Presence of superficial wound infection following total joint replacement (TJR) increases risk of deep prosthetic infection and revision surgery. Early identification and management are advocated. We conducted an audit to identify the number of suspected wound infections, treatment received, and whether diagnosis was supported by microbiological evidence. Early complication data were collected for all TJRs completed in a 12-month period (2012, n=314). Medical records were reviewed for all complications and summarised data were compared with data from 2010/11. Forty-nine complications were recorded (47 in 2010/11) with increase in number of bacteriologically confirmed wound infections (from 2 to 6) and in number of serious wound infections (n=3). Review of medical records showed that patients were treated in the community with antibiotics despite lack of objective microbiological evidence. Two of three serious wound infections were preceded by prolonged antibiotic prescription in the community. Analysis of these results led to a new system for management of suspected wound infection in TJR patients. A ‘wound care card’ is issued at time of discharge and early assessment by a specialist orthopaedic nurse is available. Early results indicate a beneficial effect with potential to improve patient experience and long-term outcome, and to reduce overuse of antibiotics

Objectives. Irrigation is the cornerstone of treating skeletal infection by eliminating pathogens in wounds. A previous study shows that irrigation with normal saline (0.9%) and ethylenediaminetetraacetic acid (EDTA) could improve the removal of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) compared with normal saline (NS) alone. However, it is still unclear whether EDTA solution is effective against infection with drug-resistant bacteria. Methods. We established three wound infection models (skin defect, bone-exposed, implant-exposed) by inoculating the wounds with a variety of representative drug-resistant bacteria including methicillin-resistant S. aureus (MRSA), extended spectrum beta-lactamase-producing E. coli (ESBL-EC), multidrug-resistant Pseudomonas aeruginosa (MRPA), vancomycin-resistant Enterococcus (VRE), multidrug-resistant Acinetobacter baumannii (MRAB), multidrug-resistant Enterobacter (MRE), and multidrug-resistant Proteus mirabilis (MRPM). Irrigation and debridement were repeated until the wound culture became negative. The operating times required to eliminate pathogens in wounds were compared through survival analysis. Results. Compared with other groups (NS, castile soap, benzalkonium chloride, and bacitracin), the EDTA group required fewer debridement and irrigation operations to achieve pathogen eradication in all three models of wound infection. Conclusion. Irrigation with EDTA solution was more effective than the other irrigation fluids used in the treatment of wound infections caused by drug-resistant pathogens. Cite this article: Z. Deng, F. Liu, C. Li. Therapeutic effect of ethylenediaminetetraacetic acid irrigation solution against wound infection with drug-resistant bacteria in a rat model: an animal study. Bone Joint Res 2019;8:189–198. DOI: 10.1302/2046-3758.85.BJR-2018-0280.R3

Complication rates are an increasingly topical issue. Figures are widely published in elective surgery. We were unable to find any overall rates published solely for trauma surgery involving metal implants. We wanted to identify our overall rate as a matter of good practise and to produce a figure for others to compare against. We wanted to identify the overall infection rate and study those infections in terms of fracture healing, implant survival and chronic soft tissue infection. A wound infection was any wound where there was a positive culture, prolonged pus drainage with or without a sinus or presence of pus at further surgery with or without a positive culture. Metal implants were any metalwork covered primarily or secondarily with soft tissue. 708 implants were inserted over the 11 month period studied. The causative organism was staphylococcus aureus in 65% of cases and a third of these were MRSA. Other organisms included coliforms, acinobacter, pseudomonas and bacillus. Of 52 patients who had a wound infection, 6 (11.5%) had no treatment with no detrimental effect, 34 patients had antibiotics alone and 27 had no further problems. 2 died from sepsis related causes, 3 died from other causes, 1 had delayed union but no evidence of continuing infection and 1 had chronic soft tissue discharge but bony union. 12 patients had further surgery and antibiotics. 6 retained their metal work and of these 3 died from sepsis related causes, 1 had no further problems, 1 tibial nailing became a chronic discharging osteomyelitis and 1 olecrannon fracture became an uninfected non-union. For the 6 patients who had their metalwork removed 2 died, 1 from sepsis, 2 had successful revisions and 2 were continuing treatment at most recent follow-up. Conclusion: overall deep wound infection rate was 7.3%. Most deep wound infections were treated with antibiotics alone with a satisfactory outcome. Re-operation rate for deep wound infection was 1.7%. There is very little information available on overall deep wound infection rates for implants in trauma surgery; we offer our findings as a comparison for future reference

