Can the presence of an infection be predicted before a revision total hip arthroplasty? Preliminary study to establish an infection score.

INTRODUCTION: The diagnosis of periprosthetic joint infection can be challenging, in part because there is no universal diagnostic test. Current recommendations include several diagnostic criteria, and are mainly based on the results of deep microbiological samples; however, these only provide a diagnosis after surgery. A predictive infection score would improve the management of revision arthroplasty cases. The purpose of this study was to define a composite infection score using standard clinical, radiological and laboratory data that can be used to predict whether an infection is present before a total hip arthroplasty (THA) revision procedure. HYPOTHESIS: The infection score will make it possible to differentiate correctly between infected and non-infected patients in 75% of cases. MATERIAL AND METHODS: One hundred and four records from patients who underwent THA revision for any reason were analysed retrospectively: 43 with infection and 61 without infection. There were 54 men and 50 women with an average age of 70±12 years (range 30-90). A univariate analysis was performed to look for individual discriminating factors between the data in the medical records of infected and non-infected patients. A multivariate analysis subsequently integrated these factors together. A composite score was defined and its diagnostic effectiveness was evaluated as the percentage of correctly classified records, along with its sensitivity and specificity. RESULTS: The score consisted of the following individually weighed factors: body mass index, presence of diabetes, mechanical complication, wound healing disturbance and fever. This composite infection score was able to distinguish correctly between the infected patients (positive score) and non-infected patients (negative score) in 78% of cases; the sensitivity was 57% and the specificity 93%. DISCUSSION: Once this score is evaluated prospectively, it could be an important tool for defining the medical - surgical strategy during THA revision, no matter the reason for revision. LEVEL OF EVIDENCE: Level IV - retrospective study.

Near-miss event assessment in orthopedic surgery: Antimicrobial prophylaxis noncompliance.

INTRODUCTION: Antimicrobial prophylaxis is one of the main safety measures to be enforced when implanting any medical device; surveys of practice, however, have found poor compliance. MATERIAL AND METHODS: This study is based on analysis of 153 dedicated in-depth analysis forms sent to orthopedic surgeons who had reported an antimicrobial prophylaxis-related near-miss event (NME) during the year 2008 as part of their certification report to the official organization, Orthorisq (orthopaedic Patient safety risk management agency). RESULTS: Antimicrobial prophylaxis guidelines exist in 95% of French centers, but in 14% are not available in the right place. 88% of orthopedic surgeons consider them well-adapted to their practice. Most declarations follow fortuitous discovery by the surgeon of an immediate peri-operative malfunction. Human causes were found in 92% of declarations, general organizational causes in 50% and material causes in 28%. Regarding corrective action, 65% of respondents reported implementing a second-order procedure, and only 20% were able to resume truly regular antimicrobial prophylaxis. CONCLUSION: The main reason for poor or non-performance of antimicrobial prophylaxis was "omission by negligence or oversight", reported in 56% of declarations. Proposals for improvement were: revised antimicrobial prophylaxis guidelines specifying "who does what"; guideline awareness checks on new, temporary and locum-tenens staff; patient involvement in personal data collection; and implementation of a check-list in line with WHO and French Health Authority recommendations. These improvement proposals were taken on board in the antimicrobial prophylaxis consensus update currently being drawn up by the French Society for Anesthesia and Intensive Care. LEVEL OF EVIDENCE: Level IV, Decision Analyses Study.

[Functional and mechanical anatomy of arm elevation]. / Anatomie fonctionnelle et mécanique de l'élévation du bras.

Experimental work on the functional anatomy of the shoulder has involved a study of the conditions involved in elevation of the arm. Movements of the upper limb are organised round a very special alignment of the scapulo-humeral joint whose geometric features and exact position have been determined. The ligaments of the joint play a major role in the controlling the attainment of this alignment. The value of this alignment in the physiology of the shoulder is demonstrated. A new terminology of shoulder movement is suggested.

Anatomic basis of ligamentous control of elevation of the shoulder (reference position of the shoulder joint).

The authors describe in detail the position of greatest stability of the shoulder joint. They review the mechanical importance of this position in the overall physiology of the shoulder-girdle and stress the essential role of two articular ligaments of the shoulder joint (the coracohumeral and inferior glenohumeral ligaments) in arrival at this reference position. There thus exists a passive control, of ligamentous origin, of movements of the shoulder-girdle. The position is essential if the shoulder is to benefit from the full range of movement and full stability which it needs in every day functioning.

[Treatment of recurrent anterior dislocations of the shoulder by the technic of pre-glenoid stapling. Study of a series of 48 cases]. / Traitement des luxations récidivantes antérieures de l'épaule par la technique de l'agrafage pré-glénoïdien. Etude d'une série de 48 cas.

Preservation of local muscular structures, and closure of the capsulo-periosteum detachment, are the two essential principles observed, when treating recurrent anterior shoulder dislocation by pre-glenoid stapling and also afford satisfactory results. This technique is used for capsulo-ligamentar lesions without alterations of the anterior edge of the glenoid cavity. If the strict technique is followed when placing the staple excellent stability result. If physiotherapy is started early, functional recovery is rapid. Sporting activities can be resumed within the third month after the operation.

Fractured odontoid with fractured superior articular process of the axis. Report of three cases.

We report three patients in whom a fractured odontoid process was associated with a fracture of the superior articular process of the second cervical vertebra. Although there were no signs of neurological disorder, damage to the C1-C2 joint in all three patients made fusion necessary. Forced lateral flexion is suggested as the possible mechanism of injury.