Wound complications after ankle surgery. Does compression treatment work? A randomized, controlled trial.

PURPOSE: Infection rates following ankle fractures are as high as 19% in selected material and is the most common complication following this type of surgery, with potential catastrophic consequences. The purpose of this study was to test a regime of intermittent pneumatic compression, a compression bandage and a compression stocking and its effect on the rate of wound complications. The hypothesis was that compression could lower the infection rate from 20 to 5%. METHODS: We performed a randomized, controlled, non-blinded trial, including 153 adult patients with unstable ankle fractures. Patients were randomized to either compression (N = 82) or elevation (N = 71). Patients with open fracture, DVT, pulmonary embolism, dementia, no pedal pulse, or no Danish address were excluded. Primary endpoint was infection. Secondary endpoints were necrosis and wound dehiscence. RESULTS: After 2 weeks, 1.4% (0.0;7.6) in the compression group had infection compared to 4.6% (1.0;12.9) in the control group, p = 0.35. The rate of necrosis after 2 weeks was 7.0% (95% CI 2.3;15.7) in the compression group compared with 26.2% (95% CI 16.0;38.5) in the elevation group, p = 0.004. No difference was shown regarding wound dehiscence. CONCLUSION: Based on this study, we cannot conclude if compression therapy prevents infection or not. This is mainly due to under-powering of the study. The effect on necrosis was in favor of compression, but the trial was not powered to show a difference regarding this endpoints and the result is thus hypothesis generating. Further research is needed before a thorough recommendation on the use of compression treatment that can be made.

Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty.

PURPOSE: Prothrombin fragment 1+2 measured in spot urine (uF1+2) is an indicator of thrombin generation. We examined whether measured levels of uF1+2 can be used to differentiate between patients who do and do not acquire sustained coagulation activation after total hip arthroplasty (THA). METHODS: We performed two separate studies in patients undergoing THA. Study 1 was a prospective pilot study aiming to roughly estimate the extent of pre- and postoperative fluctuations in the uF1+2 concentration. Study 2 was a larger prospective cohort study aiming to verify the findings of Study 1 and to examine the association between the uF1+2 concentrations and risk of vascular thrombotic complications (VTC) or death. Finally, we sought to define a cut-off concentration value that could be used to identify patients with a sustained uF1+2 elevation after the first postoperative week. The urine samples were analysed by ELISA. In both studies thromboprophylaxis was used for at least 7 days after the operation. RESULTS: The operative trauma resulted in elevation of the uF1+2 level in all patients compared with the preoperative level and levels in the healthy volunteers. Ten out of 113 patients (8.8%) in the second study suffered VTC or death, assumed to be caused by a coagulation problem. Analysis of variance revealed the following statistically significant associations: pre- vs. postoperative log uF1+2 levels (P<0.0001), log uF1+2 levels comparing patients with and without events (P=0.004); and the individual log uF1+2 levels (P<0.0001). A cut-off value of uF1+2 concentration between 0.3 and 0.5 nmol/l had a sensitivity and a negative predictive value between100% and 90%, and specificity between 45% and 63% and overall accuracy between 50% and 65%. This value was obtained by the analysis of a receiver operating characteristic curve with the purpose of identifying patients with sustained coagulation activation on day 5 after operation. CONCLUSION: Our studies suggest that measured levels of uF1+2 can be potentially used to assess the individual risk of VTC after THA and to test for non-invasive detection of sustained coagulation activation.

[Medical doctors' surgical abilities measured by means of a surgical simulator].

INTRODUCTION: The aim of the study was to test the surgical abilities between orthopaedic surgeons and anaesthetists on a surgical simulator intended for children. METHODS: The study was a prospective comparative study with 31 consultant or specialist grade medical doctors: 15 orthopaedic surgeons and 16 anaesthetists. The speed and failure rate when removing foreign bodies on a surgical simulator was measured. RESULTS: There was no statistically significant difference in speed and failure rate between orthopaedic surgeons and anaesthetists, when they were working on the simulator. Anaesthetists demonstrated statistically significant more body movement and more use of foul language doing the simulation, and they were more willing to read the written instruction but less likely to follow it. CONCLUSION: Anaesthetists may be just as handy as orthopaedic surgeons but should be given more physical and verbal space in the operation room. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Volar dislocation of the second and third carpometacarpal joint three months after a fall during a soccer game]. / Volar luksation af anden og tredje metacarp erkendt tre måneder efter fald under fodboldspil.

Volar dislocation of the second and third carpometacarpal joint is extremely rare and most often caused by high-energy trauma. In this case a 15-year-old boy fell on his hand while playing soccer. The injury was undiagnosed for three months, perhaps due to an ipsilateral forearm fracture. He was treated with open reduction and Kirchner wire fixation for nine weeks. At two years follow-up he had a painfree hand with a 20% reduction in grip strength.

[Splash basins are contaminated even during operations in a laminar air flow environment].

Few studies have investigated the potential contamination of splash basins and they have shown very divergent results: contamination ranging from 2.13% to 74% has been reported. This study set out to examine if splash basins used in a laminar air flow (LAF) environment during elective knee and hip arthroplasty constitute an unnecessary risk. Of the 49 cases sampled two cultures were positive (4%; 95% confidence interval = 0.49-13.9). We conclude that splash basins do get contaminated even in an LAF environment. Further studies with larger populations are needed to validate our findings.

[Bilateral rupture of the Achilles tendons after treatment with ciprofloxacin]. / Bilateral akillesseneruptur efter behandling med ciprofloxacin.

We report a case of spontaneous non-traumatic bilateral rupture of the Achilles tendons following ciprofloxacin treatment. A 54-year-old man presented with spontaneous Achilles tendon rupture on the left side, tendinitis and partial tear on the right side following few days of treatment with ciprofloxacin 500 mg twice daily and long-term treatment with prednisolon 10 mg once daily. This rare side effect caused by concurrent treatment with steroids and ciprofloxacin should be kept in mind. Any signs of tendinitis following this treatment should arouse the physicians' suspicion towards ciprofloxacin.

[No contamination of instruments on the trolley during elective arthroplasty]. / Ingen betydende kontaminering af instrumenter på instrumentbordet under elektiv alloplastikkirurgi

Infection following arthroplasty is a very serious complication as it has major impact on morbidity and mortality. This study set out to examine if leaving the instruments on the trolley would result in contamination from airborne pathogens during elective hip and knee arthroplasty. We conclude that instruments placed in a laminar airflow field do get contaminated, but further studies with a larger sample size are needed to verify the results.