3D printing in pediatric neurosurgery: experimental study of a novel approach using biodegradable materials.

PURPOSE: 3D printing technologies have become an integral part of modern life, and the most routinely used materials in reconstructive surgery in children are biodegradable materials. The combination of these two technologies opens up new possibilities for the application of innovative methods in neurosurgery and a patient-centered approach in medical care. The aim of the study was to determine whether a physician without specialized programming and printing skills could independently create materials in a clinical setting for the treatment of patients. METHODS: We conducted a preclinical study on 15 male Balb-C mice. Cylindrical materials made of polylactic acid (PLA) plastic were 3D printed. Sterilization of the obtained material was performed using a cold plasma sterilizer with hydrogen peroxide vapor and its plasma. The sterile material was implanted subcutaneously into the mice for 30 days, followed by histological examination. Using open-source software for modeling and printing, plates and screws made of PLA plastic were manufactured. The produced components were tested in the biomedical laboratory of the institute. RESULTS: The histological material showed that no inflammatory changes were observed at the implantation site during the entire observation period. The cellular composition is mainly represented by macrophages and fibroblasts. There was a gradual resolution of the material and its replacement by native tissues. Research conducted to assess the effectiveness of material sterilization in a cold plasma sterilizer demonstrated its high bactericidal efficiency. CONCLUSION: The method we developed for obtaining biodegradable plates and fixation elements on a 3D printer is easy to use and has demonstrated safety in a preclinical study on an animal model.

Microporous titanium and hydroxyapatite improve fixation of the tibial wall in unicompartmental knee replacement.

PURPOSE: Cementless Oxford unicompartmental knee replacement (OUKR) is associated with less pain than cemented OUKR 5 years postoperatively. This may be due to improved fixation at the tibial wall, which transmits tension and reduces stress in the bone below the tibial component. This study compares tibial wall fixation with three different types of fixation: cemented, cementless with hydroxyapatite (HA) and cementless with a microporous titanium coat and HA (HA + MPC). METHODS: Three consecutive cohorts were identified (n = 221 cemented in 2005-2007, n = 118 HA in 2014-2015, n = 125 HA + MPC in 2016-2017). Analysis was performed on anterior-posterior radiographs aligned on the tibial component taken 1-2 years postoperatively. Aligned radiographs are needed to see narrow radiolucencies adjacent to the wall. Alignment was assessed with rotation ratio (RR = wall width/internal wall height). Perfect RR is 0.3, and a maximum threshold of 0.5 was used. Quality of fixation to the wall was assessed with fixation ratio (FR = bone wall contact height/total wall height). Notable radiographic features at the tibial wall were also recorded. RESULTS: A total of 33 knees with cement, 37 knees with cementless with HA and 57 knees cementless with HA + MPC had adequately aligned radiographs. Fixation was significantly better with HA compared with cement (55% vs. 25%, p = 0.0016). The microporous coat further improved fixation (81% vs. 55%, p < 0.0001). FR > 80% was achieved in 3% of the cemented implants, 32% of HA and 68% of HA + MPC. In cementless cohorts, features suggestive of a layer of bone that had delaminated from the wall were seen in 8 (22%) HA and 3 (5%) HA + MPC knees. CONCLUSION: Radiographic tibial wall fixation in OUKR is poor with cement. It improves with an HA coating and improves further with an intermediary MPC. Improved tibial wall fixation may explain the lower levels of pain observed with cementless rather than cemented fixation described in the literature, but further clinical correlation is needed. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Safety and efficacy of silicone tape for indwelling urinary catheter fixation in intensive care patients-A randomized clinical trial.

BACKGROUND: Critically ill patients are more vulnerable to medical adhesive-related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI. AIM: To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy. STUDY DESIGN: This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes. RESULTS: The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p = .121), including the severity of the lesions (p = .902). However, partial (p = .003) and overall (p < .001) detachment of the tapes were more frequent in the silicone group. CONCLUSIONS: Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective. RELEVANCE TO CLINICAL PRACTICE: There is no evidence to support the extensive use of silicone tape in this context.

