We conducted a randomized controlled trial (RCT) to investigate if iodine impregnated incision drapes (IIID) increases bacterial recolonization rates compared to no drape use under conditions of simulated total knee arthroplasty (TKA) surgery.

Background: To prevent surgical site infection (SSI), one of the important issues is managing the patient´s own skin flora. Many prophylactic initiatives have been suggested, including the use of IIID. IIID has been debated for many years and was deemed ineffective in preventing SSI in a recent systematic review [1], while some evidence suggests a potential increase in postoperative infection risk, as a result of IIID use [2].

IIID is sparsely investigated in orthopaedic surgery. An increase in the number of viable bacteria in the surgical field of an arthroplasty operation has a potential to increase the risk of SSI in an otherwise elective and clean procedure [3].

20 patients scheduled for TKA were recruited. Each patient had one knee randomized for draping with IIID [4] while the contralateral knee was left bare, thus the patients acted as their own controls. Operating theater settings with laminar airflow and standard perioperative procedures were simulated. Sampling was performed with the cup-scrup technique [5] using appropriate neutralizers. Samples were collected from the skin of each knee prior to disinfection and on 2 occasions after skin-preparation, 75 minutes apart. Bacterial quantities were estimated by spread plating with 48-hour aerobic incubation. Outcome was measured as colony forming units per square centimeter of skin. We used Wilcoxon signed-rank test for comparative analysis within and between knees.

Following skin-disinfection we found no significant difference in bacterial quantities between the intervention and the control knee (p = 0.388). Neither did we see any difference in bacterial quantities between the two groups after 75 minutes of simulated surgery (p = 0.367). When analyzed within the intervention and control group, bacterial quantities had not significantly increased at the end of surgery when compared to baseline, thus no recolonization was detected (p = 0.665 and 0.609, respectively).

Iodine impregnated incision drapes did not increase bacterial recolonization rates in simulated TKA surgery. Thus, the results of this RCT study does not support the hypothesis that iodine impregnated incision drapes promotes bacterial recolonization and postoperative infection risk.

Introduction

The length of hospital stay following a hip fracture has decreased significantly during the past decades. Knowing that a hip fracture patient is often one with several comorbidities and high mortality, is it possible to further decrease the length of stay without compromising the quality of care?

Introduction: The main problem using first generation Gamma-nail in the treatment of intertrochanteric fractures has been a high frequency of intra- and postoperative femoral fractures. The TGN was thought to represent an improvement in design and potentially a less invasive treatment.

Material and methods: 146 fractures were randomised prospectively to either DHS or TGN. The 2 groups were comparable regarding age, gender and fracture type (AO). Follow-up was carried out after 4 and 12 months.

Results: Average operation time in the TGN group was 63 min (SD=30min) and 48 min (SD=23) in the DHS group (p=0.0016). There was no difference in intra-operative blood loss, need for blood transfusion, length of hospital stay or mortality. Two femoral fractures occurred postoperatively in the TGN group. At follow-up 12 patients in the TGN and 6 patients in the DHS group had had a reoperation (p> 0.05). Six reoperations in the TGN group and 3 in the DHS group resulted in preservation of the hip joint. The remaining patients had an arthroplasty or a Girdlestone resection. Poor reduction and/or positioning of the implant was significantly correlated to the risk of reoperation (p< 0.001). Specific technical errors could be identified among 3 fractures in the TGN group leading to reoperation. Any correlation between fracture type and reoperation could not be demonstrated.

Conclusion: In this study operation time was significantly longer in the TGN group. Among other variables no significant differences could be demonstrated. In our department, with a high number of residents performing these operations, the DHS will continue to be the standard implant. Whether the TGN has a place in a subgroup of intertrochanteric fractures, operated by specialized surgeons, needs further investigation.

Introduction: Among numerous international studies on hip fractures only few were dealing with the occurrence and risk of a subsequent hip fracture. Some studies contain information identifying patients at risk of subsequent hip fractures as well as the risk of a hip fracture following another osteoporotic fracture, others on outcome following the subsequent fracture.

Material and methods: The Funen County Hip Fracture Register contains information on every consecutive hip fracture in the county of Funen since January 1st 996. The register contains general information about the patient i.e.: type of fracture, operative treatment, complications, living conditions, ADL, as well as information from 4 and 12 month out-patient visit and if necessary re-surgery. A maximum of 155 variables can be recorded about every patient. The register has been subjected to a complete revision and validation (4.660 patient files was checked) and contained a total number of 7.457 hip fractures from January 1st 1996 to December 31st 2003. Incidence numbers were calculated based on risk of fracture from the first fracture since January 1st 1996 to death or December 31st 2003.

Results: In the period January 1st 1996 to December 31st 2003, 7,457 fractures were registered. Of these, 261 patients were registered with a second fracture, the primary fracture occurring before the period and thus excluded. Within the period 6,676 primary fractures were registered, and of these 520 patients (7.5 %) experienced a subsequent fracture. The median time from primary to subsequent fracture was 8 months (range 0–75 months) in males and 14 months (range 0–82 months) in females, the overall median was 13.5 months (range 0–82 months). In males the risk of dying after the primary hip fracture was 10 times higher than the risk of sustaining a subsequent hip fracture, in females it was five times higher.

Conclusion: Only few patients with a hip fracture will experience a subsequent hip fracture and with the short time frame presented, any intervention should have immediate impact.