable and monofilament suture and a sliding arthroscopic knot was applied to both ends. Arthroscopic suture was shift 1 cm forward every day. In group 2 skin defect was leaved open and daily dressing was made and in both group defect diameters were measured every day and noted. RESULTS: The skin defects were closed totally after 15 days in group 1 but in group 2 defects were reduced but still had a mean 1,5-cm diameter sircular defect. CONCLUSION: Closing large circular wound with purse string suture and gradual tightening decreases the healing time and expand the skin tissue without using any tissue expander.

Reliability, Readability and Quality of Online Information about Femoracetabular Impingement.

BACKGROUND: The Internet has become the most widely-used source for patients seeking information more about their health and many sites geared towards this audience have gained widespread use in recent years. Additionally, many healthcare institutions publish their own patient-education web sites with information regarding common conditions. Little is known about how these resources impact patient health, though, as they have the potential both to inform and to misinform patients regarding their prognosis and possible treatments. In this study we investigated the reliability, readability and quality of information about femoracetabular impingement, a condition which commonly affects young patients. METHODS: The terms "hip impingement" and "femoracetabular impingement" were searched in Google® in November 2013 and the first 30 results were analyzed. The LIDA scale was used to assess website accessibility, usability and reliability. The DISCERN scale was used to assess reliability and quality of information. The FRE score was used to assess readability. RESULTS: The patient-oriented sites performed significantly worse in LIDA reliability, and DISCERN reliability. However, the FRE score was significantly higher in patient-oriented sites. CONCLUSION: According to our results, the websites intended to attract patients searching for information regarding femoroacetabular impingement are providing a highly accessible, readable information source, but do not appear to apply a comparable amount of rigor to scientific literature or healthcare practitioner websites in regard to matters such as citing sources for information, supplying methodology and including a publication date. This indicates that while these resources are easily accessed by patients, there is potential for them to be a source of misinformation.

Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery.

AIM: The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. METHODS: Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. RESULTS: According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. CONCLUSION: As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

Straight versus S-shaped sternotomy: a histologic study in the sheep model.

INTRODUCTION: Straight sternotomy is the most common access for open heart surgery. Techniques have been proposed for maximizing sternal stability in high-risk patients. This trend implies a growing need for newer surgical techniques. The aim of this experimental study in the sheep model is to evaluate median vs. S shaped sternotomy the feasibility of using a special device to accelerate the sternal instability and bone healing. MATERIALS AND METHODS: We enrolled 31 sheep, weighing 18-30 kg. For all animals a midline skin incision was made. In group I (n = 16 animals), straight median sternotomy and in group II (n = 15 animals), S-shaped incision was marked on the periosteum of the sternum by new created device for standard S-shaped sternotomy. Sternum biopsies were performed on second surgery month for all survived animals from the sternum and the surrounding soft tissue. RESULTS: No early superficial wound complications were observed. Overall mortality in the initial approach group was 19.3% (6 sheep). In group I; 3 sheep had died on first surgery day, the reason may be hemorrhage and in group II; 3 sheep developed intractable VF during surgery procedure or immediately afterwards so died. There were statistically significant differences in the scores of bone healing between group 1 and group 2 (4.2 vs.7.3, ANOVA, p < 0.001). DISCUSSION: Our work is based on the use of a standard S-shaped sternotomy procedure on sheep sternum. In our experience with the sternal healing in the sheep model, the process of new bone formation was accelerated with S- shaped cut than straight sternotomy procedure.

Anatomical Localization of Lister's Tubercle and its Clinical and Surgical Importance.

The dorsal tubercle of the radius, once called Lister's tubercle, is used as a landmark in wrist arthroscopy, wrist joint injections, and similar surgical and clinical procedures. However, there is no useful information in the reference anatomy books and literature. The aim of this study was to identify the anatomical localization of Lister's tubercle on the dorsum of radius in relation to the radial styloid process and the ulnar notch of radius and to demonstrate the clinical and surgical importance of these relationships. We studied 20 dried cadaver radius specimens. The distances from Lister's tubercle to the radial styloid process and to the ulnar notch were measured by using a digital micrometer caliber and the ratio of the two measures was calculated. The dorsal tubercle of the radius is variable in position and can be either closer to the radial styloid process or to the ulnar notch. The present study showed that in 11 of the radii the dorsal tubercle of the radius was nearer to the radial styloid process than the ulnar notch, while in 9 subjects it was nearer to the ulnar notch. This anatomical variation may be relevant for wrist injections, wrist artroscopy or wrist surgery.