Femoral neck osteosynthesis using interfragmentary compression or position screw in synthetic bones. What are the mechanical differences?

PURPOSE: We aim to compare interfragmentary compression with the position osteosynthesis in the fixation of different femoral neck fractures (FN) in synthetic bones subjected to vertical load. METHODS: Forty-two synthetic femurs were subjected to neck fractures and separated into 3 groups according to the Pauwels classification: Pauwels I had 6 units (PI); Pauwels II, 24 units, with and without comminution (PII); and Pauwels III, 12 units, with and without comminution (PIII). After, they were fixed with 2 different ways: three 7, 0 mm cannulated lag screws (CSs) versus three 6, 5 mm solid fully threaded screws (SSs). Screws positioning was oriented by the Pauwels classification: inverted triangle or crossed screws. All specimens were submitted to vertical loading until failure. RESULTS: The average force was 79.4 ± 22.6 Kgf. The greatest one was recorded in model 1 (135.6 Kgf), and the lowest in model 41 (39.6 Kgf). CSs and SSs had similar resistance until failure (p = 0.2). PI showed heightened resistance and PIII showed a worse response (p < 0,01). CSs had better performance in PIII (p = 0.048). Comminution and screws orientation caused no difference on peak force (p = 0.918 and p = 0.340, respectively). CONCLUSIONS: In synthetic bones, the resistance of a femoral neck fracture osteosynthesis using a 7, 0 mm cannulated lag screw or 6, 5 mm solid fully threaded screw are similar. There was no loss of efficiency with comminution in the femoral neck. Osteosynthesis resistance decreased with the verticalization of the fracture line and, in the more vertical ones, interfragmentary compression with CSs was more resistant than positional osteosynthesis with SSs.

Comparison of femoral neck system and three cannulated cancellous screws in the treatment of vertical femoral neck fractures: clinical observation and finite element analysis.

OBJECTIVE: The purpose of this study was to compare the biomechanical and clinical results of two surgical methods for the treatment of vertical femoral neck fractures: Femoral neck system (FNS) and traditional three cannulated cancellous screws (CCS). METHODS: First, we developed three different vertical femoral neck fracture models for the finite element analysis, with angles of 55°, 65°, and 75°, respectively. Two experimental groups were set up: the FNS group and the CCS group. Each fracture group was tested under axial loads of 2100 N to measure the femur's displacement, Von Mises stress (VMS), and its internal fixation components. Secondly, we retrospectively included the cases of vertical femoral neck fractures with FNS and CCS in our hospital from May 2019 to May 2021. In this study, we compared the duration of intraoperative fluoroscopy, operative time, hospital stay, fracture healing time, Hemoglobin loss, Harris score of hip joint function, and postoperative complications among patients undergoing hip joint replacement. RESULTS: In terms of finite element analysis, FNS has better anti-displacement stability than CCS at 55°and 65°, while FNS is greater than CCS in Von Mises stress. Clinically, we followed up on 87 patients for an average of 12 months. FNS was superior to traditional CCS in fracture healing time, operation time, fluoroscopy duration, fracture healing time, and Harris hip function score. CONCLUSION: FNS is superior to traditional CCS in biomechanical and clinical aspects of treating vertical femoral neck fractures. There is potential for FNS to become a new treatment option for vertical femoral neck fractures.

Carbon-fiber-reinforced polyetheretherketone orthopedic implants in musculoskeletal and spinal tumors: imaging and clinical features.

Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) orthopedic implants are gaining popularity in oncologic applications as they offer many potential advantages over traditional metallic implants. From an imaging perspective, this instrumentation allows for improved evaluation of adjacent anatomic structures during radiography, computed tomography (CT), and magnetic resonance imaging (MRI). This results in improved postoperative surveillance imaging quality as well as easier visualization of anatomy for potential image-guided percutaneous interventions (e.g., pain palliation injections, or ablative procedures for local disease control). CFR-PEEK devices are also advantageous in radiation oncology treatment due to their decreased imaging artifact during treatment planning imaging and decreased dose perturbation during radiotherapy delivery. As manufacturing processes for CFR-PEEK materials continue to evolve and improve, potential orthopedic applications in the spine and appendicular skeleton increase. An understanding of the unique properties of CFR-PEEK devices and their impact on imaging is valuable to radiologists delivering care to orthopedic oncology patients in both the diagnostic and interventional settings. This multidisciplinary review aims to provide a comprehensive insight into the radiologic, surgical, and radiation oncology impact of these innovative devices.

Clinical effect of minimally invasive technique of internal fixation device removal in patients with healed long tubular bone fractures.

Objective: To investigate the clinical effect of minimally invasive technique applied to internal fixation removal in patients with healed long tubular bone fractures. Methods: The records of patients with internal fixation of long tubular bone fracture who underwent the removal of the internal fixation device after fracture healing in The Second Affiliated Hospital of Hainan Medical College from May 2020 to December 2021 were reviewed. According to the different operation methods of taking out the internal fixation device, patients were divided into minimally invasive group (n=40) and traditional group (n=45). The perioperative indexes, levels of inflammatory factors tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), Karnofsky Performance Score (KPS), visual analog scale (VAS) pain score and complications were compared between the two groups. Results: The drainage volume, bleeding volume, incision length and hospital stay in the minimally invasive group were significantly lower than those in the traditional group (P<0.05). The KPS score of minimally invasive group was significantly higher than that of traditional group at one week and one month after the operation, and the VAS score of minimally invasive group was significantly lower than that of traditional group at one day and one week after the operation (P<0.05). The levels of TNF-α and CRP in the observation group were significantly lower than those in the control group(P<0.05). There was one case of infection in the minimally invasive group, one case of secondary fracture and two cases of infection in the traditional group(P>0.05). Conclusions: Minimally invasive surgery for the removal of the internal fixation device in patients with healed long tubular bone fractures with internal fixation is associated with significantly improved clinical effect, relieved symptoms, reduced inflammatory response, and improved functional recovery of patients.

Cervical lateral mass screw length analysis in men versus women.

Posterior fixations with lateral mass screws have become popular. The Roy-Camille and the Magerl techniques have been established and screw length was identified as a particularly important element. Sex and ethnicity are significant factors in cervical spine morphology, but few studies have been performed for screw length. We performed measurements using computed tomography (CT) images of adult patients hospitalized for surgery of the cervical spine, with targeted 3D data analysis. The final number of patients was 47 (33 men, 14 women) and 235 vertebrae. With the Roy-Camille technique, the screw length was longest at C3 (men: 13.0 mm ± 1.9 mm, women: 13.0 mm ± 1.9 mm) and smallest at C7 (men: 10.8 mm ± 1.8 mm, women: 9.4 mm ± 1.2 mm). With the Magerl technique, the screw length was smallest at C3 (men: 14.8 mm ± 1.6 mm, women: 14.3 mm ± 1.6 mm) and longest at C7 for men (16.8 mm ± 2.8 mm), and at C6 for women (15.4 mm ± 3.0 mm). To differ from spinal canal or pedicle, cervical lateral mass showed no obvious morphological differences from that of subjects of other ethnicity. The placement of a standard lateral mass screw would not cause complications in Japanese patients, even with the use of devices designed in North America or Europe. However, the anatomical background is essential because it is important to optimize the selection for each patient to avoid complications considering sex and individual differences.

Effects of patient orientations, landmark positions, and device positions on the MRI RF-induced heating for modular external fixation devices.

