Aims. The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. Methods. This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. Results. The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points (95% confidence interval (CI) 2.2 to 5.6); p < 0.001) and in the matched cohort (4.0 points (95% CI 2.3 to 5.7); p < 0.001). Secondary outcomes showed similar results. The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort. Conclusion. The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery. Cite this article: Bone Joint J 2023;105-B(1):64–71

Aims. Around the world, the emergence of robotic technology has improved surgical precision and accuracy in total knee arthroplasty (TKA). This territory-wide study compares the results of various robotic TKA (R-TKA) systems with those of conventional TKA (C-TKA) and computer-navigated TKA (N-TKA). Methods. This is a retrospective study utilizing territory-wide data from the Clinical Data Analysis and Reporting System (CDARS). All patients who underwent primary TKA in all 47 public hospitals in Hong Kong between January 2021 and December 2023 were analyzed. Primary outcomes were the percentage use of various robotic and navigation platforms. Secondary outcomes were: 1) mean length of stay (LOS); 2) 30-day emergency department (ED) attendance rate; 3) 90-day ED attendance rate; 4) 90-day reoperation rate; 5) 90-day mortality rate; and 6) surgical time. Results. A total of 8,492 knees from 7,746 patients were included in the study. Overall robotic use had risen to 20.4% (2023 Q3 to Q4: 355/1,738) by the end of 2023, with Mako being the most popular at 10.3% (179/1,738). R-TKA had the shortest mean LOS compared with N-TKA and C-TKA (5.5 vs 6.3 and 7.1 days, respectively; p < 0.001). Only Mako (9.7%) demonstrated reduced 90-day ED attendance compared to C-TKA (13.1%; p = 0.009), Cori/Navio (15.0%; p = 0.005), and Rosa (16.4%; p < 0.001). No differences in 90-day reoperation rate and mortality were observed between all groups. Mean surgical times were longer in R-TKA groups by 20.6 minutes (p < 0.001). Conclusion. R-TKA use has increased in recent years, and has been shown to reduce hospital stay despite having a slightly longer surgical time, proving a promising candidate to alleviate the burden on healthcare systems. Individual differences between R-TKA systems contributed to variable clinical outcomes. Cite this article: Bone Jt Open 2024;6(1):12–20

The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12-month period in a single-centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritise improving documentation of informed consent for orthopaedic trauma patients to ensure a patient-centred approach to healthcare

Background: A general increase in total number of primary total hip arthroplasty (THA) has been observed in Denmark from 3.828 in 1995 to 7.645 in 2006. During the same period the number of pa-tients treated at private clinics has also increased. To our knowledge no studies, comparing patient characteristics and treatment quality between public and private hospitals, have been published. We compared patients’ characteristics and outcome following THA in private and public hos-pitals. Materials and Methods: We used data from the Danish Hip Arthroplasty Registry to identify 69 249 primary THA’ies performed between 1 January 1995 to 31 December 2006. To detect eventual difference in patient characteristics- age, gender, diagnosis leading to THA, Carlson’s comorbidity score and Charnley category were evaluated. We matched 3 658 cases operated in private with 3 658 controllers operated in public hospitals on propensity score. Scoring parameters were age, gender, diagnosis leading to THA, Carlson’s comorbidity score, Charnley category, operating time, type of anesthesia and type of prosthesis. We used multivariate logistic regression on propensity score matched data to assess association between type of hospital and outcome by computing relative risks and 95% Confidence Interval (CI). Outcomes were perioperative complications, readmission within 3 months, re-operation within 2 years, implant failure after 5 years, and mortality within 3 months of surgery. Results: Private hospitals operated on older females, patients with primary osteoarthritis and low comorbidity and Charnley category 1. Patients in private and propensity matched controls from public hospitals showed no differences in age, gender, diagnosis leading to THA, Carlson’s comorbidity score, Charnley category, operating time, type of anesthesia and type of prosthesis (p-value < 0,0001). Based on matched data, private hospitals had lower relative risk for perioperative complications (0.39, 0.26–0.60), reoperations (0.59, 0.41–0.83) and readmissions (0.57, 0.42–0.77) compared with public. There was no difference in mortality or implant failure. Discussion and Conclusions: We had no data on surgeon, general health and socioeconomic status of the patients. In addition, reported data from private clinics have not been validated in contrast to public hospitals. We found significant difference between patient characteristics operated at public versus private hospitals. No difference was evident regarding mortality and implant failure but for complications, reoperations and readmissions between private and public hospitals

