RESUMO
High numbers of primary joint replacement procedures lead to increasing numbers of revision surgeries due to periprosthetic joint infections. Several studies revealed different patient-associated and intervention-associated risk factors. Importance should be pointed on short operating times to avoid intraoperative colonisation of the implant with microorganisms. Patient-associated diseases such as diabetes and obesity should be influenced positively in the preoperative setting. Cessation of smoking should be started two months before surgery and continued until wound healing is completed. Intraoperative single-shot antibiotic prophylaxis has become clinical routine. Prolonged perioperative antibiotic prophylaxis is often conducted but has not shown to be effective in lowering infection rates.
Assuntos
Prótese Articular , Infecções Relacionadas à Prótese/prevenção & controle , Antibioticoprofilaxia , Biofilmes , Humanos , Prótese Articular/microbiologia , Infecções Oportunistas/etiologia , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas/cirurgia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Fatores de Risco , Abandono do Hábito de Fumar , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/cirurgia , Staphylococcus epidermidisAssuntos
Traumatismos em Atletas/cirurgia , Lesões do Quadril/cirurgia , Traumatismos do Joelho/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Tendões/cirurgia , Traumatismos em Atletas/diagnóstico , Lesões do Quadril/diagnóstico , Humanos , Traumatismos do Joelho/diagnóstico , Imageamento por Ressonância Magnética , Ossos Pélvicos/patologia , Ruptura , Âncoras de Sutura , Técnicas de Sutura , Traumatismos dos Tendões/diagnósticoRESUMO
Proximal humerus fractures treated with intramedullary nails show good results. However, the correct anatomical reconstruction of four-part fractures is demanding especially when using intramedullary nails. We therefore compared different intramedullary nail designs for the proximal humerus in a virtual morphological manner. Three commercially available nailing systems where virtually implanted in virtually generated reproducible four-part fractures of 25 digitised humeri. The objective of this study was to quantify and characterise the anatomical position of the proximal screws in the most vulnerable case of a four-part fracture. Taking into account a minimum distance of 5mm between the screw head and the fracture line, osteosynthesis was possible in 54 out of 75 cases. Difficulties placing the proximal screws could be observed at the localisation of the lower lesser tubercle or/and at the sulcus intertubercularis. This morphological analysis could be the basis for choosing the most sufficient implant intra operatively or even improving the nail design.