Purpose of the study: Surveillance of operative site infections (OSI) is a persistent problem in orthopedic surgery. In France, a specific administrative directive was issued on December 29, 2000 to regulate surveillance of OSI.

Material and methods: Based on evidence reported in the literature, the efficacy of any surveillance plan requires a sufficiently dense data base obtained by long-term and systematic registration of all significant information concerning all orthopedic surgery patients. Of particular importance are the ASA score, Altmeier, and antibiotic prophylaxy. During the five-year period from 1999 through 2004, a total of 8811 consecutive orthopedic surgery procedures were followed prospectively. Infections detected were registered using a dedicated software. The hospital hygiene committee and the referring surgeon performed the follow-up.

Results: On average, infection developed four months after surgery. The rate of infection was 1.2% in 1999 and declined to 0.6% in 2003 with the implementation of a few prophylactic measures. It was possible to determine which operations and which patients were at risk using as criteria the type of operation and the ASA score.

Discussion: Surveillance of OSI, with adjustment for risk factors, enabled a measurement of the risk of infection and enabled us to recognized a trend within our department. This study enabled us to define the level of risk for our patients and also develop a new preventive policy. Our findings led us to modify certain practices. Certain data reported in the literature concerning antibiotic prophylaxy were confirmed.

Conclusion: This work demonstrated the importance of following operative site infections, disclosed the implications for medical and hospital personnel, and demonstrated the efficacy of preventive measures for decreasing the rate of these infections.

We conducted a multicentre cohort study of 228 patients with osteoarthritis followed up after total hip or knee replacement. Quality of life and patient satisfaction were assessed by self-administered questionnaires. Patient satisfaction was the dependent variable in a multivariate linear regression model. Independent variables included sociodemographic factors, pre- and post-operative clinical characteristics and the pre-operative and post-discharge health-related quality of life.

The mean age of the patients was 69 years (sd 9), and 43.8% were male. Pre- and postoperative clinical characteristics were not associated with satisfaction with health care. Only pre-operative bodily pain (p < 0.01) and pre-operative social functioning (p < 0.05) influenced patient satisfaction with care.

The pre-operative health-related quality of life and patient characteristics have little effect on inpatient satisfaction with care. This suggests that the impact of the care process on satisfaction may be independent of observed and perceived initial patient-related characteristics.

Introduction: Complex humerus fractures is a frequent lesion with a greater incidence than hip fractures. The treatment is a challenge for orthopaedic surgeons. We present a new osteosynthesis technique based on a mini invasive nailing with a self stabilized screws interlocking.

Methods: We used a 15 cm intramedullary nail with a 7, 8, or 9 mm width. The proximal locking is carried out in the articular and tuberosity fragments with cancellous screws. Two or three small fragments long threaded screws are usually necessary to stabilize the fragments and the humeral head. Rigid fixation is obtained with an excellent stability due to the intra nail locking of the screws. Distal interlocking is carried out at the level of the deltoid tuberosity ensured by 1 or 2 frontal screws introduced away from the nerves and blood supply. Functional therapy is initiated on the first post-operative day.

Results: We present a series of the first 64 cases done in a prospective approach. The patients have been classified according to the Constant score. The mean balanced score is 88% at the two years follow-up. Among the advantages of the technique we point out the great comfort of the patients with a minimal pain and the possibility of an immediate rehabilitation after the surgery. Because of the use of the nail, we stop the use of the hemiarthroplasty even in the 4 fragments fractures.

Conclusion: Telegraph nailing of the complex proximal humeral fractures gives excellent results at the two years follow-up, sometimes unexpected even in the more complex cases and avoid the use of shoulder arthroplasty in the traumatic indication.