Introduction and Aims: The rate of wound infection for HIV positive patients, range from 0–33% for closed fractures to 72–80% for compound fractures. For the outcome at our institute, I undertook to study the rate of surgical wound infection in HIV positive patients undergoing unreamed intramedullary fixation for acute fractures. Method: A prospective single blind study involving 45 patients, who sustained acute fractures of the femur and/or tibia were treated with unreamed intramedullary nails at Durban’s Metropolitan hospitals during April 2002 to June 2003. Eighteen patients were HIV positive with a mean age of 29 years (20–47) compared to 28.5 years (15–56) amongst the HIV negative. There were six and three females in HIV positive and negative groups respectively. Motor vehicle accidents involving pedestrians and gunshot injuries accounted for the majority of the fractures. Although all of the patients were asymptomatic prior to injury, fourteen had associated injuries. Results: The mean follow-up was 7.3 months (1–14). Following discharge from hospital, patients were seen at two and six weeks, three, six, nine, and 12 months post-operatively. Amongst patients with closed fractures, nine were HIV positive, seven with femur and two with tibia fractures and amongst the HIV negative group 12 patients had femur and seven tibia fractures. Three of the HIV positive patients had compound fracture tibia, each with a Gustilo type II, type IIIA and type IIIB fracture, while four HIV negative patients with, two each of grade II and grade IIIB fracture tibia. Amongst the six HIV positive patients who had compound fractures of the femur one had a grade I, two grade II, two grade IIIA and two grade IIIB fractures. Four HIV negative patients had compound femoral fractures, three with grade II and one grade IIIA. Two patients had wound infection, at one week a HIV positive male with a grade IIIA fracture of the femur and a HIV negative female at two weeks with a grade IIIB fracture of the tibia, resulting in an infection rate 5.5% and 3.7% for the HIV positive and HIV negative patients respectively. This difference was not statically significant (p=0.641). Conclusion: The results show that when asymptomatic HIV positive patients are treated operatively for acute long bone fractures, be they closed or compound, the rate of surgical wound infection is comparable to those of HIV negative patients

Introduction. Wound surveillance has been reported to result in a significant fall in the incidence of wound sepsis in total knee arthroplasty (TKA). However, there is currently little guidance on the definition of surgical wound infection that is best to be used for surveillance. The purpose of this study was to assess the agreement between three common definitions of surgical wound infection as a performance indicator in TKA; (a) the CDC 1992 definition, (b) the NINSS modification of the CDC definition and (c) the ASEPSIS scoring method applied to the same series of surgical wounds. Methods. A prospective study of 500 surgical wounds in patients who underwent knee arthroplasties between May 2002 and December 2004 from a single tertiary centre were assessed according to the different definitions of surgical wound infection. Results. A total of 500 wounds were assessed in 482 patients. Mean age of patients was 70+/−11 years, 61.6% were females, duration of surgery was 101+/−49 minutes and mean follow-up was 35.2+/−25.7 months. The most commonly isolated species were Coagulase negative staphylococci (33.3%), Staphylococcus aureus (25%) and Pseudomonas aeruginosa (16.6%). The mean percentage of wounds classified as infected differed substantially with different definitions: 5.8% with the CDC definition, 3.6% with the NINSS version and 2.2% with an ASEPSIS score > 20. When superficial infections (according to CDC category) were included, 5.2% (26) of all observed wounds received conflicting diagnoses, and 1.4% (7) were classified as infected by both ASEPSIS and CDC definitions. When superficial infections were excluded, the two definitions estimated about the same overall percentage infection (2.2% and 2.6% respectively), but there were almost three times as many conflicting infection diagnoses (n=14) as concordant ones (n=5). Conclusion. Distinctions in surgical wound infection definitions contribute to notable differences in how infections are classified after TKA. Even small changes made to the CDC definition, as with the NINSS version, caused major variation in estimated percentage of wound infection. A single definition used consistently can show changes in wound infection rates over time at a single centre. However, differences in interpretation prevent comparison between different centres

