Aim. Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality, 20–30 % risk of infection in patient with implant related infection (IRI) .18F-FDG PET/CT is helpful in the management of SAB, leading to detection of more metastatic foci and treatment modification and finally decrease relapses and mortality rate. Our objective was to analyze mortality in high risk SAB patients undergoing 18F-FDG PET/CT and to see whether it's use in patients with IRI reduced their mortality. Method. We performed a retrospective study at a university hospital in Belgium. All cases of high risk adult SAB between January 2014 and June 2017 were reviewed. We collected the clinical characteristics including presence of metastatic foci on 18F-FDG PET/ CT, mortality at 1 year. Results. A total of 102 patients were included. Twenty-one patient with IRI were identified (20.6%). In 94.1 % (N=96) SAB were due to methicillin-sensitive staphylococcus aureus (MSSA). 18F-FDG PET/ CT was performed in 47% (N =48) of patients and a metastatic foci was identified in 45.8% of cases (N=22/48). The detection of metastatic foci lead to surgical intervention in a site other than the site of IRI in 38% versus 14% (P < 0.001) in patients undergoing or not 18F-FDG PET/CT respectively. The overall mortality rate was 31.3 % (32/102). The mortality rate was 16.6% (8 /48) and 41.3 % (24/54) in patients undergoing or not 18F-FDG PET/ CT respectively (P=0.03). For IRI, the overall mortality was 9.3 % versus 15.6% in patients undergoing or not 18F-FDG PET/ CT respectively (P<0.001). There was a significant difference in mortality rate at 30 (P=0.001), 90 days (P–0.01) and one year (P–0.004) between patients undergoing or not 18F-FDG PET/ CT respectively. In bivariate analysis, the overall, 30, 90 days and one year mortality rate was significantly reduced among patient with kidney failure (P< 0.001), diabetic foot infection (P=0.006), age >70 years (P=0.007) and prosthetic joint or plate infection (P< 0.001) in whom the 18F-FDG PET/ CT was performed. Conclusions. Mortality rate was reduced in high risk SAB patients undergoing 18F-FDG PET/ CT. The use of 18F-FDG PET/CT reduced mortality in patients with PJI by detecting more metastatic site leading to more aggressive treatment

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. Study Question. Is there a specific patient population at increased risk of S.aureus nasal colonization?. Methods. This study is a retrospective review of 716 consecutive patients undergoing hip or knee replacement surgery between 2011 and 2015. All patients were screened preoperatively for nasal colonization and patients who screened positive for S.aureus were treated with mupirocin. Bivariate and multivariate statistical analysis was used to assess risk factors for nasal colonization. Results. 716 patients undergoing joint replacement had preoperative nasal screening. 125 (17.50%) nasal swabs were positive for methicillin susceptible S.aureus(MSSA), 13 (1.80%) were positive methicillin resistant S.aureus (MRSA), 84 (11.70%) were positive for other organisms, and 494 (69.00%) were negative for colonization (Table 1). In bivariate analysis, diabetes (p = 0.04), renal insufficiency (p = 0.03), and immunosuppression (p = 0.02) were predictors of nasal colonization with MSSA/MRSA while smoking (p = 0.02) and immunosuppression (p = 0.001) were predictors of colonization with other bacteria. In multivariate analysis, immunosuppression (p = 0.04, OR: 1.95, 95%CI: 1.03–3.71) and renal insufficiency (p = 0.04, OR: 2.49, 95%CI: 1.01–6.18) were independent predictors of nasal colonization with MSSA/MRSA while smoking (p = 0.02, OR: 1.77, 95% CI: 1.10–2.88) and immunosuppression (p = 0.01, OR: 2.95, 95% CI: 1.45–5.86) were independent predictors of nasal colonization with other bacteria. Conclusion. Our study shows that one third of patients screened positive for nasal colonization. Patients with diabetes, renal insufficiency, and immunosuppression are at increased risk of being colonized with S.aureus. Given that these comorbidities are already known independent risk factors for periprosthetic joint infection, these patients in particular should be screened and when necessary, decolonized