PURPOSE: This paper studies the RF-induced heating for modular external fixation devices applied on the leg regions of the human bodies. Through numerical investigations of RF-induced heating related to different patient orientations, landmark positions, and device positions under 1.5T and 3T MRI systems, simple and practical methods to reduce RF-induced heating are recommended. METHODS: Numerical simulations using a full-wave electromagnetic solver based on the finite-difference time-domain method were performed to characterize the effects of patient orientations (head-first/feet-first), landmark positions (the scanning area of the patient), and device positions (device on left or right leg) on the RF-induced heating of the external fixation devices. The G32 coil design and three anatomical human models (Duke model, Ella model, and Fats model) were adopted to model the MRI RF coil and the patients. RESULTS: The relative positions of the patient, device, and coil can significantly affect the RF-induced heating. With other conditions remaining the same, changing the device position or patient orientation can lead to a peak 1-g averaged spatial absorption ratio variation of a factor around four. By changing the landmark position and the patient orientation, the RF-induced heating can be reduced from 1323.6 W/kg to 217.5 W/kg for the specific scanning situations studied. CONCLUSION: Patient orientations, landmark positions, and device positions influence the RF-induced heating of modular external fixation devices at 1.5 T and 3 T. These features can be used to reduce the RF-induced heating during MRI simply and practically.

Efficacy and morbidity of biodegradable versus titanium osteosyntheses in orthognathic surgery: A systematic review with meta-analysis and trial sequential analysis.

Titanium osteosynthesis is currently the gold standard in orthognathic surgery. Use of biodegradable osteosyntheses avoids removal of plates/screws in a second operation. This systematic review aimed to assess the efficacy and morbidity of biodegradable vs. titanium osteosyntheses in orthognathic surgery (PROSPERO CRD42018086477). Patients with syndromic disorder(s) and/or cleft lip/palate were excluded. Randomised, prospective and retrospective controlled studies were searched for in nine databases (February 2021). The time periods perioperative, short-term, intermediate, long-term, and overall follow-up were studied. Meta-analyses were performed using random-effects models. A total of 9073 records was assessed, of which 33 were included, comprising 2551 patients. Seven RCTs had 'some concerns' while another seven RCTs had 'high' risk of bias (Cochrane-RoB2). No differences in malunion (qualitative analyses), mobility of bone segments [RR 1.37 (0.47; 3.99)], and malocclusion [RR 0.93 (0.39; 2.26)] were found. The operative time was longer in the biodegradable group [SMD 0.50 (0.09; 0.91)]. Symptomatic plate/screw removal was comparable among both groups [RR 1.29 (0.68; 2.44)]. Skeletal stability was similar in most types of surgery. Biodegradable osteosyntheses is a valid alternative to titanium osteosyntheses for orthognathic surgery, but with longer operation times. Since the quality of evidence varied from very low to moderate, high-quality research is necessary to elucidate the potential of biodegradable osteosyntheses.

ACL reconstruction using a quadruple semitendinosus graft with cortical fixations gives suitable isokinetic and clinical outcomes after 2 years.

PURPOSE: The objective of this single-center randomized single-blinded trial was to assess the hypothesis that anterior cruciate ligament reconstruction (ACLR) using a four-strand semitendinosus (ST) graft with adjustable femoral and tibial cortical fixation produced good outcomes compared to an ST/gracilis (ST/G) graft with femoral pin transfixation and tibial bioscrew fixation. Follow-up was 2 years. METHODS: Patients older than 16 years who underwent primary isolated ACLR included for 1 year until August 2017 were eligible. The primary outcome measures were the subjective International Knee Documentation Committee (IKDC) score, isokinetic muscle strength recovery, and return to work within 2 years. The study was approved by the ethics committee. RESULTS: Of 66 eligible patients, 60 completed the study and were included, 33 in the 4ST group and 27 in the ST/G group. Mean age was 30.5 ± 8.9 years in the 4ST group and 30.3 ± 8.5 in the ST/G group (n.s.). No significant between-group differences were found for mean postoperative subjective IKDC (4ST group, 80.2 ± 12.5; ST/G group, 83.6 ± 13.6; n.s.), side-to-side percentage deficits in isokinetic hamstring strength (at 60°/s: ST group, 17% ± 16%; ST/G group, 14% ± 11%; n.s.) or quadriceps strength (at 60°/s: ST group, 14% ± 12%; ST/G group, 19% ± 17%; n.s.), return to work, pain during physical activities, side-to-side differential laxity, balance, loss of flexion/extension, or surgical complications. CONCLUSION: This trial demonstrates that functional outcomes after 4ST for ACLR with cortical fixations could be as good, although not better, than those obtained using ST/G. The 4ST technique spares the gracilis tendon, which thus preserves the medial sided muscle and thereby could improve function and limit donor-side morbidity. LEVEL OF EVIDENCE: Level I.