Introduction: Proximal femoral fracture (PFF) is the leading cause of Trauma admission. Deep surgical wound infection occurs in approximately 3% of these patients. The purpose of this study was to assess the cost of deep infection to the patient, in terms of mortality and social consequences, and to the National Health Service, in terms of financial burden. Methods: 61 consecutive patients (51 females, 10 males) treated for PFF, complicated with deep surgical wound infection over a seven-year period are presented. A control group consisting of 122 patients, without infection, were individually case matched (2:1) for factors that affect outcome after PFF (age, sex, ASA grade, fracture type, operation, and pre-fracture residence, social dependence, and mobility). Outcomes included length of admission (Trauma unit, rehabilitation bed, community hospital), number of operations, antibiotic administration and outpatient treatment, final destination, and mortality at one, three, and six months. A total cost of treatment was obtained from this data and supplied finance department figures. Results: MRSA was responsible for 31 cases. Infected cases required an average of two wound debridements. 16 patients had a Girdlestones procedure of whom two were subsequently revised to total hip replacement. For all patients, the average Trauma unit admission was 58 days in the infected cases, with a further 40 days spent in rehabilitation or community beds, versus 16 days and 27 days respectively in the controls (p < 0.001). 34% of infected cases died before discharge versus 15% of controls (p = 0.004). For the patients surviving to discharge, the mean total hospital stay was 124 days for the infected cases versus 45 days in the controls (p < 0.001). A higher proportion of the survivors in the control group returned to their original residence compared to the infected survivors (p = 0.002). The mortality rates in the infected group were 15% at 1 month, 31% at 3 months, and 38% at six months, versus 9%, 20%, and 25% respectively in the control group (p = 0.36, 0.12, 0.12). The median cost of treatment per infected case was 23960 versus 7390 per control case. Conclusions: Deep surgical wound infection after proximal femoral fracture is a devastating complication for both the patient and the NHS. It is associated with a higher in-patient mortality, and fewer survivors return to their pre-fracture residence. Hospital stay is greatly increased and survivors spend 4 months on average in hospital. Additional costs are huge and are incurred at all levels. The extra financial cost of treating a single infected case would fund the treatment of two non-infected cases. These costs should be considered when allocating funds and beds to Trauma services, in addition to ensuring measures known to minimise infection rates are in place

Deep prosthetic infections are a significant cause of failure after arthroplastic surgery. Superficial wound infections are a risk factor for deep infections. We aimed to quantify the risk of deep infection after superficial wound infections, and analyse the microbiology of organisms grown. We defused Superficial Infection according to the definition used by the Centre for Disease Control, and Deep Infection according to the Swedish Hip Register. We retrospectively analysed the results of 6782 THR and TKRs performed consecutively from 1988–1998. We analysed patient records, radiology and microbiological data. The latter collected prospectively by our infection control team. We identified 81 (1. 2%) superficial wound infections, however we had to exclude 3 due to poor follow-up. Of the 78 patients studied, mean age was 71 (23–89), 50 were female, 28 male, 41 THR, 37 TKR and follow-up was a mean 49 months (12–130). The majority (81%) of organisms grown in the superficial wound infections were gram positive Staphylococci. These organisms were most frequently sensitive to Erythromycin or Flucloxacillin. All the superficial infections were treated with antibiotics, 66% settled with less than 6 weeks therapy. Deep prosthetic infections occurred in 10% of superficial infections in both THR and TKR. In 80% of cases the organism in the superficial infection caused the deep infection. Wound dehiscence, haematoma, post-op pyrexia and patient risk factors had no affect on onset of deep infection. However patients who had a wound discharge with positive microbiology and those patients in whom there was clinical doubt about the diagnosis of deep infection and thus had antibiotic therapy for more than six weeks had increased risk of deep sepsis

