[Etiology of surgical site infections in orthopedic surgery after multiple injuries]. / Etiologia zakazen miejsca operowanego narzadu ruchu w mnogich obrazeniach ciala.

UNLABELLED: Surgical site infection is one of the most severe complications in patients with multiple injuries. It causes elongation of hospitalization time, greatly increases costs of treatment and may directly endanger patient's life. The aim of the study was to analyze bacterial flora causing surgical site infections in group of patients with multiple injuries. MATERIAL AND METHODS: A retrospective analysis was conducted on medical history of 31 patients with multiple injuries, who in years 2011-2012 due to surgical site infections required further treatment in Department of Musculoskeletal System Infections. RESULTS: In analyzed material majority of infections were caused by multiple bacteria species--18 (58%). Throughout the isolated flora the most frequent were gram-negative bacteria, especially A. baumanii--16 (29.6%) and P. areuginosa--5 (9.3%). Participation of gram-positive flora which until now was dominating as a cause of musculoskeletal system infections, has significantly decreased. Additionally, in this group we can see dominance of bacteria from Enterococcus genus--E. fecalis--10 (18.5%), and not as it used to be from Staphylococcus--S. aureus--6 (11%), S. epidermidis--3 (5.6%). CONCLUSIONS: The most common were acute infections caused by multiple bacteria species with dominance of gram-negative flora. Very interesting is the fact of fall of infection rate caused by Staphylococci. Monitoring of bacterial etiological factors has a key role in proper antibiotic administration, with is essential in successful surgical treatment.

Comparative Assessment of Outcomes of Surgical Treatment of Smith and Colles Distal Radius Fractures.

BACKGROUND: The aim of the present study was to assess the effectiveness of surgical treatment of distal radial fractures following open reduction and fixation with an angle-stable plate in relation to the type of injury (flexion vs. extension fracture). MATERIAL AND METHODS: A group of 25 patients with Colles fractures and 25 patients with Smith fractures treated surgically in the years 2012-2013 was analysed retrospectively. The results were evaluated using the quickDASH and Mayo Wrist Score. Radiographic follow-up assessments included radial inclination, radial height, volar tilt and articular step-off. RESULTS: The mean Mayo Wrist Score was 72.8 points for Colles fractures and 68.3 points for Smith fractures. The mean quickDASH score was 18.2 points for Colles fractures and 20.5 points for Smith fractures. However, these differences were not statistically significant. The only significant difference in the radiographic parameters investigated was in volar tilt, which was normal in the group of patients with Smith fractures (11°), whereas in the group with Colles fractures it was 5°. CONCLUSIONS: 1. In fractures of the distal radius, the type of displacement has no significant effect on the final outcome of surgical plate fixation. 2. In fractures with dorsal displacement of fragments, it is more difficult to restore volar tilt from a volar approach.

Surgical Treatment of Radial Head Fractures: Outcomes and Complications.

BACKGROUND: Appropriate treatment of radial head fractures remains an area of disputes and controversy. The present paper aims to assess the outcomes of surgical fixation of these injuries and identify the most common complications. MATERIAL AND METHODS: The medical records of 63 patients (25 women and 38 men) treated in 2011 -2014 were analysed retrospectively. The treatment outcomes were assessed according to the Broberg and Morrey rating system and the QuickDASH score. RESULTS: Of 21 patients with isolated fractures, all those with Type 2 fractures demonstrated excellent outcomes. In the group with Type 3 fractures, 11 patients showed satisfactory and 4 unsatisfactory outcomes. Of 19 patients with a fracture combined with elbow dislocation, all those with Type 2 fractures achieved excellent results while in the group with Type 3 fractures 8 patients had satisfactory and 4 had unsatisfactory outcomes. 23 patients were diagnosed with Hotchkiss' terrible triad; 7 of them had sustained Type 2 fractures and showed satisfactory outcomes while those with Type 3 fractures demonstrated 12 satisfactory and 4 unsatisfactory results. Complications included limited elbow mobility (59% of the patients), pain (52.9%), lower muscle strength (35.3%), posttraumatic arthrosis (29.4%), heterotopic ossification (11.8%) and nonunion (1.5%). Eleven patients required repeat surgery. CONCLUSIONS: 1. Today's materials used for the fixation of fracture fragments allow for a stable fixation of almost any fracture of the radial head. 2. As long as fixation of a given radial head fracture is technically possible, open reduction and internal fixation should be attempted. 3. If fixation is impossible, radial head replacement should be a method of choice.