Purpose of the study: Total knee arthroplasty (TKA) is associated with important intra- and postoperative bleeding often requiring transfusions, leading to certain risks despite classical methods of haemostasis. The purpose of this study was to estimate the efficacy of a fibrin glue for reducing postoperative blood loss after TKA.

Material and methods: This was a single centre single operator randomised prospective study. Two groups of patients received a first-intention TKA implanted without cement. For a control group (n=24) classical surgical haemostasis was performed; in another group of 22 patients, 4 ml of fibrin glue were vaporised on the internal structures and the subcutaneous tissue intraoperatively, just after insertion of the implants and associated with classical haemostasis. In all cases, the patients had gravity drainage for 48 h; the tourniquet was not removed before dressing. All patients had preventive anticoagulation postoperatively on day 1.

Results: Blood loss was calculated from d−1 to d+4 and was expressed in grams and in percentage in order to overcome the bias of body weight and gender. Mean blood loss was 17 g in the fibrin glue group (raw data) or 24% of the blood mass while it was 211 g in the control group, i.e. 31%. The percentage of blood loss was 31 and 24% with fibrin (p=0.05). Three of 22 patients, 13%, required transfusion in the fibrin glue group versus 11 of 24, 46%, in the control group. We did not take into consideration the rate of seroconversion at three and six months postoperatively.

Conclusion: Use of a fibrin glue can significantly reduce the need for transfusion and reduce blood loss postoperatively after first-intention unilateral uncemented TKA.

Purpose of the study: Within the framework of a regional study, we compared the efficacy of pinning using the PY technique and the Kapandji method for the treatment of fractures of the distal radius with posterior displacement.

Material and methods: This was a prospective study designed as a phase III randomised therapeutic trial in parallel groups. An open monocentric study with multiple operators compared the PY and Kapandji techniques. Two comparable groups were established: the PY group and the Kapandji group (K) for which we measured: quality of reduction using the radiographic frontal and sagittal radial inclination (FRI and SRI), radial length and inferior radioulnar index. Objective and subjective functional outcome assessed range of motion and the DASH and Jakim scores. The quality of the intra-articular reduction of articular fractures was assessed arthroscopically at the time of implant removal during the sixth week.

Results: The series included 97 patients followed for one year. The preoperative FRI was 15.17 with mean posterior shift of −19.2. At one year, the RI was 25.5 in the PY group versus 22.6 in the K group (p=0.009) and the SRI 10.5 in the PY group versus 3.7 in the K group (p=0.04). For fractures with a posteromedian fragment and Gerard-Marchand fractures, the DASH at one year was 2 in the PY group versus 32 in the K group. The Jakim score was 71 in the PY group versus 58 in the K group (p=0.03) for posteromedian fragment fractures. The arthroscopic control at six weeks of articular fractures did not reveal any significant difference in intra-articular reduction. There were no tendon tears in this series.

Discussion: This series shows the quality of pin fixation for wrist fractures, comparable with plating. It emphasizes the importance of adapting the type of pinning to the fracture type and the patient.

Conclusion: Treatment of fractures of the distal radius with posterior displacement with pin fixation remains a treatment of choice, reserving PY osteosynthesis for fractures with a posteromedian fragment and Gerard-Marchand fractures and Kapandji osteosynthsis for simple Colles fractures.

Purpose of the study: Prevention of operative site infections (OSI) in orthopaedic surgery requires strict observation of validated practices during hospitalisation and in the operative theatre, review of morbidity and mortality, and surveillance of OSI. Certain intrinsic patient-related risk factors of OSI cannot be controlled without direct implication of the patient and the referring physician. Search for Staphylococcus aureus (SA) colonisation and bacteriuria should be done in the ambulatory setting, before hospitalisation. The purpose of this work was to evaluate the feasibility of a search for SA in the nasal swabs and urine samples in patients scheduled for prosthesis surgery.

Material and methods: This was a prospective study on 335 patients who had a total hip arthroplasty (THA) or a total knee arthroplasty (TKA) from January 1, 2007 to December 31, 2008. Bacteriological tests were performed before hospitalisation. Before hospitalisation, the patient and the primary care physician were give information on the proper procedure for chemical decontamination. The results of these laboratory tests were analysed and OSI were followed.