Patients admitted to trauma wards are routinely screened for MRSA pre-operatively. The majority of them have implant surgery before the screening results were available. The aim of our study was to identify the incidence of MRSA wound infection in these patients and their outcome following it. We randomly reviewed 40 patients who were colonised with MRSA pre-operatively and have had implant surgeries. The case notes, drug charts and the microbiology were reviewed to identify the incidence of MRSA wound infection and its outcome in these patients. The place of residence, site of colonisation and the treatment given were also considered. 70% of the patients were admitted from home and 20% had previous admission within one year. The commonest site colonised is the nose (50%) followed by the perineum in 20%. Multiple sites were colonised in 10% of the patients. Only 50% of them with positive nasal MRSA were given nasal bactroban and chlohexidine wash was given in only 70% of them with MRSA colonisation in other areas. 22.5% (9/40) of the patients developed MRSA infection post operatively and they were treated with vancomycin or teicoplanin. Wound debridement and washout were done in 67.5%. 75% of the MRSA infected wound healed well with no MRSA in the wound site after treatment. 25% of the MRSA infected wounds had persistent MRSA in the wound. As per our study the incidence of MRSA wound infection in patients colonised pre-operatively is about 22.5%. Most cases seem to heal well without much complication with appropriate antibiotics and wound care

Late wound infection is a recognised complication of instrumented spinal deformity surgery. In most cases it is a benign complication which usually resolves after implant removal. However, some of our patients with late infection developed a pseudoarthrosis. To investigate this further we undertook a retrospective review of all patients undergoing implant removal for deep infection between 1991 and 2000. Twenty-one patients were identified, representing a late infection rate of at least 6%. They showed no specific pre- or intra-operative risk factors. Nine had some problems with early post-operative wound healing, which settled with minimal treatment. Late infection presented as localised swelling or a discharging sinus between 4 and 84 months (average 31 months) post-surgery. Blood parameters were abnormal in 15 cases, frank infection demonstrated in 19 cases, loosening of the implant in four cases and positive bacteriology culture in 14 cases. Wounds healed within 2 to 17 weeks (average 5 weeks) following implant removal, wound debridement and antibiotic therapy lasting 2 to 20 weeks (average 6 weeks). This was delayed until one year post-surgery in the three cases presenting early. Follow-up of between 6 and 92 months (average 38 months) revealed no persistent infection. Pseudoarthrosis developed in seven patients (33%). Four of these patients had progressive deformity warranting refusion and three produced minimal symptoms. Patients developing a pseudoarthrosis had an excess of post-operative wound problems, presented much earlier and had more severe infections compared to those without sequelae. Late infection is confirmed as a relatively common complication of scoliosis surgery. Implant removal, aggressive debridement and primary closure is confirmed as effective treatment to eradicate the infection. A high rate of pseudoarthrosis is the only sequelae. The excess of early infections in these cases may indicate interference with a critical stage of the fusion process. Preservation of the implants until one year post surgery was unsuccessful at preventing a pseudoarthrosis

