Dyslipidaemia is associated with Cutibacterium acnes hip and knee prosthetic joint infection.

PURPOSE: Optimization of medical factors including diabetes and obesity is a cornerstone in the prevention of prosthetic joint infection (PJI). Dyslipidaemia is another component of metabolic syndrome which has not been thoroughly investigated as an individual, modifiable risk factor. This study examined the association of dyslipidaemia with PJI caused by the lipophilic microbe Cutibacterium acnes (C. acnes). METHODS: A retrospective chart review examined patients with positive C. acnes culture at hip or knee arthroplasty explantation. A control group with methicillin-sensitive Staphylococcus aureus (MSSA) positive cultures at explantation was matched for age, sex, and surgical site, as well as a second control group with no infection. A total of 80 patients were included, 16 with C. acnes, 32 with MSSA, and 32 with no infection. All patients had a lipid panel performed within one year of surgery. Lipid values and categories were compared using multinomial logistic regressions. RESULTS: High or borderline triglycerides (TG) (relative risk ratio (RRR) = 0.13; P = 0.013) and low high-density lipoprotein (HDL) (RRR = 0.13; P = 0.025) were significantly associated with C. acnes PJI compared to MSSA-PJI. High or borderline TG (RRR = 0.21; P = 0.041) and low HDL (RRR = 0.17; P = 0.043) were also associated with a greater probability of C. acnes infection compared to no infection. CONCLUSIONS: The presence of elevated TG and low HDL were both associated at a statistically significant level with C. acnes hip or knee PJI compared to controls with either MSSA PJI or no infection. This may represent a specific risk factor for C. acnes PJI that is modifiable.

Complications of surgically treated pelvic ring injuries with associated genitourinary injuries.

OBJECTIVE: Pelvic ring injuries are often associated with vascular and intrapelvic organ injuries including damage to the genitourinary system. The purpose of this study was to examine the relationship between surgically treated pelvic ring injuries and genitourinary injuries. The primary outcome was to determine the rate of post-operative complications including infection, urinary dysfunction, and sexual dysfunction. The secondary outcome was to determine if the time to surgery was associated with post-operative complications. METHODS: Retrospective chart review from September 1, 2015 to December 31, 2019 of patients who sustained a pelvic ring injury which required surgical intervention. All patients with closed triradiate cartilage were included. RESULTS: A total of 115 patients met the inclusion criteria, 12 patients with an associated genitourinary (GU) injury were included in the GU group and 103 without GU injury were placed in the non-GU group. The median (range) age of patients in the GU group was 49.5 years (20, 64) and 48 years (15, 92) in the control group (p = 0.92). Demographic characteristics including age, Injury Severity Score and Elixhauser comorbidity score were similar between groups. Within the GU group, five patients had an injury to their bladder, four to their urethra and three had an injury to their kidney. In the GU group, one patient developed a wound dehiscence and one developed a urinary tract infection with subsequent sepsis (17%), while in the non-GU group, one patient (1%) developed erectile dysfunction (p = 0.028). Regression analysis demonstrated that having concomitant pelvic ring and GU injuries, as well as the number of surgeries were variables associated with post-operative complications, while time to surgery was not. DISCUSSION AND CONCLUSIONS: Pelvic ring injuries with concomitant genitourinary injuries were associated with increased odds of post-operative complications. No differences were noted in complication rates due to the time to surgery between groups.

Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol.

The incidence of symptomatic venous thromboembolism (VTE) has been reported in up to 10.9% of patients undergoing knee arthroscopy without chemoprohylaxis. The purpose of this study was to evaluate the effectiveness of a chemoprophylaxis protocol in patients undergoing knee arthroscopy. A retrospective review of prospectively enrolled patients in a new institutional VTE prophylaxis protocol identified all patients undergoing knee arthroscopy during a 5-year period. This risk-based chemoprophylaxis protocol was instituted based on the Caprini model: patients at more than minimal risk were prescribed enoxaparin 40 mg daily for 3 weeks, while all others were instructed to take aspirin 325 mg twice daily. The primary outcome measure was incidence of VTE within 60 days postoperatively. Demographic characteristics and other risk factors for VTE were also recorded, as well as any postoperative complications. Among the 1,276 knee arthroscopies, there were 26 VTE events (2.0%), including 23 with deep vein thrombosis (DVT), two pulmonary emboli (PE), and one patient with both DVT and PE. There were no deaths or complications requiring hospitalization or reoperation. The VTE diagnosis occurred at, on average, 9 days postoperatively. Patients in the high-risk group treated with enoxaparin had a lower VTE incidence (1.49%) than those instructed to take aspirin (2.0%); p = 0.75. Those undergoing an anterior cruciate ligament (ACL) reconstruction had the highest VTE incidence (2.87%). This study found that a chemoprophylaxis protocol with preferential use of aspirin or low-molecular weight heparin based on risk factors reduced the VTE incidence below to 2.0%, which is lower than most historical controls.

