Aims. This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis. Patients and Methods. Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study. Results. Of 72 patients, 42 (58%) were deemed to have septic joints. The sensitivity of mPCR and synovial fluid culture was 38% and 29%, respectively. No significant differences were found between the AUCs of both techniques (p = 0.138). A strong concordance of 89% (Cohen’s kappa: 0.65) was shown. The mPCR failed to detect Staphylococcus aureus (n = 1) and Streptococcus pneumoniae (n = 1; no primer included in the mPCR), whereas the synovial fluid culture missed six microorganisms (positive mPCR: S. aureus (n = 2), Cutibacterium acnes (n = 3), coagulase-negative staphylococci (n = 2)). Conclusion. The automated mPCR showed at least a similar performance to the synovial fluid culture (the current benchmark) in diagnosing septic arthritis, having the great advantage of a shorter turnaround time (within five hours). Cite this article: Bone Joint J 2019;101-B:288–296

Introduction:. Skeletal TB has a paucibacillary nature. It is often found in poorly accessible areas for biopsy purposes. Retrieved samples may have a poor representation of the underlying disease process. Additionally, patients have normally commenced anti-tubercular medication that further decreases the number of bacilli. This has resulted in poor sensitivity and specificity outcomes for the tests that are traditionally done. The polymerase chain reaction (PCR) has been proven to be a useful test for the demonstration of extrapulmonary TB. It has a high specificity and sensitivity. Objective:. The study measures the sensitivity and specificity of PCR done on fresh biopsies from patients suspected of a tuberculous spinal infection. Method and Results:. A retrospective review of results was done of spinal tissue biopsies. A total of 30 consecutive patients were identified. There were 15 males (mean age = 40,3 yrs) and 15 females (mean age = 45,8 yrs). 18 of the patients were HIV positive. Acid fast bacilli were demonstrated in 4 (13,33%) patients by staining. Culture was positive in 10 (33,33%), in which 2 had commenced antitubercular therapy. Histology reported features in keeping with tuberculosis in 9 (30%) patients. Furthermore, multiple myeloma, adenocarcinoma, osteomyelitis and thyroid carcinoma was reported. PCR was positive in 12 (40%) patients. Sensitivity of PCR was calculated as 85,7% whilst specificity was 72,7% (the amount correctly classified was 77,8%). Only 4 patients had positive tests for all 4 methods used for diagnosing tuberculosis. Conclusion:. Tuberculosis should always be considered in spinal lesions. PCR provides a quick and effective means of identifying it. This allows early commencement of anti-tubercular treatment

Aim. We used a polymerase chain reaction (PCR) lateral flow assay1) to rapidly diagnose joint infection. We evaluated the usefulness of multiplex-PCR (PCR lateral flow assay: PCR-LF) using detailed clinical data. Method. A total of 35 synovial fluid samples were collected from 26 patients in whom bacterial infection was suspected, including 22 from knee joints, 11 from hip joints, and 2 from other joints. After purifying the DNA from the samples, multiplex PCR targeting two MRSA-associated genes (femA and mecA) and the bacterial 16S rRNA gene was performed. Amplified gene fragments were specifically detected with DNA probes immobilized on stick devices through DNA-DNA hybridization and visualization, enabling diagnosis of MRSA, MSSA, MRCNS, gram-positive, and/or gram-negative bacterial infection. Genetic identification of bacteria by determining the 16S rRNA gene sequence was also performed using multiplex PCR-positive samples. Finally, the usefulness of our PCR-LF method was evaluated using detailed clinical data. Results. The results of PCR-LF were 9 gram-positive and 1 gram-negative bacterial infections. Eleven bacterial species were identified based on 16S rRNA gene sequences. Ten (90.9%)of the eleven samples (bacterial species) were identified using our PCR-LF. Five samples were detected in bacterial cultures; two are MSSA, one is Streptococcus agalactiae, one is Escherichia coli, one is Prevotella oralis. We diagnosed 6 samples as clinical infections. Therefore, the sensitivity and specificity of the culture tests were 83% and 100%, respectively, while for PCR-LF, these values were 83% and 83%. Conclusions. PCR-LF is highly sensitive and effective for the rapid diagnosis of joint infection; however, dead bacteria may also be detected. Moreover, because the target bacterial species are limited, clinical diagnosis based on the results of multiple examinations is necessary