Infection in orthopaedic surgery has a large impact on outcome. This study audits the use of a microbial sealant and the infection rate of a single surgeon’s practice over four institutions in an 18 month period. The aim is to demonstrate a reduction in infection rate with its use. A consecutive series of operative cases using a microbial sealant was compared with a similar number of cases prior to its introduction. A microbial sealant (n-butyl compare cup placement using imageless navigation to a historical control group cyanoacrylate) is used to bond to skin pre-operatively therefore immobilizing bacteria. This would reduce intra-operative wound contamination from skin flora. The criteria for surgical site infection was taken from the guideline for prevention of surgical site infection (1999) form the National Centre for Infectious Diseases. Over an 18 month period 624 consecutive operative cases where a microbial sealant was used was reviewed. This was compared with a similar cohort of cases prior to the introduction of the microbial sealant. The case load included hip and knee arthroplasty, osteotomies of the knee, knee ligament reconstruction and surgery for neck of femur fractures. Three deep and two superficial wound infections were found in the sealant group use compared with four deep and three superficial infections in the non sealant group use. The numbers available did not allow statistical evaluation over a trend of infection reduction is noted. A microbial sealant is intended to be applied on skin after standard surgical skin preparation. The results obtained in this single surgeon’s surgical case audit demonstrate a tendency for infection reduction, however a larger series is required for statistical significance

The purpose of the study was to identify factors that affect the incidence of deep wound infection after hip fracture surgery. Data from a hip fracture database of 7057 consecutively treated patients at a single centre was used to determine the relationship between deep wound sepsis and a number of factors. Fisher's exact test and the unpaired T test were used. All patients were initially followed up in a specialist clinic. In addition a phone call assessment was made at one year from injury to check that no later wound healing complications had occurred. There were 50 cases of deep infection (rate of 0.7%). There was no significant difference in the rate of deep sepsis with regards to the age, sex, pre-operative residential status, mobility or mental test score of the patient. Specialist hip surgeons and Consultants have a lower infection rate compared with surgeons below Consultant grade, p=0.01. The mean length of anaesthesia was longer in the sepsis group (76minutes) compared to the no sepsis group (65minutes), this was significant, p=0.01. The patient's ASA grade and fracture type were not significant factors. The rate of infection in intracapsular fractures treated by hemiarthroplasty was significantly greater than those that had internal fixation, p=0.001. The rate of infection in extracapsular fractures fixed with an extra-medullary device was significantly greater than those fixed with an intra-medullary device, p=0.021. The presence of an infected ulcer on the same leg as the fracture was not associated with a higher rate of deep infection. In conclusion we have found that the experience (seniority) of the surgeon, the length of anaesthesia and the type of fixation used are all significant factors in the development of deep sepsis. These are all potentially modifiable risk factors and should be considered in the treatment of hip fracture patients

Current perception is that standard Cefuroxime only [C4] based prophylaxis regimen demonstrated higher association with C Difficile (C. Diff) diarrhoea. This has prompted change in antibiotics prophylaxis combination regimens like Flucloxacillin-Gentamycin (F-G], Teicoplanin- Gentamycin [T-G] and single dose Cefuroxime-Gentamycin [C-G]. The current study was done to investigate the association of C. Diff diarrhoea and surgical site infection (SSI) rate with Cefuroxime only regimen prophylaxis in fracture neck of femur surgery. A retrospective analysis for 2009–2012 was performed for 1502 neck of femur fracture patients undergoing surgery. The factors studied were ASA grade, SSI, C. Diff diarrhoea rates in patients with Cefuroxime (induction plus two doses) based prophylactic regimen. The data was obtained from coding department and further streamlined based on microbiology. 1242 patients were included in the study who received Cefuroxime only regimen. The Male : Female distribution was 353 : 889. The average ASA grade was 3. The analysis demonstrated that C. Diff diarrhoea rate in the study population was 1.29%. The SSI rate stood at 3.06% with superficial infection at 2.5 % and deep at 0.56 %. Our single centre based study demonstrated low C. Difficile related diarrhoea rates with Cefuroxime only regimen. The SSI rates were also low as compared to the current literature thus concluding that Cefuroxime only antibiotic regimen can safely be administered in neck of femur surgery.

