Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures.

BACKGROUND: Intramedullary nailing (IMN) has been frequently indicated to treat long bone open and closed fractures, but IMN infection (IMNI) may have devastating consequences. Sonication has been regarded as an important add-on for microbial identification on a variety of orthopaedic implant-associated infections, but its role in the IMNI is poorly studied. We aim at evaluating the accuracy obtained by conventional peri-implant tissue culture (TC) samples with sonication fluid cultures (SCs) of IMNI. METHODS: Longitudinal prospective cohort study ongoing since June 2014, which included patients with indication for IMN removal due to any reason. Clinical diagnosis of INMI was defined according to publication addressing fracture-related infections. Minimal of two samples from TC were cultured. SCs followed the protocol previously published. Statistical analysis was performed using McNemar's test for related proportions. RESULTS: We included 54 patients submitted to IMN retrieval, of whom 47 presenting clinical signs of IMNI. Sensitivity for detecting microorganisms using TC and SC was 89.4% (42/47) and 97.6% (40/41), and specificity was 71.4% (5/7) for both TC and SC (p = 1.00). Positive and negative predictive values for TC and SC were 95.5% (42/44), 95.2% (40/42), 50% (5/10), and 83.3% (5/6), respectively. The most frequent organisms isolated in both TC and SC were Staphylococcus aureus, S. epidermidis, and Enterococcus sp. Polymicrobial infection was diagnosed in 14.8% (8/54) and 25% (12/48) by TC and SC, respectively (p = 0.19). CONCLUSION: Sonication fluid and tissue samples presented similar accuracy on the diagnosis of IMNI, but SC was advantageous of detecting polymicrobial infection.

Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients.

BACKGROUND: Studies addressing the management of intramedullary infection are mainly retrospective and with a limited number of cases. Reaming can be performed using either conventional reaming or using the reamer/irrigator/aspirator (RIA) system. Until now there have been no comparative prospective studies between these two methods. We aimed to compare the efficacy of RIA with conventional reaming followed by insertion of antibiotic-loaded cement, for the treatment of intramedullary nail infection of long bones. We assessed the rate of remission between groups after two-year follow-up and identified microorganisms using tissue cultures and sonication of explanted intramedullary nail (IMN). METHODS: A noninferiority, randomized clinical trial was carried out between August 2013 and August 2015 involving 44 patients of whom a locked IMN implant of the femur and/or tibia was retrieved and who all met the clinical and radiological criteria for IMN-associated osteomyelitis. Patients were randomized into two groups: RIA alone versus conventional reaming followed by antibiotic-loaded cement insertion. Both groups also underwent six-weeks of antibiotic treatment according to the results of the antibiogram. Patients were evaluated after 1, 3, 6, 12 and 24 months for radiological and clinical follow-up. RESULTS: After 24 months, the rate of infection remission was similar between the two groups, 87% in the RIA group and 95.5% in the conventional reaming group (p = 0.60). Among four patients who had recurrence of infection, the time to reappearance of symptoms varied from 20 days to twenty-two months. Staphylococcus aureus and coagulase-negative Staphylococci were isolated in 23 (40.4%) and 13 (22.9%) patients, respectively. Interestingly, we identified 20% (9/45) of polymicrobial infection. CONCLUSION: This study concludes that the RIA system alone, is noninferior to conventional reaming followed by antibiotic cement spacer in the treatment of IMN infection. However, RIA shows greater efficacy in the collection of infected medullary bone tissue, mainly in cases of infected retrograde nail of the femur. TRIAL REGISTRATION: ISRCTN82233198. Retroactively registered on July 29, 2019.

Radiographic study on the anatomical characteristics of the proximal femur in Brazilian adults.