Experience with resorbable sonic pins for the attachment of distraction devices in posterior cranial vault distraction operations.

BACKGROUND: Distraction techniques are effective methods for the treatment of craniosynostoses when a significant gain of an intracranial volume is required. However, this technique raises some challenges at different stages of the treatment. While installing the distractors in patients with thin calvarial bone, there is a risk of dural damage from the titanium screws. The need for wide exposure of the devices and the screws during removal causes soft tissue damage and bleeding. OBJECTIVE: This study aimed to evaluate sonic pin use in the distraction procedures. METHODS: Resorbable sonic pins were used in 11 consecutive posterior cranial vault distraction procedures to attach distraction devices to the calvarial bone. RESULTS: This method allowed for a less traumatic and faster removal of the devices without the risk of leaving foreign bodies in the wound. In three out of 11 cases on follow-up, displacement of proximal distractor footplate and partial relapse of distraction were detected. Though there was a smaller volume increase in these patients, all of them benefited clinically from the PCVD and did not require reoperations. CONCLUSIONS: This method allows a strong and stable attachment of the distractor devices to the cranial vault bones with a reduced risk of dural tears due to the screws. It also allows for easier and less traumatic device removal.

[Proximal fixation devices in endovascular repair of abdominal aortic aneyrysm with unfavourable proximal neck anatomy]. / Ustroistva proksimal'noi fiksatsii stent-grafta pri éndovaskuliarnom lechenii anevrizmy briushnogo otdela aorty s neblagopriiatnoi anatomiei proksimal'noi sheiki.

Abdominal aortic aneurysm is a common vascular disease requiring surgical treatment. Currently, endovascular aortic repair is a good alternative to open surgery. However, high incidence of unfavorable anatomical variants of the proximal landing zone limit the use of endovascular aortic repair in these patients. Additional techniques can increase applicability of endovascular procedure with optimal results. Two patients with unfavorable proximal neck anatomy undergoing endovascular aortic repair with anchor type of proximal fixation devices are reported in the article.

Metal artifact reduction in CT, a phantom study: subjective and objective evaluation of four commercial metal artifact reduction algorithms when used on three different orthopedic metal implants.

Background Metal implants may introduce severe artifacts in computed tomography (CT) images. Over the last few years dedicated algorithms have been developed in order to reduce metal artifacts in CT images. Purpose To investigate and compare metal artifact reduction algorithms (MARs) from four different CT vendors when imaging three different orthopedic metal implants. Material and Methods Three clinical metal implants were attached to the leg of an anthropomorphic phantom: cobalt-chrome; stainless steel; and titanium. Four commercial MARs were investigated: SmartMAR (GE); O-MAR (Philips); iMAR (Siemens); and SEMAR (Toshiba). The images were evaluated subjectively by three observers and analyzed objectively by calculating the fraction of pixels with CT number above 500 HU in a region of interest around the metal. The average CT number and image noise were also measured. Results Both subjective evaluation and objective analysis showed that MARs reduced metal artifacts and improved the image quality for CT images containing metal implants of steel and cobalt-chrome. When using MARs on titanium, all MARs introduced new visible artifacts. Conclusion The effect of MARs varied between CT vendors and different metal implants used in orthopedic surgery. Both in subjective evaluation and objective analysis the effect of applying MARs was most obvious on steel and cobalt-chrome implants when using SEMAR from Toshiba followed by SmartMAR from GE. However, MARs may also introduce new image artifacts especially when used on titanium implants. Therefore, it is important to reconstruct all CT images containing metal with and without MARs.

