Post-operative infection with fresh frozen allograft: reported outcomes of a hospital-based bone bank over 14 years.

Femoral head bone allografts have traditionally been used to provide mechanical stability to areas of bony deficiency, or for its osteoinductive and osteoconductive properties. Concerns have been raised over increased infection rates following the use of fresh-frozen graft tissue. This retrospective study aims to investigate the outcomes of fresh frozen femoral heads kept in a regulated, non-commercial bone bank at a university teaching hospital.The local bone bank database was used to identify released femoral heads during a 14 year study period (September 1999-December 2013) whereby a retrospective review of patient records was undertaken to determine clinical outcome. During the observed study period, 427 femoral heads were released from cold storage. Of these, 270 femoral heads had a mean follow-up of 347 days. 157 femoral heads were excluded due to insufficient follow-up data (n = 132) or discarded due to breaks in the cold chain prior to use (n = 25). Of the 270 included femoral heads, 231 (85.6 %) had no reported complications with good graft incorporation. In the remaining 39 with reported complications, only 5 (2.6 %) developed a postoperative infection. Our findings suggest that the use of fresh frozen allograft does not materially increase the risk of post-operative bacterial infection. Our reported post-operative infection rates are comparable with infection rates of other similar studies on fresh frozen allograft use.

The economic impact of individually packaged screws.

BACKGROUND: Trends in orthopaedic surgery have seen a migration towards using individually packaged screws (IPS). The manufacturers claim IPS improves sterility, traceability, and avoids the effects of repeated sterilisation. In recent times there has been increasing pressure on the NHS to be more cost-efficient. Challenging decisions must be made to make cost-efficient choices without comprising the quality of care provided. AIM: This study investigates the cost-benefit of IPS compared to the conventional screw rack stored screws (SRSS). METHODS: A single-centred observational study was carried out in a district general hospital between February and March 2013. One-hundred and forty-seven screws were requested intra-operatively and the screw acquisition time was measured with a digital handheld timer. Screw acquisition time was defined as the time taken from the initial verbal request to when the screw was mounted ready for use. The screws were categorised into two groups: SRSS and IPS. RESULTS: The mean screw acquisition time for the SRSS group (n = 94) was 6.6 s (S.D ± 2.5). The mean screw acquisition time for the IPS group (n = 53) was 102.1 s (S.D ± 25.7). The mean difference between SRSS and IPS was 96 s (95%CI 90.3-100.8; p < 0.001). CONCLUSION: Our study suggests that the use of IPS significantly (p < 0.001) increases the operation duration and costs compared to SRSS. Based on ankle ORIF procedures alone, the use of IPS could potentially increase department spending by approximately £76,680 per year.