OBJECTIVE: To ascertain the geometry of the femur in the Brazilian population by means of a radiographic study and to correlate the values with regard to sex and right/left side. METHODS: Five hundred anteroposterior radiographs of the pelvis of skeletally mature patients (250 of each sex) who did not present any osteoarthrosis, fractures or tumoral or infectious lesions were analyzed. The length and width of the femoral neck, length of the femoral axis, neck-shaft angle and femoral offset were measured. RESULTS: The following means were observed: 36.54 mm for the length of the femoral neck; 37.48 mm for the width of the femoral neck; 108.42 mm for the length of the femoral axis; 130.47° for the neck-shaft angle; and 44.4 mm for the femoral offset. CONCLUSION: The mean values for the main measurements on the proximal femur in Brazilians differed from those of previous studies. It could also be shown that there was a statistically significant mean difference between men and women for all the variables, both on the left and on the right side, and that the men had greater means than the women.

OBJETIVO: Verificar a geometria do fêmur da população brasileira por meio de estudo radiográfico e correlacionar os valores quanto ao sexo e ao lado direito/esquerdo. MÉTODOS: Foram analisadas 500 radiografias anteroposteriores de bacia de pacientes esqueleticamente maduros, 250 de cada sexo, sem a presença de osteoartrose, fraturas e lesões tumorais ou infecciosas. Foram mensurados os valores do comprimento e da largura do colo do fêmur, do eixo femoral, do ângulo colodiafisário e do offset femoral. RESULTADOS: Observou-se uma média de 36,54 mm do comprimento do colo do fêmur, 37,48 mm da largura do colo do fêmur, 108,42 mm do comprimento do eixo femoral, 130,47° do ângulo colodiafisário e 44,4 mm do offset femoral. CONCLUSÃO: Os valores médios das principais medidas do fêmur proximal dos brasileiros diferem de trabalhos prévios. Foi possível evidenciar também que existe diferença média estatisticamente significante entre homens e mulheres para todas as variáveis, tanto do lado esquerdo quanto do direito, e que os homens tiveram média maior do que as mulheres.

Radiographic study on the anatomical characteristics of the proximal femur in Brazilian adults / Estudo radiográfico dos aspectos anatômicos do fêmur proximal dos adultos brasileiros

To ascertain the geometry of the femur in the Brazilian population by means of a radiographic study and to correlate the values with regard to sex and right/left side. METHODS: Five hundred anteroposterior radiographs of the pelvis of skeletally mature patients (250 of each sex) who did not present any osteoarthrosis, fractures or tumoral or infectious lesions were analyzed. The length and width of the femoral neck, length of the femoral axis, neck-shaft angle and femoral offset were measured. RESULTS: The following means were observed: 36.54 mm for the length of the femoral neck; 37.48 mm for the width of the femoral neck; 108.42 mm for the length of the femoral axis; 130.47° for the neck-shaft angle; and 44.4 mm for the femoral offset. CONCLUSION: The mean values for the main measurements on the proximal femur in Brazilians differed from those of previous studies. It could also be shown that there was a statistically significant mean difference between men and women for all the variables, both on the left and on the right side, and that the men had greater means than the women...

Verificar a geometria do fêmur da população brasileira por meio de estudo radiográfico e correlacionar os valores quanto ao sexo e ao lado direito/esquerdo. MÉTODOS: Foram analisadas 500 radiografias anteroposteriores de bacia de pacientes esqueleticamente maduros, 250 de cada sexo, sem a presença de osteoartrose, fraturas e lesões tumorais ou infecciosas. Foram mensurados os valores do comprimento e da largura do colo do fêmur, do eixo femoral, do ângulo colodiafisário e do offset femoral. RESULTADOS: Observou-se uma média de 36,54 mm do comprimento do colo do fêmur, 37,48 mm da largura do colo do fêmur, 108,42 mm do comprimento do eixo femoral, 130,47° do ângulo colodiafisário e 44,4 mm do offset femoral. CONCLUSÃO: Os valores médios das principais medidas do fêmur proximal dos brasileiros diferem de trabalhos prévios. Foi possível evidenciar também que existe diferença média estatisticamente significante entre homens e mulheres para todas as variáveis, tanto do lado esquerdo quanto do direito, e que os homens tiveram média maior do que as mulheres...

Profile of trauma victims of motorcycle accidents treated at hospital São Paulo.