Fixation-free incisional hernia repair in the elderly: our experience with a tentacle-shaped implant.

BACKGROUND: Incisional hernia in aged patients represents a challenge even for experienced surgeons. Besides increased risk of complications due to comorbidities, mesh fixation and assuring a sufficient mesh overlap of the defect are the main issues in carrying out the repair. AIMS: In order to assure broader coverage of the abdominal wall and a tension- and fixation-free repair, a specifically designed prosthesis was developed for the surgical treatment of incisional hernias. The results of a fixation-free incisional hernia repair carried out in elderly patients using a tentacle-shaped implant are reported herewith. METHODS: A tentacle-shaped flat mesh with a large central body and integrated arms was used to repair incisional hernia in 23 elderly patients. The mesh was placed fixation-free and secured in place through the friction exerted by the tentacles. All tentacle straps were positioned with a special passer needle. Implant placement was preperitoneal in 18 patients and retromuscular sublay in five. RESULTS: In a follow-up of 18 to 59 months (mean 36 months), four seromas occurred. Postoperative fast track helped avoid the typical complications affecting this patient subset. No infection, hematoma, chronic pain, mesh dislocation or recurrence have been reported to date. DISCUSSION: The tentacle strap system allowed for reduced skin incision thus minimizing surgical trauma and ensuring easier and faster implant placement. CONCLUSION: The tentacle arms of the implant ensured mesh stability and broad defect overlap. Besides a very low complication rate, none of the typical postoperative complications of aged patients occurred.

Resorbable screw and sheath versus resorbable interference screw and staples for ACL reconstruction: a comparison of two tibial fixation methods.

PURPOSE: The anterior cruciate ligament (ACL) reconstruction is one of the most performed and successful orthopaedic procedures. The results are considered independent by the choice of the graft and the fixation devices. A growing interest on resorbable non-metallic fixation devices versus standard metallic fixation devices has been noted over recent years with few clinical experiences reported in the literature. The aim of this study is to compare the clinical and radiological outcomes of patients undergoing ACL reconstruction using autologous hamstring tendons with tibial fixation by a centrally placed resorbable screw and sheath to a combination of an eccentrically placed resorbable interference screw and supplementary staple fixation. METHODS: Ninety patients undergoing an isolated, single-bundle, primary ACL reconstruction with autologous hamstring tendons, using the same femoral fixation, were randomized to a tibial fixation with a centrally placed resorbable screw and sheath, BioIntrafix (group A), or an eccentrically placed resorbable interference screw, BioRCI, and two non-resorbable staples (group B). The latter has represented for many years our standard fixation method. Clinical evaluations (KOOS, IKDC, KT-2000™ side-to-side difference) and radiological analyses were conducted in both groups with a minimum follow-up of 2 years. RESULTS: We assisted in a satisfactory pain relief and functional improvements, without significant clinical and radiological differences in both groups. No further surgery was needed in patients with the screw/sheath tibial fixation. Seven patients with the screw/staples tibial fixation needed the surgical removal of the fixation devices due to pes anserinus irritation or local infection years after the index operation. Other parameters such as the tunnel enlargement were not statistically different in the two groups. CONCLUSIONS: Good clinical and radiological outcomes of ACL reconstruction by a screw/sheath tibial fixation have been reported showing comparable results with respect to screw/staples fixation. There were no failures associated with loss of fixation with either of tibial fixation methods. A fewer number of surgical removals of tibial devices were also recorded in patients treated by the screw/sheath fixation system, related to the absence of local intolerance or infection compared to subjects with a standard tibial fixation.

Staphylococcus lugdunensis: a neglected pathogen of infections involving fracture-fixation devices.

