[Multicentre study of infection incidence in knee prosthesis]. / Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla.

OBJECTIVE: To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. MATERIAL AND METHOD: A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. RESULTS: 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. DISCUSSION: In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures.

Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla / Multicentre study of infection incidence in knee prosthesis

Objetivo. Determinar la incidencia de infección de localización quirúrgica en el procedimiento prótesis de rodilla, durante un año de seguimiento en 12 hospitales madrileños. Material y método. Estudio prospectivo de enero a diciembre de 2009, utilizando el programa Indicadores Clínicos de Mejora Continua de Calidad. Se incluyeron prótesis de rodilla primarias y de revisión intervenidas el año previo. Se utilizaron criterios de infección de localización quirúrgica y categorías por índice de riesgo de los Centros para el Control y Prevención de Enfermedades y del National Nosocomial Infections Surveillance. Se calcularon tasas crudas y ajustadas por índice de riesgo. Resultados. Se analizaron 2.088 procedimientos quirúrgicos de prótesis de rodilla. La tasa global de infección de localización quirúrgica fue del 2,1%. El 65% de las infecciones fueron de órgano/espacio. El 60% de las infecciones se identificaron precozmente. Se obtuvo confirmación microbiológica en el 41,9% de los casos. La profilaxis quirúrgica fue adecuada en el 63,3%, siendo la principal causa de inadecuación su duración en el 85,7%. La preparación prequirúrgica fue correcta en el 50,3% de los pacientes. La tasa de infección en artroplastias de rodilla fue dos veces superior a la esperada según el National Healthcare Safety Network y similares a las tasas nacionales. Discusión. La tasa de infección de nuestro estudio se encuentra dentro del rango de las tasas de infección descritas en otros estudios europeos ya publicados. Las estrategias de vigilancia y control de las infecciones asociadas a la asistencia sanitaria permiten evaluar tendencias y el impacto de las medidas de prevención (AU)

Objective. To determine the incidence of surgical site infection in knee prosthesis surgical procedure for a follow-up period of one year in twelve hospitals in Madrid region. Material and method. A prospective study was carried out from January to December 2009 using a national surveillance system called Indicadores Clínicos de Mejora Continua de Calidad. Primary and revision knee joint replacements in patients operated on in the previous year were included. Criteria used to define surgical site infection and patient risk index categories were those established by the Centers for Disease Control and Prevention and National Nosocomial Infections Surveillance. The incidence rates were worked out crude and adjusted by hazard ratio. Results. 2,088 knee prosthesis procedures were analyzed. The overall incidence of surgical site infection was 2.1%. Sixty-five percent of the infections were organ/space. Sixty percent of the infections were identified in the early postoperative period. Of all surgical site infections, 41.9% were microbiologically confirmed. Antibiotic prophylaxis was implemented correctly in 63.3% of the cases. The most important cause of inappropriate prophylaxis was an unsuitable duration in 85.7% of the cases. The presurgical preparation was carried out correctly in 50.3% of surgical operations. The incidence of knee arthroplasty infection was twice as high as in the National Healthcare Safety Network and similar to national rates. Discussion. In this study, the incidence of infection was within the range of infection rates in other published European studies. Surveillance and control strategies of health care for associated infections allow us to assess trends and the impact of preventive measures (AU)

Effect of alendronate in elderly patients after low trauma hip fracture repair.

SUMMARY: One year of once weekly alendronate, when given shortly after the surgical repair of a hip fracture, produces reductions in bone markers and increases proximal femoral bone density. The therapy was well tolerated. INTRODUCTION: Hip fracture is the most devastating type of osteoporotic fracture and increases notably the risk of subsequent fractures. The aim of this paper was to evaluate the effects of 1 year therapy with a weekly dose of alendronate in the bone mineral density and bone markers in elderly patients after low trauma hip fracture repair. METHODS: Two hundred thirty-nine patients (81 +/- 7 years; 79.8% women) were randomized to be treated either with calcium (500 mg/daily) and vitamin D(3) (400 IU/daily; Ca-Vit D group) or with alendronate (ALN, 70 mg/week) plus calcium and vitamin D(3) (500 mg/daily and 400 IU/daily, respectively; ALN + Ca-Vit D group). RESULTS: One hundred forty-seven (61.5%) patients completed the trial. Alendronate increased proximal femoral bone mineral density (BMD) in the intention-to-treat analysis (mean difference (95% confidence interval); total hip 2.57% (0.67; 4.47); trochanteric 2.96% (0.71; 5.20), intertrochanteric 2.32% (0.36; 4.29)), but the differences were not significant in the BMD of the femoral neck (0.47%; (-2.03; 2.96) and the lumbar spine (0.69%; (-0.86; 2.23)). Bone turnover markers decreased during alendronate treatment. CONCLUSION: The present study demonstrates for the first time the anti-resorptive efficacy of alendronate given immediately after surgical repair in an elderly population with recent hip fracture. This effect should positively affect the rate of subsequent fractures.