Aims. To describe the incidence of adverse clinical outcomes related to COVID-19 infection following corticosteroid injections (CSI) during the COVID-19 pandemic. To describe the incidence of positive SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) testing, positive SARS-COV2 IgG antibody testing or positive imaging findings following CSI at our institution during the COVID-19 pandemic. Methods. A retrospective observational study was undertaken of consecutive patients who had CSI in our local hospitals between 1 February and 30June 2020. Electronic patient medical records (EPR) and radiology information system (RIS) database were reviewed. SARS-CoV-2 RT-PCR testing, SARS-COV2 IgG antibody testing, radiological investigations, patient management, and clinical outcomes were recorded. Lung findings were categorized according to the British Society of Thoracic Imaging (BSTI) guidelines. Reference was made to the incidence of lab-confirmed COVID-19 cases in our region. Results. Overall, 1,656 lab-confirmed COVID-19 cases were identified in our upper tier local authority (UTLA), a rate of 306.6 per 100,000, as of 30June 2020. A total of 504 CSI injections were performed on 443 patients between 1 February and 30June 2020. A total of 11 RT-PCR tests were performed on nine patients (2% of those who had CSI), all of which were negative for SARS-CoV-2 RNA, and five patients (1.1%) received an SARS-CoV-2 IgG antibody test, of which 2 (0.5%) were positive consistent with prior COVID-19 infection, however both patients were asymptomatic. Seven patients (1.6%) had radiological investigations for respiratory symptoms. One patient with indeterminate ground glass change was identified. Conclusion. The incidence of positive COVID-19 infection following corticosteroid injections was very low in our cohort and no adverse clinical outcomes related to COVID-19 infection following CSI were identified. Our findings are consistent with CSI likely being low risk during the COVID-19 pandemic. The results of this small observational study are supportive of the current multi-society guidelines regarding the judicious use of CSI. Cite this article: Bone Joint Open 2020;1-9:605–611

Aim. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is commonly associated with serious cases of community-onset skin and musculoskeletal infections (Co-SMSI). Molecular epidemiology analysis of CA-MRSA recovered from skin and soft tissues specimens is lacking in Latin America. This study aimed to identify phenotypic and genotypic features of MRSA isolates recovered from patients presenting Co-SMSI. Methods. Consecutive MRSA isolates recovered from Co-SMSI of patients admitted from March 2022 to January 2023 in a Brazilian teaching hospital were tested for antimicrobial resistance and characterized by their genotypic features. Identification was carried out by automated method and through MALDI-TOF MS. Antimicrobial susceptibility was tested by disk diffusion, broth microdilution and E-test strips for determination of the minimal inhibitory concentration (MIC) according to recommendations from the Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Gene mecA characterization and Sccmec typing were performed by multiplex polymerase chain reaction (PCR) assay, and gene lukF detection by single PCR. Patients were prospectively followed up for two months, in order to determine their clinical characteristics and outcomes. Results. Overall, 48 Staphylococcus aureus isolates were obtained from 68 samples recovered from patients with Co-SMSI. Twenty two (42%) were phenotypically characterized as MRSA, although mecA gene was only identified in 20 of those samples. Sccmec was untypable in 12 isolates, Sccmec was type II in 4 isolates and 2 were classified as type IVa. LukF gene was identified in 5 isolates. Antimicrobial resistance profile showed that all isolates were susceptible to linezolid and vancomycin with MIC = 1 and MIC = 2 in 66,7% and 33.3%, respectively. Susceptibility to quinolones was worryingly low and none of the isolates were sensitive to usual doses of ciprofloxacin and levofloxacin, and showed increased rates of resistance to increased exposure to these drugs, as well. Isolates were both susceptible to gentamicin and tetracycline in 85% and resistance to also Sulfamethoxazole/Trimethoprim occurred in only 2 isolates. Mortality rate evaluated within 1 month of the initial evaluation was 10% among MRSA isolates. Conclusions. Our results showed that CA-MRSA isolates causing Co-SMSI demonstrated an alarming pattern of multidrug resistance, including to β-lactam and quinolones, which have been commonly prescribed as empirical therapy for patients with skin, soft tissue and musculoskeletal infections