PURPOSE: Cases of fracture-fixation device infection involving Staphylococcus lugdunensis are not frequent. The clinical characteristics and the choice of treatment strategies of these infections are not obviously known to date. METHODS: We performed a review of fracture-fixation device infection involving S. lugdunensis managed by our centres. RESULTS: Among the 38 cases of fracture-fixation device infection involving S. lugdunensis, 53% were located in the tibia. Most of our cases (87%) were chronic infections. Purulent discharge, which occurred in 79% of cases, was the most frequent clinical symptom, followed by pain in 63%, local inflammation in 55%, and fever in 37%. Bacteremia and severe sepsis occurred in 10% and 18% of cases, respectively. Four cases (10%) were treated exclusively with antimicrobial treatment alone. Thirty-four cases (89%) were treated with a combination of surgery with antimicrobial therapy including surgical debridement, antibiotics and osteosynthesis device retention in six cases (16%), and osteosynthesis device removal in 27 cases (71%). The mean length of antibiotic treatment was 119 days. The relapse rate was high that was not related to selection of resistant strains. Polymicrobial infection had no impact on clinical outcome. A combination of surgery with antimicrobial therapy was identified as a significant prognostic factor associated with remission (p = 0.042). CONCLUSIONS: S. lugdunensis is probably involved in more infections than has been reported. Using appropriate microbiological methods laboratories should routinely identify the species of all coagulase-negative Staphylococci isolates involved in fracture-fixation device infection to better achieve the treatment strategies of fracture-fixation device infection involving S. lugdunensis.

Mini titanium plates; hearkening the end of non-rigid cranial bone flap fixation.

BACKGROUND AND OBJECTIVE: Craniotomy bone flaps should be replaced for both cosmetic and protective purposes. Different methods are available commercially. The aim of this study was to assess outcome of bone flap fixation using mini titanium plates and screws. METHODS: Between March, 2011 and March, 2014, 71 patients underwent cranial bone flap fixation with mini titanium plates and screws after craniotomy and excision of supratentorial lesions at Combined Military Hospital, Peshawar. There were 42 males and 30 females with a mean age of 40.07. All patients had supratentorial lesions. Intracranial lesion size ranged from 3 cm by 2 cm to 7 cm by 5 cm. The changes of local incision and general condition were observed. RESULTS: Subcutaneous effusion occurred in two patients. One patient developed a mild postoperative wound infection. CT scan showed good repositioning of the flap and edge to edge apposition at two weeks after operation. All the patients were followed up for 12 months post operatively. Skull had good appearance without any discharge and, local deformity or effusion. Repeat CT/MRI showed no subsidence or displacement of cranial flap or artifacts. CONCLUSION: Mini titanium plate and screw fixation of cranial flaps is a simple, cost effective and safe option for repositioning and immediate stability as compared to traditional sutures.

[Adolescent idiopathic scoliosis : Guideline for practical application]. / Adoleszente idiopathische Skoliose : Leitfaden für die praktische Anwendung.

Juvenile or adolescent idiopathic scoliosis is a relatively common spinal deformity, with an incidence of more than 1 %. Early diagnosis can lead to successful therapy. In the case of pathological clinical findings, the anteroposterior X­ray of the whole spine leads the way to the correct grading, according to Cobb angle measurement. Depending on the individual risk of progression, brace treatment will be started with a Cobb angle range of 20-25°. Important predictors of therapeutic success are sufficient primary corrective power and patient compliance. COBB angles of 40-50° usually lead to the recommendation for surgery, which is performed as either anterior or posterior spinal fusion in skeletally mature adolescents, depending on the grade of the deformity according to Lenke's classification. To achieve the best possible results, it is recommended that both conservative and surgical treatments are carried out by scoliosis specialists.

Innovation in catheter securement devices: minimising risk of infection, trauma and pain.

Urinary catheters are one of the most common invasive devices used in the NHS. The risks are well-documented and the practice of catheterisation of the bladder has been around for years. Traditionally catheter fixation devices have not been widely used, despite many best practice guidelines advising on their use as a standard within catheter care and maintenance. This article considers some of the evidence around urinary catheterisation and the benefits and limitations of fixation devices. There will be a product focus on the Optimum Medical Ugo Fix Gentle catheter fixation device, with case histories to demonstrate patient satisfaction with the product.