Fracturas de la extremidad distal del radio. Reducción abierta y fijación interna por abordaje dorsal / Distal radius fractures. Open reduction and internal fixation adopting a dorsal approach

El tratamiento de las fracturas del radio distal mediante un abordaje y osteosíntesis dorsal es un tema controvertido. Se debe tener en cuenta la anatomía de la región dorsal del extremo inferior del radio, donde existe una mayor dificultad para adaptar el material de fijación y la posible irritación del irritación de los tendones extensores. A pesar de estas dificultades, existen autores que han publicado buenos resultados con una tasa aceptable de complicaciones usando este tipo de abordaje y osteosíntesis. Revisamos las indicaciones y resultados de la fijación interna por abordaje dorsal mediante técnicas mínimamente invasivas, técnicas de doble placa, técnica con placa única dorsal y técnicas con dispositivos intraextramedulares

Distal radius fracture treatment adopting a dorsal osteosynthesis approach is subject to controversy. Consideration is required of the anatomy of the distal region of the lower end of the radius, where adaptation of the fixation material is more difficult and the extensor tendons may suffer irritation. Despite these difficulties, a number of authors have published good results, with an acceptable complications rate, when using this type of approach and osteosynthesis technique. A review is made of the indications and results of internal fixation via the dorsal approach using minimally invasive techniques, double plate techniques, single dorsal plate techniques, and intra- / extramedullary devices

Tratamiento de las fracturas de meseta tibial mediante reducción abierta y fijación interna / Treatment of tibial plateau fractures by open reduction and internal fixation

Objetivo. Describir los resultados funcionales obtenidos tras el tratamiento quirúrgico mediante reducción abierta y fijación interna de las fracturas de meseta tibial. Material y método. Se revisaron de forma retrospectiva 48 casos de fractura de meseta tibial tratadas mediante reducción abierta y fijación interna en el período comprendido entre los años 1991-1995. Se recogieron y analizaron las variables epidemiológicas, complicaciones pre y posquirúrgicas y la técnica de síntesis empleada. La clasificación de las fracturas se realizó según la sistemática de Schatzker y la de AO. Resultados. Los resultados globales obtenidos a través de la Knee Score de Insall fueron excelentes en 28 pacientes, buenos en 9, regulares en 8 y malos en 3. El factor determinante en los resultados funcionales fue la edad en el momento de la fractura, teniendo menos importancia el tipo de fractura o el uso de injerto óseo (AU)

Trochanteric fractures treated with a proximal femoral nail.

We followed prospectively 295 patients with trochanteric fractures treated with the proximal femoral nail. The average age of the patients was 80 years and three out of four were female. The most frequent fracture type was A2 (59%). Clinical and radiographic controls were performed at 1, 3 and 6 months. There were technical complications during the operation in 12% of the cases, complications in the immediate postoperative period in 27% and late complications were detected in 4% of patients. Previous walking ability was recovered by 71%. The surgical technique is not complex, the number of complications recorded was acceptable and the overall results obtained are comparable with other fracture systems.

[Urologic complication during total hip replacement. Apropos of a case and review of the literature]. / Complicación urológica en el transcurso de reemplazamiento total de la cadera. A propósito de un caso y revisión de la bibliografía.

The authors present a case of vesical lesion during the recovery of a total loose hip prosthesis, without any type of endopelvic instrumentation being carried out. They show the cause of the perforation and warn against this type of complication in the above-mentioned surgery.