Background

Several studies have shown that Staphylococcus aureus (S.aureus) nasal colonization is associated with postoperative surgical site infection and that preoperative decolonization can reduce infection rates. Up to 30% of joint replacement patients have positive S.aureus nasal swabs and patient risk factors for colonization remain largely unknown. Many joint replacement patients continue to undergo surgery without being screened.

Introduction: Systemic sclerosis of the hand is an uncommon form of arthritis that can cause significant functional loss in the hand. Because of decreased microcirculation, wound-healing problems are feared and surgical interventions avoided. We report the results after operations performed on the hand and forearm of patients with systemic sclerosis with special reference to wound healing problems.

Material and methods: This retrospective study evaluates the results of 41 consecutive operations performed in 19 patients between 1985 and 2000 at our unit. The mean age was 50 years (14 – 84 years). Sixteen patients were female and 3 male. Twelve patients were operated twice or more. Operations were elective in 27 cases, with excision of calcinosis in 8 patients, excision of calcinosis plus skin transplant in 2 patients, neurolysis of median, radial or ulnar nerve in 7 patients, wrist procedures (fusion or implant) in 3 patients and other procedures (e. g. finger joint fusion, removal of osteosynthetis material, finger osteotomy) in 7 patients.

In 14 cases the operations were indicated in reason of spontaneous skin necrosis or defects. These operations were: amputation with or without flap in 3 cases, wound revision in 6 cases, wound revision and flap in 5 cases (including skin transplantation in 3 of these patients).

Results: One wound healing problem occurred in the 27 elective operations. The patient operated with an arthrodesis of the small finger PIP-joint had to have both the cerclage wire and K-wire removed to obtain complete wound healing.

Seven of 14 patients in the group with spontaneous skin necrosis healed uneventfully after operation. Two patients had consecutive wound infections that caused a longer healing period of 5 months; another patient also had a longer healing period but his wounds healed shortly after he quit smoking. Four patients had necrosis/infections, which required additional surgery.

Conclusion: In systemic sclerosis, surgery performed in elective operations does not seem to have an increased rate of infections or other wound healing problems. Even larger operations like wrist arthrodesis or wrist prosthesis can be performed. In non-elective cases with spontaneous skin necrosis, in critically ischaemic fingers, the wound healing is not always easy and several operations can be necessary, however a good end result, without need for amputations, can be achieved.

Introduction: The most common method for internal fixation of olecranon fractures is AO tension band wiring (TBW). A number of complications related to this technique have been described, such as subcutaneous prominence of the device, skin irritation, infection, loss of extension in the elbow joint and non-union.

To avoid those complications Dr. Robert J. Medoff has designed a new device, the ulnar sled, which will be shown on a picture.

The objective of this cadaver study was to determine the stability of olecranon fracture fixation with the ulnar sled and compare it with AO method.

Methods: In six matched pairs of fresh-frozen arms a fracture of the olecranon was created and stabilized with either TBW or the ulnar sled.

The ulnar sled (US) group: The two free legs of the sled were inserted into two pre-drilled holes from the tip of the olecranon into the ulna medullary cavity of the ulna. The washer was then placed with its slot over the prominence of the sliding plate and with a screw fixed bicortically into the ulna, through the distal part of the proximal oval washer hole. Compression over the fracture site could be observed visually and the washer was finally fixed with another bicortical screw in its distal hole.

The TBW group: In the TBW group the AO technique with oblique bicortical K-wires and the two-knot-modification was used.

Mechanical Testing: First the brachialis and then the triceps muscle were sequentially loaded with 5 kg (50N) for 20 cycles in three different angles: 45, 90 and 135. The fracture displacement was measured before and after loading.

Results: The increase in the fracture gap after 20 cycles of loading for the two fixation techniques will be shown in a table. There was no significant increase of the fracture gap for either device when loading the brachialis muscle at any of the three flexion angles. The fracture displacement in 90 in triceps loading was 0.23mm in the the US group and in 0.19mm in the TBW group. This difference was not significant (p> 0.05). Similar results were obtained for the other flexion angles. Almost no displacement was observed in brachialis loading with either method.

Discussion: The results suggest that the ulnar sled method is a stable surgical method for fixation of uncommuted olecranon fractures when compared to TBW.