Aim. Diagnosis of periprosthetic shoulder infections (PSI) is difficult as they are mostly caused by low-virulent bacteria and patients do not show typical infection signs, such as elevated blood markers, wound leakage, or red and swollen skin. Ultrasound-guided biopsies for culture may therefore be an alternative for mini-open biopsies as less costly and invasive method. The aim of this study was to determine the diagnostic value and reliability of ultrasound-guided biopsies for cultures alone and in combination polymerase chain reaction (PCR), and/or synovial markers for preoperative diagnosis of PSI in patients undergoing revision shoulder surgery. Method. A prospective explorative diagnostic cohort study was performed including patients undergoing revision shoulder replacement surgery. A shoulder puncture was taken preoperatively before incision to collect synovial fluid for interleukin-6 (IL-6), calprotectin, WBC, polymorphonuclear cells determination. Prior to revision surgery, six ultrasound-guided synovial tissue biopsies were collected for culture and two additional for PCR analysis. Six routine care tissue biopsies were taken during revision surgery and served as reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV; primary outcome measure), and accuracy were calculated for ultrasound-guided biopsies, and synovial markers, and combinations of these. Results. Fifty-five patients were included. In 24 patients, routine tissue cultures were positive for infection. Cultures from ultrasound-guided biopsies diagnosed an infection in 7 of these patients, yielding a sensitivity, specificity, PPV, NPV, and accuracy of 29.2%, 93.5%, 77.8%, 63.0%, and 65.6%, respectively. Ultrasound-guided biopsies in combination with synovial WBC increased the NPV to 76.7% and accuracy to 73.8%. When synovial WBC and calprotectin were combined with ultrasound-guided biopsies, it resulted in a better diagnostic value: sensitivity 69.2%, specificity 80.0%, PPV 69.2%, NPV 80.0%, and accuracy 75.8%. Ultrasound-guided biopsies in combination with calprotectin and ESR yielded a sensitivity of 50.0%, specificity of 93.8%, PPV of 80.0%, NPV of 78.9%, and accuracy of 79.2%. Synovial fluid was obtained in 42 patients. Sensitivities of WBC, PMN, IL-6, and calprotectin were between 25.0% and 35.7%, specificities between 89.5% and 95.0%, PPVs between 60.0% and 83.3%, NPVs between 65.4% and 69.4%, and accuracies between 64.5% and 70.6%. Conclusions. In this prospective study we showed that ultrasound-guided biopsies for cultures alone and in combination with PCR and/or synovial markers are not reliable enough to use in clinical practice for the preoperative diagnosis of low grade PSI

Aim. Culture-based conventional methods are still the gold standard to identify microorganisms in hip and knee PJIs diagnosis. However, such approach presents some limitations due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range polymerase chain reaction (PCR), are available for diagnostic use in a suspected PJI. However, limited data is available on their sensitivity and specificity. This study aimed to evaluate the performance of a rapid and simple Investigational Use Only (IUO) version of the BioFire® JI multiplex PCR panel when compared to traditional microbiological procedures. Method. Fifty-eight native synovial fluid samples were recovered from 49 patients (female n=26; male =23) who underwent one or multiple septic or aseptic revision arthroplasties of the hip (n=12) and knee (n=46). The JI panel methodology was used either on specimens freshly collected (n=6) or stored at −80°C in our Musculoskeletal Biobank (n=52). The JI panel performance was evaluated by comparison with culture reference methods. Patient's medical records were retrieved from our institutional arthroplasty registry as well as our prospectively maintained PJI infection database. Results. The JI panel identified additional microorganisms in 3/39 (7.7%) positive cases, and a different microorganism in 1/39 (2.6%) sample. Out of 9/58 (15.5%) culture negative samples, two (22%) were positively detected by the JI panel. In total 49/58 (84%) native synovial fluid specimens were positive by culture methods, versus 39/58 (81.2%) with the JI panel. Ten samples are currently under investigation for confirmatory results. Out of 39 positive detections with the JI panel, 35 (89.7%) were concordant with the identified microorganism (n=29 same species; n=6 same genus). The combined information from the JI panel results and clinical records revealed the existence of 6/58 (10.3%) PJIs’ cases which would have required a different antibiotic therapeutic approach. Conclusions. The work presented, provides additional value for the clinical use of the JI panel to the improvement of PJI management in terms of rapid and successful treatment decisions, patient outcome, and healthcare costs. This technique shows high sensitivity to detect PJIs specific microorganisms in both fresh as well frozen native synovial fluid samples, thus emphasizing its use for retrospective studies analysis

