Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

INTRODUCTION: Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. MATERIAL AND METHOD: A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. RESULTS: 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. CONCLUSIONS: In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

[Influence on the results of surgical treatment of osteoarthritis of the hip using anatomical stem ABG]. / Wplyw dostepu operacyjnego na wyniki leczenia choroby zwyrodnieniowej stawu biodrowego z zastosowaniem trzpienia anatomicznego ABG.

The aim of this study was to evaluate the clinical and radiological results of treatment and quality of life, and impact of surgical approach in patients after arthroplasty using anatomical stem ABG II in the Department of Orthopaedics and Trauma Regional Hospital. St. Luke in Tarnów of years 2008-2011. The material consisted of 68 patients operated using a Proxima stem (surgical approaches; anterolateral--34 cases, posterior lateral---34 cases similarly). The average age was 62.2 years. Patients stayed in the hospital an average of 8 days. Term follow-up was determined after 6 weeks, 3 months and then once a year. Postoperative results were evaluated using the scale: Harris and WOMAC NRS. X-rays were evaluated for setting and migration of the prosthesis components. In assessing patients with HHS to scale achieved 73.5% of very good and good. Compared to the pre-operative assessment resulted in a significant improvement in mobility of the hip after arthroplasty. According to the standardized WOMAC extended the average score of treatment was 77.0 points. During the study showed significant reduction in pain intensity after surgery. Average NRS score before surgery was 6.4 points and 1.4 points after surgery. In the material appropriate settings were 51 and 17 axial axis of the prosthesis. No effect on clinical outcomes set in the HHS and WOMAC scales. There was no effect on the results of surgical treatment.

[Problems with treatment of trochanteric femur fractures at elderly patients]. / Problemy w leczeniu zlaman kretarzowych kosci udowej u osób w wieku podeszlym.

Authors analyzed patients complications with trochanteric fractures of femur treated in Department Orthopedic and Casualty of St. Lukas Hospital in Tarnów from 01.01.2008 to 31.12.2009 in this study. During this period were treated 167 patients. In most of cases operative treatment such as: Dynamic Hip Screw fixation, Gamma nailing, Ender's method and angle plate with screws were used. Prosthetic replacement was also used and 9 patients weren't operated because of coexisting pathological states. Basing on a done analyze of clinical material it was pronounced that independently from used surgical procedure regional and general complications are being occurred.

[Osteoporosis in orthopedics--disease of civilization]. / Osteoporoza w ortopedii--choroba cywiIizacyjna.

Osteoporosis is classificatied by WHO as one of the main civilizations diseases and is situated on the third place as a cause of death. Epidemiological data indicates that 25% of Polish population after 50 years old risk osteoporotic fractures. Low BMD, which coexist in osteoporosis is the main reason of the osteoporotic fractures. Orthopaedic procedures of osteoporosis and it's main complications--fractures are symptomatic. Orthopaedy tends for new implants technology and modern surgery procedure left the nonoperative treatment as for as possible.

[The surgical treatment outcomes of acromio-clavicular joint dislocation healing with closed reposition and Kirschners' wires stabilisation]. / Wyniki leczenia operacyjnego zwichniecia stawu barkowo-obojczykowego sposobem zamknietej repozycji i stabilizacji grotami Kirschnera.

The results of surgical treatment of acromioclavicular joint dislocation in 21 patients using closed reposition and stabilization with the use of 2 Kirschner arrowheads were presented in this study. Results of treatment were obtained on the basis of movable shoulder joint restriction, severity of pain, radiological images, as well as a subjective assessment of the operated limb function. Observation period ranged from 3 months to 3 years. It has been concluded, that closed reduction and fixation with Kirschner wires (arrowheads) is simple, barely invasive method of treatment for acromioclavicular dislocation and gives good final results, although a significant percentage of complications was observed.

[Total hip arthroplasty as solution to the problem of trochanteric fracture of the femur in patient with severe hip osteoarthritis]. / Endoptotezoplastyka calkowita jako rozwiazanie problemu zlamania okolicy kretarzowej kosci udowej u pacjenta z zaawansowana choroba zwyrodnieniowa stawu biodrowego.

The paper presents a case of sub- and intertrochanteric fracture of the right femur in a patient with coexisting severe osteoarthritis of the ipsilateral hip. The patient underwent silmultaneous fracture treatment and total hip replacement. Applied management as well as treatment results have been analyzed.

Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties.

Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. MATERIAL AND METHODS: The study was conducted in 2012-2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). RESULTS: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. CONCLUSIONS: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.

Quality of live of patients in the evaluation of outcomes of short stem hip arthroplasty for hip osteoarthritis.

BACKGROUND. The aim of the study was to evaluate clinical outcomes and broadly defined quality of life in patients with hip osteoarthritis after short stem hip arthroplasty. MATERIAL AND METHODS. The study enrolled patients operated on at the Trauma and Orthopedics Department of St. Luke's Regional Hospital in Tarnów in the years 2008-2010. The experimental group consisted of 67 patients aged 22 to 77 years (average age 54.0 years) who received Proxima short stem implants (DePuy, J&J, USA). The control group consisted of 68 patients, operated on at the same department and in the same period, who were implanted with the ABG II prosthesis with a classic anatomical stem (average age 62.2 years). The average duration of hospital stay was 8 days. Follow-up examinations were scheduled at 6 weeks, 3 months and subsequently once a year. Post-operative outcomes were evaluated with the Harris Hip Score (HHS), WOMAC index and NRS. RESULTS. Analysis of HHS scores in the experimental group showed that 89.6% of the patients demonstrated excellent and good outcomes. The hip range of motion improved significantly after arthroplasty compared to preoperative values. The mean standardized extended WOMAC score was 85.5. Pain intensity in the experimental group decreased significantly after surgery. The mean preoperative NRS score was 6.6 vs. 1.0 after surgery. The outcomes in the control group were also excellent and good, but far worse than those in the experimental group as regards both clinical status and quality of life. A comparison of HHS scores showed statistically significant differences between the groups (p=0.018). The mean WOMAC score in the control group was 77.0, which is a statistically significant difference compared to the figure in the experimental group (p=0.001). Both groups had lower NRS scores after surgery, but the values were significantly worse in the control group (p=0.001). CONCLUSIONS. The outcomes of Proxima short stem arthroplasty in patients with hip osteoarthritis were better than the outcomes of patients who were implanted with the classic anatomical ABG stem. Pain reduction and an increased hip range of motion had the strongest impact on improving patients' quality of life after short stem prosthesis hip arthroplasty.