Golf cart injuries in children: the experience of trauma centers in a single state in the USA.

Golf carts remain a source of morbidity in children. We aimed to establish the incidence and injury characteristics of pediatric patients injured due to golf cart usage over an 11-year period. This is a retrospective study using a single state trauma database of patients ages 0-17 years admitted to a trauma center and who sustained injures while a golf cart was in use. Thirteen Pediatric and Adult Trauma Centers within the state of Pennsylvania were evaluated from 1 January 2004 to 31 December 2014. The inclusion criteria were met by 108 patients. The mean annual incidence of injuries was 0.35/100 000. The median age of patients was 11 years. The median hospital length of stay and injury severity score were 2 days and 9.5, respectively. The majority of the patients (75.9%) sustained at least one bone fracture. Skull fractures were more prevalent (43.5%), whereas extremity fractures were sustained by 26.9% of patients. Intracranial hemorrhages were sustained by 29.6% of patients. Ejections and rollovers accounted for 58.3% and 31.4% of patient injuries, respectively. The concussion rate was 26.9%. Neither age group nor sex was associated with a difference in fractures, intracranial hemorrhage or concussions. Golf cart injuries in pediatric patients commonly stem from ejections and rollover mechanisms resulting in skull fractures, extremity fractures, intracranial hemorrhages and concussions. The overall incidence of injury was 0.35 cases per 100 000. Further efforts are needed to increase awareness of these injuries and modify regulations regarding the use of golf carts in the pediatric population.

Definitive fixation of open tibia fractures: Does reopening the traumatic wound increase complication rates?

BACKGROUND: It is unknown if surgical approach or use of previous traumatic wounds for open fracture instrumentation has an impact on patient complications or outcomes. This study sought to compare infection and nonunion rates in the staged treatment of open tibia fractures where the traumatic wound was reopened during definitive fixation versus when they were not. METHODS: A retrospective review was performed on all patients at a single institution level 1 trauma center. All patients who had a minimum of 1 year clinical and radiographic outcomes were included. Primary outcome measures were incidence of infection and nonunion. Groups of patients were compared based on surgical approach for definitive fixation. RESULTS: A total of 96 patients were included - 48 patients received definitive treatment and wound closure during initial management of the open fracture (group 1), 22 patients had staged fixation through new incisions (group 2), and 26 patients had their traumatic wound reopened during definitive fixation (group 3). Rates of infection were 10.4%, 31.8% and 11.5% respectively (p = 0.15). Rates of nonunion were 20.8%, 27.3% and 30.8% (p = 1.0). No statistically significant differences in regards to primary outcomes were found between the staged fixation groups. Multiple logistic regression also showed no difference in infection or nonunion when controlling for known risk factors. CONCLUSION: For open tibia fractures that underwent staged fixation, no significant differences in infection or nonunion were observed between procedures that involved reopening the traumatic wound versus procedures performed through new incisions. The presence of a distal tibia periarticular fracture was found to be independently associated with infection risk.

Patient Characteristics and Surgical Start Time Affect Length of Stay Following Anterior Total Hip Arthroplasty.

BACKGROUND: Currently, no consensus exists for selection criteria of appropriate candidates for outpatient total hip arthroplasty (THA). This study evaluates patient characteristics associated with same-day discharge, examined surgical start time's effect on rates of same-day discharge, and compares readmission and reoperation rates between groups. METHODS: All patients who underwent a THA by one surgeon at a single quaternary care hospital between February 2016 and May 2018 were captured. All patients were given the option for same-day discharge. Patient characteristics and perioperative variables were analyzed. RESULTS: A total of 429 patients met inclusion criteria, 153 (36%) were discharged on the day of surgery. In a multivariate analysis, age (P = .000), multiple comorbidities (P = .004), and start time remained statistically significant (P = .000). Patients with start times prior to 9 AM had odds ratio of 11.56 of being discharged same day when compared to those with start times after 12 PM. Patients discharged the day of surgery were less likely to have a 90-day emergency room visit (P = .010), a readmission within 30 days (P = .001) or 90 days (P = .000), or a reoperation (0 vs 14, P = .003). CONCLUSION: Same-day discharge following THA is safe and feasible. Patient's age and number of comorbidities should be considered when developing selection criteria for same-day discharge programs. Patients selected for same-day discharge should receive earlier operating room start times.

