Usefulness of Urinoculture to Patients With Dementia and Femoral Neck Fracture at Admission to Hospital: Preliminary Results.

INTRODUCTION: While preoperative urinary tract infection (UTI) has the potential to cause bacteremia and postsurgical acute prosthetic joint infections (APJIs), the influence of asymptomatic bacteriuria (AB) in these infections remains unclear. So the majority of guidelines not recommend the treatment of AB prior to the surgery. However, as patients with dementia usually cannot explain the symptoms of dysuria, the differential diagnosis between AB and UTI may be very difficult in this group of patients. The principal aim of the study was to compare the rate of positive urine culture at admission in patients with femoral neck fracture with and without dementia and secondarily try to assess the connection of positive urinoculture and postoperative acute gram-negative PJI. METHODS: All patients with a femoral neck fracture underwent a urine culture on hospital admission and were prospectively recorded. Variables such as sex, age, institutionalization, dementia and other comorbidities, PJI rate, and in-hospital death were collected. The results of cultures were retrospectively revised. Patients who received postoperative antibiotics or had been diagnosed with UTI during hospital stay were excluded. Statistical comparisons between patients with and without dementia were performed using SPSS software version 17. RESULTS: A total of 148 patients were included (52 with dementia). The rate of positive urine culture was 32% (n = 16) in patients with dementia and 11.5% in patients without dementia (P = .003). Of these 16 patients with dementia and positive urine culture, 2 (12.5%) developed an acute gram-negative PJI, whereas there were no cases in the group without dementia (P = .011). DISCUSSION: The only difference between UTI and AB is the expression of symptoms by the patient. However, as patients with dementia have difficulties to explain UTI symptoms, some UTI may be underdiagnosed. CONCLUSION: Patients with dementia have a statistically higher rate of presurgical positive urine culture compared with patients without dementia.

Adherence of S. epidermidis on different metals. A comparative in vitro study.

AIM: Staphylococcus epidermidis is the most common cause of orthopedic infections. Adhesion and biofilm formation on orthopedic implant surfaces play an important role in the physiopathology of these infections. The aim of our study was to evaluate the adhesion of S. epidermidis on the surface of metals usually used in orthopedics. METHODS: Previously sterilized circular metal plates of titanium (Ti), porous titanium (p-Ti), cobalt chromium (CoCr) and stainless steel (SS) were hung completely submerged in a liquid medium with a known concentration of S. epidermidis (RP62A). They were incubated for 1 h or 24 h at 36°C. After incubation, each plate was washed with PBS and sonicated during 5 minutes in 10 mL of saline. Different dilutions were performed and 100 µL from each sample was cultured on agar plates. RESULTS: 26 metal plates were incubated for 1 h and other 55 metal plates for 24 h. The lowest bacterial count (cfu/mm2) at 1 h was observed in CoCr plates while in p-Ti it was 6 times higher. At 24 h the highest bacterial count was observed in SS plates while the lowest in Ti. However, these differences were not statistically significant. CONCLUSIONS: After 1 h and 24 h of exposure, the lowest adherence was observed in CoCr and Ti plates, respectively. However, bacterial attachment occurred with all materials. It is necessary to further investigate new materials able to avoid bacterial attachment.

Use of cemented spacer with a handmade stem to treat acute periprosthetic tibial fracture infection: a case report.

We report an 85-year-old woman with dementia and dependent for normal life activities who was admitted due to a left periprosthetic tibial fracture. The tibial component was replaced by one with a long stem and she was discharged. Four weeks after the intervention the patient was re-admitted due to an acute prosthetic joint infection. All the components were removed and a bone-cement spacer with a handmade stem with a metal core was implanted. Radiological signs of fracture consolidation were observed after 3 months of follow-up. Due to the previous health status of the patient, it was decided to keep the spacer as a definitive treatment. After 24 months, the patient was able to sit without pain and to stand up with help using a knee brace. There were no radiological or clinical signs of infection.

Traumatic hip dislocation in childhood.

We report the outcome of closed reduction of traumatic hip dislocation in 28 children younger than 16 years of age (average age, 8 years 10 months). At an average follow-up of 8 years and 10 months (range, 2 years - 42 years), 18 patients were asymptomatic and enjoying a normal life, and some of them returned to practice sport activities. The remainder had complications related to associated injuries. There were no cases of avascular necrosis of the femoral head during follow-up. The majority of dislocations were attributable to low energy injuries in children younger than 10 years of age. Traumatic hip dislocation in children is uncommon. Management after reduction is not clearly defined in the literature. It is important to perform reduction as soon as possible to avoid later avascular necrosis.