This is a study to investigate the diagnostic and prognostic value of MRI in spinal cord injury. We performed this prospective study on sixty two patients of acute spinal trauma. We evaluated the epidemiology of spinal trauma & various traumatic findings by MRI. MRI findings were correlated with clinical findings at admission & discharge according to ASIA impairment scale. Four types of MR signal patterns were seen in association with spinal cord injury-cord edema / non haemmorhagic cord contusion (CC), severe cord compression (SCC), cord hemorrhage (CH) and epidural heamatoma (EH). Isolated lesion of cord contusion was found in 40%. All other MR signal patterns were found to be in combination. In cord contusion we further subdivided the group into contusion of size < 3 cm and contusion of size > 3 cm to evaluate any significance of length of cord contusion. In cord heammorhage involving >1cm of the cord, focus was said to be sizable. On bivariate analysis, there was a definitive correlation of cord contusion (CC) involving <3cm & > 3cm of cord with sensory outcome. In >3cm, chances of improvement was 5.75 times lesser than in patients with CC involving <3cm of cord (odds ratio = 5.75 (95% CI: 0.95, 36), Fisher's exact p = 0.0427 (p<.05). In severe cord compression (SCC) the risk of poor outcome was more (odds ratio 4.3 and p=0.149) however was not statistically significant. It was noted that the patients in which epidural hematoma (EH) was present, no improvement was seen, however, by statistical analysis it was not a risk factor and was not related with the outcome (odds ratio – 0.5 and p = 0.22). Presence of cord oedema / non haemorrhagic contusion was not associated with poor outcome (odds ratio 0.25 and p=0.178). On multiple logistic regression / multivariate analysis for estimating prognosis, sizable focus of haemorrhage was most consistently associated with poor outcome (odds ratio −6.73 and p= 0.32) however it was not statistically significant. The risk of retaining a complete cord injury at the time of follow up for patients who initially had significant haemorrhage in cord was more than 6 fold with patients without initial haemorrhage (odds ratio 6.97 and p= .0047). Besides being helpful in diagnosis, MRI findings may serve as a prognostic indicator for clinical, neurological and functional outcome in acute spinal trauma patients

Aims

The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture.

Aims

Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic infection through a systematic review of available evidence.

Aims

Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty.

Aims

Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland.

Introduction

Studies have addressed the issue of increasing prevalence of work-related musculoskeletal (MSK) pain among different occupations. However, contributing factors to MSK pain have not been fully investigated among orthopaedic surgeons. Thus, this study aimed to approximate the prevalence and predictors of MSK pain among Saudi orthopaedic surgeons working in Riyadh, Saudi Arabia.

Aims

Sickle cell disease (SCD) is an autosomal recessive inherited condition that presents with a number of clinical manifestations that include musculoskeletal manifestations (MM). MM may present differently in different individuals and settings and the predictors are not well known. Herein, we aimed at determining the predictors of MM in patients with SCD at the University Teaching Hospital, Lusaka, Zambia.

Using inaccurate quotations can propagate misleading information, which might affect the management of patients. The aim of this study was to determine the predictors of quotation inaccuracy in the peer-reviewed orthopaedic literature related to the scaphoid. We randomly selected 100 papers from ten orthopaedic journals. All references were retrieved in full text when available or otherwise excluded. Two observers independently rated all quotations from the selected papers by comparing the claims made by the authors with the data and expressed opinions of the reference source. A statistical analysis determined which article-related factors were predictors of quotation inaccuracy. The mean total inaccuracy rate of the 3840 verified quotes was 7.6%. There was no correlation between the rate of inaccuracy and the impact factor of the journal. Multivariable analysis identified the journal and the type of study (clinical, biomechanical, methodological, case report or review) as important predictors of the total quotation inaccuracy rate.

We concluded that inaccurate quotations in the peer-reviewed orthopaedic literature related to the scaphoid were common and slightly more so for certain journals and certain study types. Authors, reviewers and editorial staff play an important role in reducing this inaccuracy.