Aims. Elective surgery has been severely curtailed as a result of the COVID-19 pandemic. There is little evidence to guide surgeons in assessing what processes should be put in place to restart elective surgery safely in a time of endemic COVID-19 in the community. Methods. We used data from a stand-alone hospital admitting and operating on 91 trauma patients. All patients were screened on admission and 100% of patients have been followed-up after discharge to assess outcome. Results. Overall, 87 (96%) patients remained symptom-free and recovered well following surgery. Four (4%) patients developed symptoms of COVID-19, with polymerase chain reaction ribonucleiuc acid (PCR-RNA) testing confirming infection. Conclusion. Based on our findings, we propose that if careful cohorting and screening is carried out in a stand-alone cold operating site, it is reasonable to resume elective operating, in a time of endemic but low community prevalence of SAR-Cov2. Cite this article: Bone Joint Open 2020;1-6:229–235

Periosteum is important for bone homoeostasis through the release of bone morphogenetic proteins (BMPs) and their effect on osteoprogenitor cells. Smoking has an adverse effect on fracture healing and bone regeneration. The aim of this study was to evaluate the effect of smoking on the expression of the BMPs of human periosteum. Real-time polymerase chain reaction was performed for BMP-2,-4,-6,-7 gene expression in periosteal samples obtained from 45 fractured bones (19 smokers, 26 non-smokers) and 60 non-fractured bones (21 smokers, 39 non-smokers). A hierarchical model of BMP gene expression (BMP-2 > BMP-6 > BMP-4 > BMP-7) was demonstrated in all samples. When smokers and non-smokers were compared, a remarkable reduction in the gene expression of BMP-2, -4 and -6 was noticed in smokers. The comparison of fracture and non-fracture groups demonstrated a higher gene expression of BMP-2, -4 and -7 in the non-fracture samples. Within the subgroups (fracture and non-fracture), BMP gene expression in smokers was either lower but without statistical significance in the majority of BMPs, or similar to that in non-smokers with regard to BMP-4 in fracture and BMP-7 in non-fracture samples. In smokers, BMP gene expression of human periosteum was reduced, demonstrating the effect of smoking at the molecular level by reduction of mRNA transcription of periosteal BMPs. Among the BMPs studied, BMP-2 gene expression was significantly higher, highlighting its role in bone homoeostasis

Objectives:. The study goal was to retrospectively evaluate the diagnostic accuracy and complication rates of a fluoroscopically guided motorized core biopsy system in the thoraco-lumbar area. Materials And Methods:. The data of fifty eight (58) patients (28 male & 32 female) with an average age of 42.13 years that underwent biopsy of the spine using a motorized core biopsy system between March 2006 and October 2013 (7.7 years) at a level two teaching institution were retrospectively reviewed. Patient characteristics (age, sex), spinal biopsy level, histology, microbiology and fresh tissue polymerase chain reaction (PCR) diagnosis were considered. Results:. Of the 58 patients biopsied 7 were excluded: three patients had a biopsy taken intra-operatively, two patients had a cervical spine biopsy, one patient had a psoas abscess and one had biopsy of the sacral spine. 38 Lumbar (74%) & 13 thoracic (25.4%) biopsies were evaluated. One patient (1.9%) had slightly more bleeding warranting insertion of Port-o-vac drain. No pneumothorax, paraesthesiae or penetration of the spinal canal was reported. In 35 of 51 histological examinations a diagnosis was achieved (68%); 19 of 51 had positive MC&S (37%). The most common diagnosis was tuberculosis (n=21) 41%, followed by multiple myeloma (n=4) 7.8%, adenocarcinoma (n=3) 5.8%, lymphoma (n=3) 5.8%, chronic osteomyelitis (n=3)5.8%, leiyomyosarcoma (n=1)1.9%. Conclusions:. Our results are comparable to published data with an average of 74% histopathological diagnosis and 0–10% complication rate in published literature. We therefore can conclude that the use of motorized core biopsy system is safe and can achieve acceptable diagnostic yield