Wound complications are common in patients with soft tissue sarcomas (STS) treated with surgical excision. Limited data is available on predictive factors for wound complications beyond the relationship to neo-adjuvant or adjuvant radiotherapy. Likewise, the association between blood transfusion, patient comorbidities and post-operative outcomes is not well described. In the present study we identified the predictive factors for blood transfusion and wound complications in patients undergoing surgical resection of soft tissue sarcoma from a national cohort.

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent surgical resection of a STS from 2005 to 2013. Primary malignant soft tissue neoplasms were identified using the following ICD-9 codes: 171.2, 171.3 and 171.6. Patients treated with both wide excision and amputation were identified using the current procedural terminology (CPT) codes. Prolonged operative time was defined as greater than 90th percentile of time required per procedure. A multivariable logistic regression model was used to identify associations between patient factors and post-operative wound complications (superficial and deep surgical site infections (SSI), and wound dehiscence). A similar regression model sought to identify prognostic factors for blood transfusion and associations with post-operative outcomes.

A total of 788 patients met our inclusion criteria. Of theses, 64.2% had tumours in the lower limb, 23.1% patients had tumours in the upper limb, and 12.7% patients had pelvic tumours. Six hundred and forty patients (81.2%) underwent surgical excision; 148 (18.8%) patients had an amputation. Multivariable logistic regression modeling identified American Society of Anaesthesiologist (ASA) class 3 and 4 (OR=2.3, P=0.03; OR=8.3, P=0.001, respectively), amputation (OR=14.0, P<0.001) and prolonged operative time (OR=4.6, P<0.001) as significant predictors of blood transfusion. Radiotherapy (OR=2.6, P=0.01) and amputation (OR=2.6, P=0.01) were identified as predictors of superficial SSI, whereas ASA class 4 (OR=6.2, P=0.03), prolonged operative time (OR=3.9, P=0.012) and return to the operating room (OR=10.5, P<0.001) were associated with deep SSI. Male gender (OR=1.8, P=0.03), diabetes (OR=2.3, P=0.03), ASA class 3 (OR=2.4, P=0.003), amputation (OR=3.8, P<0.001) and steroids (OR=4.5, P=0.03) were identified as predictors for wound dehiscence and open SSI.

A national cohort demonstrates that male gender, diabetes, chronic steroid use, higher ASA score and radiotherapy are associated with an increased incidence of wound complications. One in twenty-three patients undergoing resection of an STS will require a blood transfusion, and this risk is correlated with amputation, prolonged operative time and increased ASA score. Strategies to decrease the risk of blood transfusion and wound complication should be considered for these patient groups.

Methicillin-resistant Staphylococcus aureus (MRSA) has increased in prevalence and significance over the past ten years. Studies have shown rates of MRSA in Trauma and Orthopaedic populations to be from 1.6% to 38%. Rates of MRSA are higher in long term residential care.

It has been Department of Health policy to screen all Trauma and Orthopaedic patients for MRSA since 2001. This study audited rates of MRSA screening in patients who presented with fractured neck of femur treated with Austin Moore hemi-arthroplasty over the course of one year. Rates of MRSA carriage and surgical site infection (SSI) were derived from the computerised PAS system and review of case notes.

9.8 % of patients were not screened for MRSA at any time during their admission. The rate of MRSA carriage within the study population was 9.2%. The MRSA SSI rate was 4.2%. MRSA infections are associated with considerable cost and qualitative morbidity and mortality.

There is good evidence for the use of nasal muprocin and triclosan baths in reducing MRSA. Single dose Teicoplanin has been shown to be as effective as traditional cephalosporin regimes. There is new guidance for the use of prophylactic Teicoplanin for prevention of SSI. We should consider introducing both topical and antimicrobial MRSA prophylaxis.

Background: Several studies have shown that uncomplicated hip or knee arthroplasties induce an abrupt rise in serum C-reactive protein (CRP) concentration for a few days, falling thereafter to preoperative level within a couple of weeks, if no infection is present.

Aim: To evaluate the computer-aided CRP levels analysis in a primary hospital care setting.