Pediatric ATV Injuries in a Statewide Sample: 2004 to 2014.

OBJECTIVES: To establish the incidence, mortality rate, and fracture location of pediatric patients injured while using an all-terrain vehicle (ATV) over an 11-year period. METHODS: A retrospective study using a state trauma database for patients ages 0 to 17 years who sustained injuries while using an ATV. Thirty-two pediatric and adult trauma centers within the state were evaluated from January 1, 2004, to December 31, 2014. RESULTS: The inclusion criteria were met by 1912 patients. The estimated mean annual incidence during the period of the study was 6.2 patients per 100 000 children in the pediatric population <18 years of age. There was a decrease of 13.4% in the mean incidence when comparing the first 5 years of the study with the last 6 years. The median age of patients was 14 years. The median hospital length of stay and injury severity score were 3 days and 9, respectively. There were 28 fatalities (1.5%). The mean mortality incidence was 0.09 deaths per 100 000 children and remained relatively constant. The majority of patients (55.4%) sustained at least 1 bone fracture at or below the cervical spine. The femur and tibia were more commonly fractured (21.6% and 17.7% of the patients, respectively). CONCLUSIONS: Despite current guidelines by the American Academy of Pediatrics, patients younger than 16 years of age remain victims of ATV injuries. Although there was a 13.4% reduction in the incidence of ATV-related injuries in recent years, continued preventive guidelines are still necessary to avert these injuries in children and adolescents.

Lawnmowers Versus Children: The Devastation Continues.

BACKGROUND: Accidents with lawnmowers can cause mutilating injuries to children. Safety guidelines regarding the use of lawnmowers were promoted by professional organizations beginning in 2001. The Pennsylvania Trauma Systems Foundation maintains a database including all admissions to accredited Levels 1 to 4 trauma centers in the state. The annual rates of admission for children in our state and the severity of injuries subsequent to introduction of safety guidelines have not been reported, to our knowledge. Ride-on lawnmowers have been associated with more severe injuries in children. QUESTIONS/PURPOSES: We asked: (1) What was the incidence of hospital admissions for children with lawnmower-related injuries during 2002 to 2013 and did the incidence vary by age? (2) What was the severity of injuries and did the severity vary by age? (3) How often did these injuries result in amputation? (4) What types of lawnmowers were involved? METHODS: This was a retrospective study using a statewide trauma registry. We queried the Pennsylvania Trauma Outcome Study database for children 0 to 17 years old admitted to trauma centers in Pennsylvania between January 2002 and January 2014 with injuries resulting from lawnmower-related accidents. All accredited Levels 1 to 4 trauma centers in the state are required to submit their data to the Pennsylvania Trauma Systems Foundation which maintains the Pennsylvania Trauma Outcome Study database. Demographic information, Injury Severity Scores, International Classification of Diseases procedure codes, and injury location codes were recorded. Type of lawnmower was determined from the narratives and was identified in 60% (119/199) of patients. Traumatic and surgical amputations performed during the index hospitalization were included in the analysis. Information on later surgeries was not available. Subjects were stratified by age: 0 to 6, 7 to 12, and 13 to 17 years old. RESULTS: The incidence of lawnmower injuries in Pennsylvania was a median five of 100,000 children (range, 4-12/100,000) during the study period. The median age was 6 years (range, 1-17 years). The median Injury Severity Score was 4 (range, 1-75). Children 0 to 6 years old had higher median Injury Severity Scores (median, 8; range, 1-75) compared with those 13-17 years old (median, 4; range, 1-20; difference of the medians, 4; p < 0.001). A total of 53% of the patients (106/199) underwent at least one amputation. There were 83 amputations in or of the foot, 18 in the leg, 14 in the hand, and three in the arm. Ride-on lawnmowers accounted for 92% (110/119) of mowers identified by type. CONCLUSIONS: The incidence of serious injuries to children owing to lawnmower-related trauma did not change during the 12-year study period. If children younger than 6 years had not been near the lawnmower and those younger than 12 years had not been operating one, at least 69% of the accidents might have been prevented. We recommend annual publicity campaigns during spring to remind the public of the dangers of lawnmowers to children. LEVEL OF EVIDENCE: Level IV, therapeutic study.