A new anchor augmentation technique with a cancellous screw in osteoporotic rotator cuff repair: an in vitro biomechanical study on sheep humerus specimens.

PURPOSE: The aim of this study was to test a simple technique to augment the pullout resistance of an anchor in an over-drilled sheep humerus model. METHODS: Sixty-four paired sheep humeri were harvested from 32 male sheep aged 18 months. Specimens were divided into an augmented group and non-augmented group. FASTIN RC 5-mm titanium screw anchors (DePuy Mitek, Raynham, MA) double loaded with suture material (braided polyester, nonabsorbable USP No. 2) were used in both groups. Osteoporosis was simulated by over-drilling with a 4.5-mm drill. Augmentation was performed by fixing 1 of the sutures 1.5 cm inferior to the anchor insertion site with a washer screw. This was followed by a pull-to-failure test at 50 mm/min. The ultimate load (the highest value of strength before anchor pullout) was recorded. A paired t test was used to compare the biomechanical properties of the augmented and non-augmented groups. RESULTS: In all specimens the failure mode was pullout of the anchor. The ultimate failure loads were statistically significantly higher in the augmented group (P < .0001). The mean pullout strength was 121.1 ± 10.17 N in the non-augmented group and 176.1 ± 10.34 N in the augmented group. CONCLUSIONS: The described augmentation technique, which is achieved by inferior-lateral fixation of 1 of the sutures of the double-loaded anchor to a fully threaded 6.5-mm cancellous screw with a washer, significantly increases the ultimate failure loads in the over-drilled sheep humerus model. CLINICAL RELEVANCE: Our technique is simple, safe, and inexpensive. It can be easily used in all osteoporotic patients and will contribute to the reduction of anchor failure. This technique might be difficult to apply arthroscopically. Cannulated smaller screws would probably be more practical for arthroscopic use. Further clinical studies are needed.

A newly designed intramedullary nail with distal interlocking system for tibia fractures in adults - the clinical results.

BACKGROUND: The surgical treatment of fractures of the tibia includes reamed and unreamed options. Reamed nails have mechanical advantages but they significantly harm the endosteal circulation. Unreamed nails spare the endosteal circulation, but provide a less stable fixation. In both systems, immediate full weight-bearing is not possible due to instability related to distal interlocking (DI). Further, DI is responsible for the majority of the fluoroscopy requirement and a significant loss of surgical time. In our study, we present the clinical results of a new intramedullary (IM) nail and system, which allows stable fixation with an unreamed technique that permits immediate full weight-bearing, with a minimum fluoroscopy requirement for DI. METHODS: Fifty tibia fractures (49 patients) operated using our new IM system between 2008 and 2010 were evaluated retrospectively. They were allowed full weight-bearing the day after surgery. The patients were followed at least 10 months postoperatively. RESULTS: Mean fluoroscopy time was 18 seconds (min: 10, max: 30) for DI. Mean union time was 9 weeks (min: 6, max: 12). There was no neurovascular injury, deep infection, malunion, delayed union, or nonunion. CONCLUSION: We demonstrated that our newly developed IM nail and new DI system may be an option to solve the stability problems sourced from the DI screw. It also significantly decreases the requirement of fluoroscopy.

The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida.

BACKGROUND: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. MATERIALS AND METHODS: Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months). RESULTS: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05). CONCLUSION: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.

Domestic electric drills in the service of orthopaedic surgery: a potential and preventable source of surgical site infections.

OBJECTIVE: We aimed to assess the contamination potential of the exhaust air from venting ports of running domestic electric drills which are commonly used in orthopaedic surgeries by means of both microbiological sampling and particle counting. METHODS: In an empty operating room, the exhaust air from five running sterile domestic electric drills measured using a particle counter and microbiological sampling was made via aspirating isolator with colony formations noted for a 2-week period. International Organization for Standardization (ISO) 14644 criteria were implemented with respect to the sterility standards. RESULTS: All of the drills produced statistically significantly higher levels of particles than the ambient air (p<0.01). There was no statistically significant difference in the number of collected particles among drills (p>0.05). No bacterial growth was detected in microbiological sampling via blood agar medium in the ambient air. Conversely, Staphylococcus epidermidis, Micrococcus luteus, and Staphylococcus capitis were isolated from the exhaust air of all running drills. There was no correlation between the number of particles produced by drills and the microbiological sampling. CONCLUSION: Domestic electric drills are not safe and may be a direct source of surgical site infection, as the use or re-use of these drills during orthopaedic surgery increases the risk of infection with contaminated aerosols that are produced by these devices.