In this study we evaluated the performance of the newly available ITI-Cartridge (UniveroTM i60 implant and tissue infection (ITI) multiplex polymerase chain reaction (PCR) System, Curetis®, Holzgerlingen, Germany) in diagnosing periprosthetic joint infection (PJI). 30 patients that received an operative revision in the orthopaedic department of the University Hospital Bonn due to suspected PJI or aseptic loosening of a painful total hip or knee arthroplasty between Januar 2014 and November 2014 were included in this retrospective study. The microbiological workup included a minimum of three periprosthetic tissue specimens, joint aspirate and the explanted foreign body for sonication were investigated. Additionally, histopathological examination of the periprosthetic membranes, cell counting of the joint aspirate and multiplex PCR diagnostic of the sonication fluid cultures and of the joint aspirate were performed. All patients were summarized in two diffrent groups (PJI vs. free of infection) according to the classification of the International Consensus Group on Periprosthetic Joint Infection [4]. In our collective sonication fluid cultures had a sensitivity of 88.89% with a specificity of 61.54%. Other microbiological specimens, especially tissue samples and joint aspirates showed both a sensitivity of 66.67%, and a specificity of 92.31% and respectively 84.62%. PCR-based rapid testing of sonication fluid yielded out a sensitivity of 50% with a specificity of 100%. PCR of the joint aspirate documented a slightly better sensitivity of 55.56 % with a specificity of 100%. When summarized these two PCRs the sensitivity rose to 66.67% with a specificity of 100%. In summary, PCR-diagnostic is an additional method to gain ancillary informations in diagnosing PJI but it has to be interpretated carefully in synopsis with the results obtained from tissue cultures, sonication fluid cultures, histopathological examination and clinical course. The performance of the newly available multiplex PCR system ITI-Cartridge did not persuade us, so that PCR diagnostic of sonication fluid culture or joint aspirate was not included in our algorythm of diagnosing PJI

Purpose and Introduction. The burden of Tuberculosis (TB) in South Africa is significant with recent reports showing an increase in the incidence of multi-drug resistant (MDR) TB. Little is known of the incidence and epidemiology, especially of MDR Tuberculous arthritis in children in the South African setting. The purpose of this study is to identify the number of TB cases identified with positive histology, culture and sensitivity. Methods. A retrospective review of laboratory results of children under the age of 14 years with Tuberculous arthritis at a South African Hospital between January 2008 and December 2012 was performed. The data was extracted from the NHLS data base for all synovium, bone or joint fluid collected for TB culture, sensitivity and histology. Results. Over a five year period positive cultures were found in ten patients. Of these ten patients five were sensitive and two were resistant to Isoniazid and Rifampicin using polymerase chain reaction (PCR) testing. Three had no sensitivity requested. Positive histology was found in nine of these patients consisting of chronic granulomata. The mean white cell count was 9 X ?10?∘9cells/l (Range 5–20), mean C reactive protein was 22 mg/l (Range 2–57) and mean erythrocyte sedimentation rate was 36 mm/hr (Range 8–70). Four of the ten patients had HIV testing – they were all negative. Conclusions. This study shows good correlation between positive TB culture and histology. The high prevalence of MDR TB (20%) in these patients is of major concern with further alarm regarding the appropriate treatment of these patients if sensitivities are not routinely checked. Emphasis must be placed on requesting and following up sensitivity testing in these patients. NO DISCLOSURES

Introduction. The ability of activated platelets to induce cellular proliferation is well recognised. In a previous diffusion model, platelets combined with Tri-calcium phosphate (TCP) led to an osteoprogenitor mitogenic response followed by cellular differentiation. This study was designed to look at osteoprogenitor responses when cultured directly onto TCP granules combined with activated platelets. Method. Human osteoprogenitors were loaded onto TCP with activated platelets at a low seeding density and high seeding densities. Cellular proliferation was assessed using the pico-green DNA content analysis. Differentiation towards osteoblastic phenotype was assessed using an alkaline phosphatase assay. RNA extraction, reverse transcription and quantitative real-time polymerase chain reaction was used to assess gene expression for type 1 collagen and osteocalcin. Histological assessment for live/dead staining and alkaline phosphatase was used on cultured granule samples. Results. In the low seeding density, platelets induced an early proliferative response compared with controls. After 14 days of culture the cells had not differentiated to an osteoblastic phenotype. When seeded at high densities, cellular differentiation was induced by the activated platelets. Significant cellular proliferation was not observed after seeding at high density. Conclusions. This study demonstrates that osteoprogenitors respond to the local environment which is modulated by both cell-cell contact factors and inflammatory cytokines from the platelets. This study helps to define the concentration of progenitors and platelets needed for further on-growth studies. It may also help define the optimal conditions for seeding cells and platelets for clinical use of composite bone graft substitutes