Purpose. To investigate sociodemographic and clinical characteristics in patients operated for lumbar disc herniation in public and private hospitals, and evaluate whether selection for surgical treatment were different across the two settings. Methods and results. A cross-sectional multicenter study of patients who underwent a total of 5308 elective surgeries for lumbar disc herniation at 41 hospitals. Data were included in the Norwegian Registry for Spine Surgery (NORspine). Of 5308 elective surgical procedures, 3628 were performed at 31 public hospitals and 1680 at 10 private clinics. Patients in the private clinics were slightly younger, more likely to be man, have higher level of education, and more likely to be employed. The proportions of disability and retirement pension were more than double in public as compared to private hospitals. Patients operated in public hospitals were older, had more obesity and co-morbidity, lower educational level, longer duration of symptoms, and sick leave and were less likely to return to work. Patients operated in public hospitals reported more disability and pain, poorer HRQol and general health status than those operated in private clinics. The differences were consistent but small and could not be attributed to less strict indications for surgical treatment in private clinics. Conclusion. Indications for surgical treatment of lumbar disc herniation appear to be similar in public and private hospitals. Patients operated in private clinics seem to be handled more effectively. They were younger, healthier and had more socioeconomic and lifestyle attributes, known to be predictors more favorable outcomes after surgery

Aims. Displaced femoral neck fractures (FNF) may be treated with partial (hemiarthroplasty, HA) or total hip arthroplasty (THA), with recent recommendations advising that THA be used in community-ambulant patients. This study aims to determine the association between the proportion of FNF treated with THA and year of surgery, day of the week, surgeon practice, and private versus public hospitals, adjusting for known confounders. Patients and Methods. Data from 67 620 patients in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1999 to 2016 inclusive were used to generate unadjusted and adjusted analyses of the associations between patient, time, surgeon and institution factors, and the proportion of FNF treated with THA. Results. Overall, THA was used in 23.7% of patients. THA was more frequently used over time, in younger patients, in healthier patients, in cases performed on weekdays (adjusted odds ratio (OR) 1.27; 95% confidence interval (CI) 1.14 to 1.41), in private hospitals (adjusted OR 4.34; 95% CI 3.94 to 4.79) and by surgeons whose hip arthroplasty practice has a relatively higher proportion of elective patients (adjusted OR 1.65; 95% CI 1.49 to 1.83). Conclusion. Practice variation exists in the proportion of FNF patients treated with THA due to variables other than patient factors. This may reflect variation in resources available and surgeon preference, and uncertainty regarding the relative indication

Aims. The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. Patients and Methods. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Results. Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. Conclusion. The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470–477

Fragility fractures are an emerging healthcare problem in Sub-Saharan Africa and hip fractures (HFs) are associated with high levels of morbidity, prolonged hospital stays, increased healthcare resources utilization, and mortality. The worldwide average healthcare cost in the first-year post HF was US$43,669 per patient in a 2017 systematic review, however there are no studies quantifying fracture-associated costs within SSA. We estimated direct healthcare costs of HF management in the South African public healthcare system. We conducted a prospective ingredients-based costing study in 200 consecutive consenting HF patients to estimate costs per patient across five regional public sector hospitals in KwaZulu-Natal (KZN). Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by relevant unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR). Generalised linear models were used to estimate total covariate adjusted costs and cost predictors. The mean unadjusted cost for HF management was ZAR114,179 (95% CI; ZAR105,468–125,335). The major cost driver was orthopaedics/surgical ward costs ZAR 106.68, contributing to 85% of total cost. The covariate adjusted cost for HF management was ZAR114,696 (95% CI; ZAR111,745–117,931). After covariate adjustment, total costs were higher in patients operated under general anaesthesia compared to surgery under spinal anaesthesia and no surgery. Direct healthcare costs following a HF are substantial: 58% of the gross domestic per capita (US$12,096 in 2020), and six-times greater than per capita spending on health (US$1,187 in 2019) in SA. As the population ages, this significant economic burden to the health system will increase. Further research is required to evaluate direct non-medical, and the indirect costs incurred post HF