OBJECTIVE: To evaluate retrospectively, through analysis of medical records, the epidemiological aspects of patients traumatized by motorcycle accidents treated at the orthopedics ward, Hospital São Paulo, Brazil. METHODS: It is a retrospective observational study. The analysis of patients' medical records comprised the period from January 2008 to December 2009. The data checked were: age, gender, type of collision, type and location of fracture, treatment performed (conservative or surgical), type of surgery, cost of synthesis material and hospitalization, period of hospitalization and postoperative complications. After data collection, statistical analysis was performed. RESULTS: We analyzed 381 victims involved in motorcycle accidents. Patients were predominantly male (85%), with a mean age of 30.7 years old. Referring to distribution and site of lesions, 75.5% of individuals had lower limb fractures and in 95.4% of the cases, the treatment of choice was surgery. Twenty-nine patients were rehospitalized due to postoperative complications, such as exposure and failure of synthesis material, wound infection, necrosis, osteomyelitis, and pseudoarthrosis. CONCLUSION: It was possible to identify useful characteristics for planning preventative strategies to reduce the rate of motorcycle accidents and redirect public investment in health. Level of Evidence III, Retrospective Study.

Perfil das vítimas de trauma por acidente motociclístico tratados no Hospital São Paulo / Profile of trauma victims of motorcycle accidents treated at Hospital São Paulo

Verificar, retrospectivamente por meio da análise de prontuários,os aspectos epidemiológicos dos indivíduos traumatizadospor acidente motociclístico tratados na enfermaria de Ortopedia eTraumatologia do Hospital São Paulo, SP, Brasil. Métodos: Trata-sede estudo observacional retrospectivo. A análise dos prontuários dospacientes compreendeu o período de janeiro de 2008 a dezembro de2009. Os dados verificados foram: idade, sexo, tipo de colisão, tipo elocal da fratura, tratamento realizado (conservador ou cirúrgico), tipode cirurgia, custo do material de síntese e da internação, tempo deinternação e complicações pós-operatória. Após o levantamento, osdados foram tabulados e analisados estatisticamente. Resultados:Foram analisados 381 vítimas de acidentes envolvendo motocicletas.Houve predomínio do gênero masculino entre as vítimas (85%), commédia de idade de 30,7 anos. Quanto à distribuição e local das lesões,75,5% dos indivíduos sofreram fraturas dos membros inferiorese em 95,4% dos casos, o tratamento de escolha foi o cirúrgico. Foramreinternados 29 pacientes por complicações pós-operatórias, taiscomo exposição do material de síntese, falha do material de síntese,infecção da ferida operatória, necrose, osteomielite e pseudoartrose.Conclusão: Foi possível identificar características úteis para o planejamentode estratégias preventivas com o objetivo de reduzir os índicesde acidentes motociclísticos e redirecionar os investimentos públicosna área da saúde. Nível de Evidência III, Estudo Retrospectivo...

To evaluate retrospectively, through analysis of medicalrecords, the epidemiological aspects of patients traumatizedby motorcycle accidents treated at the orthopedics ward,Hospital São Paulo, SP, Brazil. Methods: It is a retrospectiveobservational study. The analysis of patients’ medical recordscomprised the period from January 2008 to December 2009.The data checked were: age, gender, type of collision, type andlocation of fracture, treatment performed (conservative or surgical),type of surgery, cost of synthesis material and hospitalization,period of hospitalization and postoperative complications.After data collection, statistical analysis was performed. Results:We analyzed 381 victims involved in motorcycle accidents. Patientswere predominantly male (85%), with a mean age of 30.7years old. Referring to distribution and site of lesions, 75.5%of individuals had lower limb fractures and in 95.4% of the cases,the treatment of choice was surgery. Twenty-nine patientswere rehospitalized due to postoperative complications, suchas exposure and failure of synthesis material, wound infection,necrosis, osteomyelitis, and pseudoarthrosis. Conclusion: Itwas possible to identify useful characteristics for planning preventativestrategies to reduce the rate of motorcycle accidentsand redirect public investment in health. Level of Evidence III,Retrospective Study...