Results: Three hundred thirty-five patients (195 THA and 143 TKA) were included; the sex-ratio was 0.95 M/F. Sixty-one patients (18%) exhibited SA colonization, including two meticillin resistant strains. Urine samples were positive in 30/323 patients (9.3%). Three patients presented an early OSI: two infections of a revision THA and one infection of a revision TKA. Two of these patients had an SA infection, including one who was colonized and had applied the chemical decontamination protocol before hospitalization.

Discussion: By treating bacteriuria before hospitalization, deferral of the scheduled operations could be avoided. Laboratories must run two sets of tests to search for both met-S and met-R SA, which in our experience was not always the case despite written prescriptions. Implementation of chemical decontamination of the nasal passages and skin before surgery requires a well-established cooperation between the primary care physician and the hospital. The three infections recorded in this series involved revision procedures, with a context of rheumatoid polyarthritis for two patients.

Conclusion: Systematic screening for SA colonization in orthopaedic surgery remains a subject of debate, particularly concerning the cost-efficacy balance, but can be quite useful in certain situations such as revision or prosthetic surgery in immunodepressed patients.

Purpose of the study: To compare the DHS plate fixation with the Targon PF nail for the treatment of intratro-chanteric fractures.

Material and methods: This was a prospective randomized study including 60 patients hospitalized in the emergency setting between December 2003 and June 2004for intratrochanteric fractures. The AO classification was used. We analyzed: patient status (ASA), operative time (type of implant, duration), the postoperative period (blood loss, radiologic findings, duration of hospital stay, early postoperative complications) and at last follow-up, Harris hip score, date of resumed walking, mortality. Patients were assessed at three months postop. This study included 60 patients, 34 with a Targon PF nail and 26 with a DHS. Mean patient age for nailing was 81 years (SD 12.8, range 23–86); for DHS it was 82 years (SD 9.8; range 47–97).

Results: Mean blood loss was 410 ml with the Targon PF nail and 325 ml with the DHS, a nearly significant difference (p=0.07). The other results did not demonstrate any significant difference. At three months five cases of screw cut out were noted. Bone healing was achieved in all cases. The Trargon PF nail and the DHS provide equivalent results, with less bleeding an lesser cost for the DHS.

Purpose: This retrospective analysis was performed to determine the long-term usefulness of carpectomy and to define prognostic factors.

Material and methods: Forty-four patients were operated. There mean age was 39.2 years, and mean follow-up was 17 years (10–35 years). Twenty-two patients had osteoarthritis, one STT, thirteen SNAC-wrist, two SLAC-wrist, and three radiocarpal osteoarthritis. The wrists were free of degenerative lesions in 22 cases: eight Kienböck disease, five longstanding perilunar dislocations, six fracture sequelae, and one rheumatoid polyarthritis. Seventeen patients had had several procedures before the present operation. The dorsal approach was used for all patients except five. Complementary styloidectomy was associated in two cases. clinical and radiological outcome was assessed at one, five and fifteen years. Factors predictie of outcome were analysed with the Student test and the Man and Whitney test.

Results: The pain score (Cooney scale 1 to 4) was 3.19 preoperatively and 1.56, 1.88 and < 2 at one, five and fifteen years respectively. Flexion amplitude improved from 44° preoperatively to 61°, 68° and 62° at one, five and fifteen years respectively. Mean grip force, compared with the other wrist was 57.5%, 75% and 64% at one, five and fifteen years. Radiographically, at fifteen years 80% of the patients had a centred capitatum on the AP view of the lunar facet. On the lateral view, 56% of the patients exhibited anterior translation of the apitatum and 37% were centred. There was a degradation of the radiocapitum space requiring revision for arthrodesis in five cases.

Discussion, conclusion: This study confirms the long-term preservation of outcome after proximal carpectomy: 89% of the patients were satisfied at fifteen years. These findings also indicate that reconstruction of recent trauma (fracture-dislocation) produces variable results. For patients with grade II or II osteoarthritis (SNAC or SLAC-wrist) carpectomy should be reserved for selected patients with occupational or sports activities not requiring grip force. For grade III wrists, carpectomy can be proposed for elderly patients with limited activity. Grade IV is a contraindication for carpectomy. We do not recommend this procedure for patients with rheumatoid arthritis or Kienböck disease.