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.
The Synex cage is an expanding titanium implant designed for reconstruction of the anterior column in injury, post-traumatic kyphosis or tumour of the thoracolumbar spine. It is supplemented by a stabilizing implant. As it is expandable in situ it therefore can be inserted via a relatively small exposure. The design enables good purchase of the endplates and reduces the possibility of secondary displacement. Surgery for anterior reconstruction is usually performed via an anterior approach, however, there are incidences were a posterolateral approach is indicated. The Synex cage is useful in these circumstances, as being expandable, posterolateral insertion with preservation of the nerve roots is possible. The Synex cage is then supplemented with a posterior construct. The cage can be inserted via a left or right posterolateral approach. A specially designed angled screwdriver is now available to release the ratchet mechanism and if necessary collapse the cage. We present, what is, to the best of our knowledge and that of the manufacturer, the first two patients where a Synex cage has been inserted using the posterolateral approach.
