Increased Duration and Frequency of Lateral C-Arm Draping Does Not Increase Contamination Rates.

This study sought to quantify the rate of culture-positive drape contamination with varying degrees of drape manipulation for intra-operative fluoroscopic imaging. In this prospective cohort study, 30 patients with operatively closed lower extremity fractures were evaluated. The clip-drape technique was employed to cover the emitter. Swab samples were collected for bacterial growth. A t-test was applied for statistical comparison. Three of 30 cases (10% of operations) showed evidence of contamination. There was no statistically significant difference between duration of drape use or the amount of drape manipulations. None of the 30 patients in this study developed surgical site infection 90-days post-surgery. The clip drape technique for lateral fluoroscopy appears to be effective in maintaining surgical field sterility. Moreover, the number of drape manipulations and length of time the drape was in use was not related to drape contamination. Level of Evidence: Therapeutic Level II. (Journal of Surgical Orthopaedic Advances 32(2):107-110, 2023).

Review of Calcaneal Osteotomies Fixed With a Calcaneal Slide Plate.

BACKGROUND: The calcaneal slide osteotomy is a common procedure used for the surgical correction of heel varus and valgus deformities. A variety of fixation methods exist including screws and plates. The literature shows a high rate of hardware prominence with screws leading to subsequent removal of hardware. Few studies have examined the use of plates for fixation of a calcaneal osteotomy. The purpose of this study was to assess outcomes following fixation of a calcaneal osteotomy with a calcaneal slide plate. METHODS: This is a retrospective consecutive case series of all patients who underwent either a medial or lateral calcaneal slide osteotomy using the specialized calcaneal slide plate between September 2013 and December 2018 by a single surgeon. The primary outcome measures were the rate of hardware removal, healing of the calcaneal osteotomy, and any associated complications such as infection or incision healing delays. Patient baseline demographics and procedure-related data were recorded. The minimum follow-up was 4 months. A total of 81 procedures were performed using this calcaneal slide plate. RESULTS: All of the patients had one or more additional procedures at the same time as the calcaneal osteotomy. All of the calcaneal osteotomies healed without displacement. Only 1 patient (1.2%) returned to the operating room and had removal of the calcaneal slide plate, which was after osteotomy union for an infected wound. There were no cases of hardware failure or removal due to it being symptomatic. CONCLUSION: A specialized calcaneal slide plate was an effective fixation device for both medial and lateral calcaneal slide osteotomies for a variety of foot and ankle conditions. The union rate was 100% and none of the patients had hardware symptoms, which is an improvement on published reports of symptomatic hardware after calcaneal slide osteotomy. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Bridge-Enhanced Anterior Cruciate Ligament Repair: The Next Step Forward in ACL Treatment.

Anterior cruciate ligament (ACL) injuries are common in young and active patients. In this patient population, surgical treatment with an autograft tendon is recommended to reconstruct a new ACL. ACL reconstruction has a high patient satisfaction, improved patient reported outcomes and allows young patients to return to an active lifestyle, including sports. However, long-term follow-up shows these patients are at higher risk for degenerative arthritis, frequently at a young age. Recent research has focused on re-investigating the utility of performing an ACL repair rather than a reconstruction in the hopes that maintaining a patient's native ligament may not only restore knee stability, but provide improved knee kinematics and lessen the risk of late osteoarthritis and also limit donor site morbidity from autograft harvests. Historically, patients undergoing ACL repair suffered poor outcomes due to issues with intra-articular healing of the ligament; but now, with new bioengineering techniques, bridge-enhanced ACL repairs may provide a feasible alternative in the treatment of ACL injuries.