In spite of its incidence decreasing to 1% nowadays, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Early diagnosis, selection of an appropriate surgical strategy, accurate identification of the responsible microorganisms and construction of an appropriate antibiotic regimen are essential elements of any management strategy. Our study aim was firstly to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware and secondly to investigate the role of possible metabolic factors affecting the sensitivity of the sonication method.

We investigated 70 patients undergoing revision hip or knee arthroplasty because of loosening of the prostheses, at our institution, between October 2011 and November 2013. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection.

Infectious Diseases Society of America (IDSA) Guidelines were used for the definition of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivity of sonication fluid culture was 81.25% and the sensitivity of conventional tissue cultures was 56.25% (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05).

The sonication method represents a reliable test for the diagnosis of prosthetic – joint infections with a greater sensitivity than the conventional periprosthetic tissue cultures, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis.

In treating open long bone fractures our current policy includes early administration of intravenous antibiotics and surgery on a scheduled trauma list. We have reviewed our infection rates 6 years following the initiation of this policy. 220 fractures were studied. Our records included time of administration of antibiotics, time to theatre and seniority of surgeon. We identified cases of superficial or deep infection. Surgical debridement occurred within 6 hours of injury in 45% of cases and after 6 hours in 55%. Overall infection rates were 11% and 15.7% respectively. Intravenous antibiotics were administered within 3 hours of injury in 80% of cases and after 3 hours in 20% of cases. Overall infection rates were 14% and 12.5% respectively. Infection rates where the most senior surgeon present was a consultant were 9.5% compared to 16% with the consultant absent. Our results suggest that the change in policy may have contributed to an improvement of the deep infection rate to 4.3% from the previous figure of 8.5%, although this decrease was not statistically significant. Time to theatre has not adversely affected the infection rate, and presence of a senior surgeon may have improved infection rates, although both trends were not statistically significant.

Introduction

Early identification and conservative management of paediatric Monteggia fractures has been shown to correlate with good results. Nevertheless, several authors advocate more aggressive management with open reduction and internal fixation (ORIF) for unstable fractures. We herein present the experience of a tertiary paediatric hospital in the management of Monteggia fractures.

Introduction

Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and internal fixation for the less displaced fractures.