Aims. Antibiotic prophylaxis involving timely administration of appropriately dosed antibiotic is considered effective to reduce the risk of surgical site infection (SSI) after total hip and total knee arthroplasty (THA/TKA). Cephalosporins provide effective prophylaxis, although evidence regarding the optimal timing and dosage of prophylactic antibiotics is inconclusive. The aim of this study is to examine the association between cephalosporin prophylaxis dose, timing, and duration, and the risk of SSI after THA/TKA. Methods. A prospective multicentre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKA/THA at one of 19 high-volume Australian public/private hospitals. Data were collected prior to and for one-year post surgery. Logistic regression was undertaken to explore associations between dose, timing, and duration of cephalosporin prophylaxis and SSI. Data were analyzed for 1,838 participants. There were 264 SSI comprising 63 deep SSI (defined as requiring intravenous antibiotics, readmission, or reoperation) and 161 superficial SSI (defined as requiring oral antibiotics) experienced by 249 (13.6%) participants within 365 days of surgery. Results. In adjusted modelling, factors associated with a significant reduction in any SSI and deep SSI included: correct weight-adjusted dose (any SSI; adjusted odds ratio (aOR) 0.68 (95% confidence interval (CI) 0.47 to 0.99); p = 0.045); commencing preoperative cephalosporin within 60 minutes (any SSI, aOR 0.56 (95% CI 0.36 to 0.89); p = 0.012; deep SSI, aOR 0.29 (95% CI 0.15 to 0.59); p < 0.001) or 60 minutes or longer prior to skin incision (aOR 0.35 (95% CI 0.17 to 0.70); p = 0.004; deep SSI, AOR 0.27 (95% CI 0.09 to 0.83); p = 0.022), compared to at or after skin incision. Other factors significantly associated with an increased risk of any SSI, but not deep SSI alone, were receiving a non-cephalosporin antibiotic preoperatively (aOR 1.35 (95% CI 1.01 to 1.81); p = 0.044) and changing cephalosporin dose (aOR 1.76 (95% CI 1.22 to 2.57); p = 0.002). There was no difference in risk of any or deep SSI between the duration of prophylaxis less than or in excess of 24 hours. Conclusion. Ensuring adequate, weight-adjusted dosing and early, preoperative delivery of prophylactic antibiotics may reduce the risk of SSI in THA/TKA, whereas the duration of prophylaxis beyond 24 hours is unnecessary. Cite this article: Bone Jt Open 2022;3(3):252–260

Aims. The purpose of this exploratory study was to investigate if the 24-hour activity profile (i.e. waking activities and sleep) objectively measured using wrist-worn accelerometry of patients scheduled for total hip arthroplasty (THA) improves postoperatively. Patients and Methods. A total of 51 THA patients with a mean age of 64 years (24 to 87) were recruited from a single public hospital. All patients underwent THA using the same surgical approach with the same prosthesis type. The 24-hour activity profiles were captured using wrist-worn accelerometers preoperatively and at 2, 6, 12, and 26 weeks postoperatively. Patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS)) were collected at all timepoints except two weeks postoperatively. Accelerometry data were used to quantify the intensity (sedentary, light, moderate, and vigorous activities) and frequency (bouts) of activity during the day and sleep efficiency. The analysis investigated changes with time and differences between Charnley class. Results. Patients slept or were sedentary for a mean of 19.5 hours/day preoperatively and the 24-hour activity pattern did not improve significantly postoperatively. Outside of sleep, the patients spent their time in sedentary activities for a mean of 620 minutes/day (. sd. 143) preoperatively and 641 minutes/day (. sd. 133) six months postoperatively. No significant improvements were observed for light, moderate, and vigorous intensity activities (p = 0.140, p = 0.531, and p = 0.407, respectively). Sleep efficiency was poor (< 85%) at all timepoints. There was no postoperative improvement in sleep efficiency when adjusted for medications (p > 0.05). Patient-reported outcome measures showed a significant improvement with time in all domains when compared with preoperative levels. There were no differences with Charnley class at six months postoperatively. However, Charnley class C patients were more sedentary at two weeks postoperatively when compared with Charnley class A patients (p < 0.05). There were no further differences between Charnley classifications. Conclusion. This study describes the 24-hour activity profile of THA patients for the first time. Prior to THA, patients in this cohort were inactive and slept poorly. This cohort shows no improvement in 24-hour activity profiles at six months postoperative. Cite this article: Bone Joint J 2019;101-B:415–425