Material and Methods: 300 patients undergoing total knee and hip replacements were screened before and for 5 days after arthroplasty. The data were recorded in a database and mathematical algorithm to obtain integral and progressive field surface of the CRP curve.

Results: An elevated C-reactive protein level on the fifth postoperative day correlated positively with the development of acute periprosthetic infection in the first three months postoperatively.

Conclusions: The patient’s individual pattern not following one of the four normal patterns can be argued to necessitate introduction of any infection treatment (whether debridement with retention or antimicrobial therapy alone) within the first three months after the operation.

Effective pre-surgical preparation is an important step in limiting surgical wound contamination and prevention of surgical site infection. The purpose of this study is to evaluate bacterial skin contamination after surgical skin preparation in foot surgery prior to surgery and at the end of surgery, in order to determine if current techniques are satisfactory in eliminating harmful pathogens, and to compare the results of the cultures obtained pre and post operatively with infection rate.

Twenty consecutive patients scheduled for Hallux Valgus procedures were studied. Each lower extremity was prepared in the regular method with a two-step technique, Septal scrub followed by a Alcohol Chlorhexidine antiseptic solution. After preparation and draping, cultures were obtained at three locations: the hallux nailfold, first, second, third and fourth web spaces, and the anterior ankle (control). Prior to surgery, positive cultures were obtained from 80% of hallux nailfolds and 5% of web spaces. At the end of surgery, positive cultures were obtained from 80% of hallux nailfolds and 25% of web spaces. None of the controls had positive culture. 5% of all cases developed post operative infection.

Based on the findings of the current study, pre-surgical skin preparation with a two-step Septal scrub followed by a Alcohol Chlorhexidine antiseptic solution is not sufficient in eliminating pathogens in foot and ankle surgery. No statistical correlation was found between the results of the cultures obtained preoperatively or post operatively with post operative infection rate. The unique environment of the foot and its resident organisms probably plays a role in the higher infection rates associated with surgery of the foot. Better methods of preparing the surgical site should be searched for.

The routine use of intraoperative vancomycin powder to prevent postoperative wound infections has not been borne out in the literature in the pediatric spine population. The goal of this study is to determine the impact of vancomycin powder on postoperative wound infection rates and determine its potential impact on microbiology. A retrospective analysis of the Harms Study Group database of 1269 adolescent idiopathic scoliosis patients was performed. Patients that underwent a posterior fusion from 2004-2018 were analyzed. A comparative analysis of postoperative infection rates was done between patients that received vancomycin powder to those who did not. Statistical significance was determined using Chi-squared test. Additionally, the microbiology of infected patients was examined. In total, 765 patients in the vancomycin group (VG) were compared to 504 patients in the non-vancomycin group (NVG). NVG had a significantly higher rate of deep wound infection (p<0.0001) and associated reoperation rate compared to VG (p<0.0001). Both groups were compared for age, gender, race, weight, surgical time, blood loss, number of levels instrumented, and preop curve magnitude. There were significant differences between the groups for race (p<0.0001); surgical time (p=0.0033), and blood loss (p=0.0021). In terms of microbiology, VG grew p.acnes (n=2), and serratia (n=1), whereas NVG grew p.acnes (n=1) and gram positive bacilli (n=1). The remaining cultures were negative. The use of intraoperative vancomycin powder in adolescent idiopathic scoliosis appears to contribute significantly to deep wound infection prevention and reduction of associated reoperations. Based on this study's limited culture data, Vancomycin does not seem to alter the microbiology of deep wound infections