Aim. The purpose of this study was to establish the diagnostic utility and spectrum of fluoroscopy guided percutaneous transpedicular biopsies of the thoraco-lumbar spine performed at our institution and to review some aspects regarding the diagnosis of spinal tuberculosis (TB). Methods. A retrospective study was performed on a consecutive series of 48 patients who underwent fluoroscopy guided percutaneous transpedicular biopsies of the spine performed at our institution. Biopsy specimens were sent for microscopy, culture and sensitivity (MC&S) as well as for TB microscopy, culture and polymerase chain reaction (PCR) and for histology. Results. There were 26 females and 22 males. The ages ranged from 23 to 79 years with a mean of 47 years. Fifteen biopsies were performed in the thoracic spine and 33 in the lumbar spine. A diagnosis was established in 83% of patients. The most common diagnosis, made in 58% of cases, was TB. The second most common diagnosis was metastatic disease, diagnosed in 15%. In 3 patients a diagnosis was made of concomitant TB and metastatic adenocarcinoma. No complications were encountered. Regarding the diagnosis of spinal TB we found that microscopy for alcohol and acid fast bacilli has a very low yield, with TB cultures, PCR and histology delivering a higher yield. TB PCR was also found to be positive in some cases where the TB cultures were negative which had implications for our institution's protocol regarding performance of TB PCR testing. Conclusion. Fluoroscopy guided percutaneous transpedicular biopsies of the thoraco-lumbar spine is a safe and effective tool in the diagnostic work-up of a patient with a spinal lesion of uncertain cause. We recommend that in all cases specimens should be send for histology and bacteriological studies and if spinal TB is suspected samples should be sent for histology, MC&S and PCR. NO DISCLOSURES

Aims. To identify the most common infecting organisms associated with deep infection and infected non-union of the tibia, as well as the rate of ‘culture-negative’ infections, at a tertiary referral trauma centre dealing with military and civilian trauma. Method. Between 2008 and 2010 all patients with a confirmed clinical diagnosis of implant-related infection or infected non-union of the tibia were identified retrospectively from a database and their records analysed. After a period of at least 10–14 days without antibiotics, all patients underwent surgical debridement in which ‘clean’ samples were went for microbiological analysis. Skeletal stablity was achieved with a circular frame and intravenous antibiotics were started pending culture and sensitivity results. Results. There were 31 patients; 28 male, 3 female. Mean age 41yrs. 21 patients (68%) had sustained open fractures. In 11 patients, tissue cultures were negative. In the remainder, 8 patients cultured one organism, 6 two organisms, 2 three organisms, and 2 four organisms. Only those with open fractures grew more than 2 organisms. A total of 15 different infecting organisms (all of which were bacteria) were identified. The most common organisms isolated were Staphylococcus aureus, coagulase-negative Staphylococcus, Bacillus and Enterobacter cloacae. There were 3 cases of MRSA infection, all in open fractures. The most frequently used antibiotics for definitive therapy were ciprofloxacin, rifampicin and vancomycin. Conclusions. The majority of patients had sustained open fractures. Patient with open fractures were more likely to have polymicrobial infections. There was a high rate of culture-negative infections, particularly in the closed fracture group. Meticulous sampling and processing of microbiology samples is essential to minimise the number of culture-negative infections. Laboratory techniques such as polymerase chain reaction may help improve culture yields