Slipped Capital Femoral Epiphysis (SCFE) is a common paediatric disorder with documented racial predilection. No data exists regarding the Australian indigenous and Australian non-indigenous populations. This study provides a comprehensive demographic and epidemiologic analysis of SCFE in South Australia, with emphasis on establishing associations between increasing obesity and incidence. A demographic review of all cases of SCFE managed in South Australian public hospitals between 1988 and 2007 was performed. Clinical presentation, surgical management and complication profile information was collected. Given that obesity is implicated in the biomechanical causation of SCFE due to increased shearing forces, particular emphasis was placed on gathering weight, race, gender and age data. A profile of the incidence and nature of SCFE was generated. Comparisons were then drawn between this profile and existing epidemiologic percentile data of weight, age and gender in South Australia. A rising prevalence of obesity in South Australia corresponded with a rising incidence of SCFE. However, this relationship was not linear as the incidence of SCFE has doubled in the last 20 years and the average weight of SCFE patients has increased markedly. The indigenous population was found to have higher rates of obesity than the non- indigenous population in South Australia. The indigenous population also has a relative risk of developing a SCFE of over three times the non-indigenous population. The overall rate of complications in South Australian public hospitals was low, with avascular necrosis being recognised in our profile. The rise in incidence of SCFE in South Australia; especially noticeable in the indigenous population is associated with an increasing prevalence of obesity. The considerable morbidity associated with SCFE was confirmed in our analysis and further highlights the importance of public health initiatives to tackle obesity in our community

Introduction: Criticism is often made of general practitioners’ referrals to an orthopaedic service in a public hospital. There is often inadequate information about any previous treatment and it is difficult to assess the levels of pain and disability in the individual patient. Method: A review of 200 referral letters from general practitioners for patients to attend as orthopaedic out-patients has been carried out. One hundred of these patients were from the North Shore Hospital catchment area and the rest were from the Auckland Hospital catchment area. The letters were analysed according to history, previous treatment, results of previous treatment, and investigations including results of blood tests and x-rays. Results: An analysis of the results showed that, in general, 50% of the patients’ referrals were inadequately documented and, in particular, it was difficult to assess the individual patient’s level of pain and disability relating to the primary orthopaedic problem. Discussion: It is suggested that referral letters should contain adequate information to start the initial prioritisation of patients to allow those who have the greater need to have access to the limited resources of the public hospital service

Background & Purpose: This pragmatic randomised clinical trial (RCT) investigated differences in the clinical outcomes of physiotherapy for low back pain (LBP) delivered in. public hospital-based secondary care versus. private community-based primary care in Ireland. Methods: Between March 2005 and May 2006, 160 consenting subjects [110F, 50M; mean age (SD) yrs: 41.28 (12.83)] were recruited, stratified (acute: < 3/12; chronic: > 3/12), and randomly allocated to public hospital (H) or private community (P) physiotherapy. Subjects completed clinical outcomes (Roland Morris Disability Questionnaire (RMDQ). SF-36, Fear Avoidance Beliefs & Back Beliefs Questionnaires) at baseline, 3, 6 and 12 months post randomisation and the Patient Satisfaction with Outpatient Physical Therapy (PTOPS) survey at the end of treatment. Intention-to-treat analysis was conducted using the Statistical Package for the Social Sciences (SPSS, Version 12). Results: There were no significant differences between groups at baseline (p> 0.05). Patient response rates were 85% (n=137), 80% (n=128) and 74% (n=118) at 3, 6, and 12 months. Despite significantly longer waiting times for public hospital physiotherapy, repeated measures ANOVA found no significant differences over time between groups for any of the outcome measures (p> 0.05), except ‘patient satisfaction with outcome,’ which was significantly higher in the P group (median difference: 0.00; p=0.020, Mann Whitney U=1324.50). Conclusions & Implications: The trial cannot recommend one physiotherapy setting over the other for LBP management. However, the limited adherence to LBP clinical guidelines in both settings and the lack of improvement in psychosocial outcomes in subjects managed in both settings warrant further investigation. Acknowledgements: Physiotherapists, General practitioners and patients in both settings

Aims

It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital.

Purpose of study:. To analyse the bacteriological spectrum, identify most appropriate antibiotics for hand infections, and to characterize patterns and sites of hand infections. This information was collected against the background of a high prevalence of HIV infected patients and increasing antibiotic resistance. Description of methods:. This was a prospective, cross-sectional, analytical study done on 66 patients presenting with hand infections at a public hospital from January to June 2009. A standardised treatment protocol was followed in managing these patients. Data was collected from each participant, and laboratory reports were followed up for the identity and antibiotic susceptibility of causative organisms. All patients were counselled for HIV status and consenting participants were tested. Summary of results:. Staphylococcus aureus was the commonest isolate. Results show that Cloxacillin is still an effective first line antibiotic for community acquired hand infections in the absence of immunosuppression. Alternative empiric therapy would be Clindamycin – especially in the B-lactamase intolerant patient. HIV infection played a significant role in the bacteriology of hand infections with an increased incidence of polymicrobial and gram negative infections. Data regarding age, gender, types of infection, mechanism of injury, x-ray findings and laboratory values are also reported. Conclusion:. Hand infections are common conditions that have significant morbidity. Referral is often delayed and infections present late. Immunosuppression seems to play a role in the bacteriology, the incidence of polymicrobial infections and the antibiotic sensitivity. Cloxacillin seems to be an adequate first line treatment for acute community acquired bacterial hand infections in immunocompetent patients in our institution, excluding human bites and farm yard injuries

Aims

Pneumatic tourniquets are often used during the surgical treatment of unstable traumatic ankle fractures. The aim of this study was to assess the risk of reoperation after open reduction and internal fixation of ankle fractures with and without the use of pneumatic tourniquets.

Rural surgical practice in Australia provides a unique environment to the Orthopaedic Surgeon. Whilst most of the work load mimics that of city practice, the rural surgeon has little choice but to master a broad schema of surgical skills, and keeping up with the current literature and techniques can be challenging. At our public hospital over the last audited twelve month period, 108 primary total knee replacements were performed by 4 surgeons out of 236 joint replacements including revision surgeries. At the Private hospital a total of 215 joint replacements were performed in the same period including revision surgeries, of which 127 were knee arthroplasties. It is recognised that the incidence of complications from arthroplasty can be increased in low volume joint replacement surgeons. This centre is a mid volume centre, but rural and generally underfunded. In light of this, it is not unreasonable to look at techniques or evolving technologies that may improve the ability of an individual surgeon to position a joint replacement in an optimal position and with economic consideration. Conventional navigation has a number of factors associated with it that may make its use in a rural centre less attractive. These include capital cost of both hardware and software; Most rural centres do not have the ability to purchase the hardware and thus the issue of transporting hard ware on site, and representative support, may all be issues. The potential benefit of patient specific implants [PSI] may thus be two-fold in this setting. The surgeon and the patient benefit from the technology, but the technology does not need to be transported to the site. As a result of these considerations, a single surgeon in a rural centre, commenced using PSI's after gaining initial experience with the implant using traditional techniques. This early study looks at this experience and attempts to quantify some of the issues around this technology