Our study sought to establish the necessity of prolonged pre-operative antibiotic prophylaxis in patients presenting with zone II and zone V acute flexor tendon injuries (FTI). We hypothesized that a single dose of prophylactic antibiotic was adequate in prevention of post-operative wound infection in acute zone II and V FTI. This was a prospective study of 116 patients who presented with zone II and zone V acute FTI. The study included patients who were 18 years and older. Those with macroscopic contamination, immunocompromised, open fractures, bite injuries, and crush injuries were excluded. Patients were randomised into a group receiving a single dose of prophylactic antibiotic and another group receiving a continuous 8 hourly antibiotic doses until the day of surgery. Each group was subdivided into occupational and non-occupational injuries. Their post-operative wound outcomes were documented 10 – 14 days after surgery. The wound outcome was reported as no infection, superficial infection (treated with wound dressings), and deep infection (requiring surgical debridement). There was 0.9% rate of deep post-operative wound infections, which was a single zone V acute FTI case in a single dose prophylactic antibiotic group. There was a 7.8% superficial post-operative wound infection rate, which was mainly zone II acute FTI in both antibiotic groups. There was a strong association between zone II acute FTI and post-operative wound infection (p < 0.05). There was no association between (antibiotic dosage or place of injury) with post-operative wound infection (p > 0.05). There is no benefit in prescribing prolonged pre-operative antibiotic in patients with acute, simple lacerations to zone II and zone V FTI if there is no macroscopic wound contamination

Introduction. Cheilectomy is a recommended procedure for the earlier stages of osteoarthritis of the 1. st. metatarsophalangeal joint. Although good improvement in symptoms have been reported in many studies, the long term performance of this procedure is not well understood. It is thought that a significant number of patients go onto have arthrodesis or joint replacement. We report on a large cohort of patients who received this procedure and report on the complications and mid-term outcome. Methods. This is a retrospective study looking at all patients who underwent cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to access patient details and outcome measures recorded include: postoperative wound infection, patient reported improvement in pain and the incidence of further surgical interventions like revision cheilectomy and conversion to arthrodesis and arthroplasty. X-rays were studied using PACS to stage the osteoarthritis (Hattrup and Johnson classification). Results. A total of 240 feet in 220 patients (20 bilateral surgeries) were included in the study, there were 164 Females (75%) and 56 Males (25%), the median age was 55 years (range 22–90 years). Radiological assessment showed 89 Stage 1 arthritis(42%), 105 Stage 2 (50%), 17 Stage 3 (8%) and 9 patients were excluded due to unavailable X-rays. 5 patients (2%) had superficial wound infection. There were 16 further surgeries (7%) performed in this cohort, 12 arthrodesis (5%), 3 revision cheilectomy and 1conversion to arthroplasty. 157 patients were found to be pain-free at the latest post-operative visit (77%), 48 reported minimal pain (23%), 15 patients were excluded due to unavailable data. Conclusion. Cheilectomy appears to produce good improvement in pain with a low complication rate. The rate of conversion to arthrodesis/arthroplasty is lower than in many reported studies

Aims. We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m. 2. ) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m. 2. . Methods. In a two-year period, 4,711 patients had either total hip arthroplasty (THA; n = 2,370), total knee arthroplasty (TKA; n = 2,109), or unicompartmental knee arthroplasty (UKA; n = 232). Of these patients, 392 (8.3%) had morbid obesity. We compared duration of operation, anaesthetic time, length of stay (LOS), LOS > three days, out of hours attendance, emergency department attendance, readmission to hospital, return to theatre, and venous thromboembolism up to 90 days. Readmission for wound infection was recorded to one year. Oxford scores were recorded preoperatively and at one year postoperatively. Results. On average, the morbidly obese had longer operating times (63 vs 58 minutes), longer anaesthetic times (31 vs 28 minutes), increased LOS (3.7 vs 3.5 days), and significantly more readmissions for wound infection (1.0% vs 0.3%). There were no statistically significant differences in either suspected or confirmed venous thromboembolism. Improvement in Oxford scores were equivalent. Conclusion. Although morbidly obese patients had less favourable outcomes, we do not feel that the magnitude of difference is clinically significant when applied to an individual, particularly when improvement in Oxford scores were unrelated to BMI. Cite this article: Bone Jt Open 2021;2(7):515–521