Iatrogenic femoral neck fracture during closed nailing of the femoral shaft fracture.

BACKGROUND: Intramedullary nails have become a popular implant in the management of femoral shaft fractures. The occurrence of a femoral neck fracture after closed intramedullary nailing is an exceptional complication of this technique that has been rarely reported in the literature. METHODS: We report a retrospective study to identify the possible causes that could produce a fracture of the femoral neck after nailing of the ipsilateral femur. RESULTS: A total of four neck fractures were identified in a series of 494 femoral shaft nailing, all of them not visible on the initial plain films. In two cases, the nail entry point was located lateral to the tip of the greater trochanter. In the other two cases, the entry point was located too medial to the greater trochanter, violating the superoexternal cortex of the femoral neck. CONCLUSION: The event of a femoral neck fracture during closed intramedullary nailing is an unusual complication that may be caused due to a technical mistake related to the location of the nail entry portal in the proximal femur.

[Thromboembolic disease in orthopedic surgery]. / Enfermedad tromboembólica en pacientes de cirugía ortopédica.

Thromboembolic complications are frequent after orthopaedic surgery of the limbs. Strategies to minimize these complications go from recognize the risk factors of the patient to introduce new antithrombotic drugs, and including general medical care, regional anaesthesia and early mobilization. Based in epidemiological studies, prophylaxis must be extended 4-6 weeks in total hip and knee arthroplasty and in surgery of the hip fracture.

Enfermedad tromboembólica en pacientes de cirugía ortopédica / Thromboembolic disease in orthopedic surgery

Las complicaciones tromboembólicas son muy frecuentes después de cirugía ortopédica de las extremidades inferiores. Las estrategias para disminuir su incidencia van desde reconocer los factores de riesgo a la introducción de nuevos fármacos antitrombóticos, pasandopor los cuidados generales del paciente, el uso de anestesia regional y la movilización precoz. En base a estudios epidemiológicos se determina que la profilaxis debe prolongarse hasta las 4-6 semanas en la artroplastia total de cadera y de rodilla, y en la cirugía de la fractura de cadera

Thromboembolic complications are frequent after orthopaedic surgery of the limbs. Strategies to minimize these complications go from recognize the risk factors of the patient to introduce new antithromboticdrugs, and including general medical care, regional anaesthesia and early mobilization. Based in epidemiological studies, prophylaxis must be extended 4-6 weeks in total hip and knee arthroplasty and in surgery of the hip fracture

Fractura por sobrecarga en la carilla articular vertebral en un jugador de tenis de competición / Strees fracture of the vertebral articular facet in a competitive tennis player

La fractura por sobrecarga de los elementos vertebrales posterioreses una causa relativamente frecuente de dolor de espalda enlos atletas. Esta lesión ocurre normalmente en el istmo, y laespondilolisis resultante puede ser uni o bilateral. Las fracturaspor sobrecarga que asientan en los restantes elementos de la parteposterior de la columna vertebral son muy raras.Se presenta el caso inusual de una fractura aislada de la carillaarticular inferior de la tercera vértebra lumbar en un jugador detenis profesional que aquejaba dolor de espalda. Las radiografíasanteroposterior, lateral y oblicuas sugerían la presencia de undefecto en la carilla articular derecha de L3. La tomografía fueconfirmativa. La gammagrafía topográfica computarizada(SPECT) demostró un aumento de captación a nivel de la articularinferior derecha de L3 que permitió establecer el diagnósticode fractura por sobrecarga. El paciente fue controlado con tratamientoconservador (AU)

A stress fracture of the posterior elements of the lumbar spine isa relative common cause of pain in the back in athletes. Thislesion usually occurs in the isthmus, and the resultant spondylolysismay be uni or bilateral. Stress fractures rarely involve theremainder of the posterior part of the spinal column.An unusual case of an isolated inferior facet fracture of the thirdlumbar vertebra is described in a professional tennis player complainingback pain. Anteroposterior, lateral and standard obliqueradiographs were suspicious for a defect in L3 lumbar right facet.Tomograms were confirmatory. A single-photon emission computedtopographic (SPECT) scan demonstrated increased tracer uptakein the L3 right inferior facet. The working diagnosis was lumbarfacet stress fracture. The patient was treated conservatively (AU)

Rotura del ligamento interespinoso lumbar en un atleta practicante de remo / Rupture of the lumbar interspinous ligament in a rower

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