Intramedullary nailing (IMN) has been frequently indicated to treat long bone open and closed fractures, but infection following internal fixation may have devastating consequences, with higher costs. Treatment of intramedullary nail-associated infections (IMNI) is challenging and based upon surgery and adequate antibiotic administration, which requires the correct identification of causative microorganisms. However, there have been difficulties for the microbial diagnosis of IMNI, as the peri-prosthetic tissue cultures may show no microbial growth, particularly in patients with previous use of antibiotics. Sonication have shown higher sensitivity and specificity for microbial identification on a variety of orthopedic implant-associated infections. Aim: To compare clinical and microbiological results and sensitivity for the pathogen identification obtained by conventional peri-implant tissue culture samples with culture of samples obtained by sonication of explanted IMN implants, among patients presenting IMNI of long bones. Methods: Longitudinal prospective cohort study performed at a tertiary public hospital, ongoing since August 2011. We analyzed all patients with indication for IMN implant removal, and orthopedic-implant associated infections was defined according to previous publications addressing osteosynthesis-associated infections (Yano 2014). Minimal of 2 samples from the peri-implant tissue were taken and sent under sterile conditions to the laboratory for culture. Statistical analysis was performed McNemar's test for related proportions. Results: We included 26 patients presenting clinical signs of IMNI, of which tissue and sonication cultures were performed for 26 (100%) and 20 (77%) patients, respectively. Among them, 88% were male, with mean age was 35.9 years (range, 19–59 yo). Causes of trauma were mainly motorcycle crashes accounting 54% of accidents; tibia and fibula were affected in 65% and 27%, respectively. Gustilo open fracture classification was grade II (35%) and IIIA (35%). First stage management with external fixation for fracture stabilization was performed in 75% of trauma patients. Sensitivity of peri-prosthetic tissue culture and sonication was 80.7% (21/26), and 95% (19/20) (p< 0.05), respectively. Only one infected patient presented negative tissue and fluid cultures. Gram-positive cocci were isolated in 75% and 79% in tissue and sonication fluid cultures, respectively. Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus sp., were isolated from tissue and sonication culture in 43.5% and 36.3%, 8.7% and 22.7%, 13% and 13.7%, respectively. Polymicrobial infection was diagnosed in 3.8% (1/26) and 15.8% (3/19), patients by tissue and sonication fluid cultures (p< 0,01), respectively. Conclusion: Sonication of retrieved infected intramedullary nails has the potential for improving the microbiological diagnosis of IMNI

Aims

Knee osteoarthritis (OA) is characterized by a chronic inflammatory process involving multiple cytokine pathways, leading to articular cartilage degeneration. Intra-articular therapies using pharmaceutical or autologous anti-inflammatory factors offer potential non-surgical treatment options. Autologous protein solution (APS) is one such product that uses the patient’s blood to produce a concentrate of cells and anti-inflammatory cytokines. This study evaluated the effect of a specific APS intra-articular injection (nSTRIDE) on patient-reported outcome measures compared to saline in moderate knee OA.

Hip fracture is a common cause of hospital admission and is often followed by reduced quality of life, or by death. International experiences indicate there are many benefits to be gained from national hip fracture registries. This pilot project aims to implement a hip fracture registry at three sites, a large metropolitan public hospital (Flinders Medical Centre), a large metropolitan private hospital (Epworth HealthCare) and a rural regional hospital (Goulburn Valley Health) to assess the feasibility of establishing a national registry. Patients undergoing surgery for a hip fracture will be recruited from the three participating hospitals between March and September 2009. A minimum data set will be collected at discharge, from hospital records. Items include patient demographics, fracture descriptors, length of stay, residential status, mobility, health status, surgical details and discharge destination. A phone interview at four months after surgery will measure outcomes by using the Extended Glasgow Outcomes Scale and documenting residential status, mobility, hip pain and readmissions. Re- operations, if any, will be collected. The availability of data from State Health Departments for validation of hospital case data will be reported. The pilot study is in progress at the time of writing. Ethical approval has been obtained, data collection, transmission and storage systems have been developed and deployed, and case data collection is underway. Case data will be summarised to describe hip fracture at the participating hospitals. Analysis will review the data elements in the pilot data set and assess their priority for inclusion in a national register—taking account of the quality of the data obtained and the time and other resources required for their collection. We will also evaluate the four-month review process. Any potential obstacles to a national registry that are identified during the pilot will be described and ways to overcome them will be proposed. A national hip fracture registry will improve the quality of care and safety of patients following hip fracture by developing an efficient mechanism to compare and improve the effectiveness of acute health care delivery by all hospitals involved in the management of hip fractures