Background. Current treatments for the prevention of thromboembolism include heparin and low-molecular weight heparins (LMWHs). A number of studies have suggested that long term administration of these drugs may adversely affect osteoblasts and therefore, bone metabolism. Xarelto(tm) (Rivaroxaban) is a new anti-thrombotic drug for the prevention of venous thromboembolism in adult patients undergoing elective hip and knee replacement surgery. The aim of this in vitro study was to investigate the possible effects of rivaroxaban on osteoblast proliferation, function, matrix mineralisation and gene expression compared to enoxaparin, a commonly used LMWH. Methods. Primary human osteoblast cultures were treated with varying concentrations of rivaroxaban (0.013, 0.13, 1.3 and 13 μg/ml) or enoxaparin (0.1, 1.0 and 10 international units/ml). The effect of each drug on osteoblast function and matrix mineralisation was evaluated by measuring alkaline phosphatase activity and calcium deposition, respectively. The MTS assay was used to assess the effect of drug treatments on cell proliferation. Changes in osteocalcin, Runx2 and BMP-2 messenger RNA (mRNA) expression following drug treatments were measured by real-time polymerase chain reaction (PCR). Results. Rivaroxaban and enoxaparin treatment did not adversely affect osteoblast proliferation. However, both drugs caused a significant reduction in osteoblast function, as measured by alkaline phosphatase activity, with a moderate reduction in calcium deposition also observed. This reduction in osteoblast function was associated with a reduction in the mRNA expression of the bone marker, osteocalcin, the transcription factor, Runx2, and the osteogenic factor, BMP-2. Conclusion. These data show that rivaroxaban treatment may negatively affect bone through a reduction in osteoblast function. The increased duration of recommended Rivaroxaban therapy (2 and 5 weeks) post-arthroplasty compared to Enoxaparin therapy (average one week) may have a more pronounced effect on bone homeostasis

The purpose of this study was to profile the mRNA expression for the 23 known matrix metalloproteinases (MMPs), 4 tissue inhibitor of metalloproteinases (TIMPs) and 19 ADAMTSs (a disintegrin and metalloproteinase with thrombospontin motif) in Dupuytren's Disease and normal palmar fascia. Dupuytren's Disease (DD) is a fibroproliferative disorder affecting the palmar fascia, leading to contractures. The MMPs and ADAMTSs are related enzymes collectively responsible for turnover of the extracellular matrix. The balance between the proteolytic action of the MMPs and ADAMTSs and their inhibition by the TIMPs underpins many pathological processes. Deviation in favour of proteolysis is seen in e.g. invasive carcinomata, whereas an imbalance towards inhibition causes e.g. fibrosis. A group of patients with end-stage gastric carcinoma was treated with a broad spectrum MMP inhibitor in an attempt to reduce the rate of carcinoma advancement; a proportion developed a ‘musculoskeletal syndrome’ resembling DD. Tissue samples were obtained from patients undergoing surgery to correct contractures caused by DD and from healthy controls undergoing carpal tunnel decompression. The DD tissue was separated macroscopically into cord and nodule. Total RNA was extracted and mRNA expression analysed by quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR), normalised to 18S rRNA. Comparing across all genes, the DD nodule, DD cord and normal palmar fascia samples each had a distinct mRNA expression profile. Statistically significant (p<0.05) differences in mRNA expression included: higher MMP-2, -7 and ADAMTS-3 levels in both cord and nodule; higher MMP-1, -14, TIMP-1 and ADAMTS-4 and -5 in nodule alone, lower MMP-3 in nodule and cord and lower TIMP-2, -3 and -4 and ADAMTS-1 and -8 levels in nodule alone. The distinct mRNA profile of each group suggests differences in extracellular proteolytic activity which may underlie the process of fascial remodelling in DD

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This study explored the shared genetic traits and molecular interactions between postmenopausal osteoporosis (POMP) and sarcopenia, both of which substantially degrade elderly health and quality of life. We hypothesized that these motor system diseases overlap in pathophysiology and regulatory mechanisms.

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There is little published on the outcomes after restarting elective orthopaedic procedures following cessation of surgery due to the COVID-19 pandemic. During the pandemic, the reported perioperative mortality in patients who acquired SARS-CoV-2 infection while undergoing elective orthopaedic surgery was 18% to 20%. The aim of this study is to report the surgical outcomes, complications, and risk of developing COVID-19 in 2,316 consecutive patients who underwent elective orthopaedic surgery in the latter part of 2020 and comparing it to the same, pre-pandemic, period in 2019.

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The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld.