The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis.Aims
Methods
Open tibial fractures have a high infection risk making treatment difficult and expensive. Delayed skin closure (beyond 7 days) has been shown to increase the infection rate in several studies (1). We aim to calculate the cost of infection as a complication of open tibial fractures and to determine the effect of delayed skin closure on this cost. We retrospectively reviewed all records of patients treated with a free flap in our institution for an open tibial fracture from 2002 to 2013. We calculated direct costs of treatment by the DRG-values (2014 figures), based on length of stay (LOS), diagnosis, orthopaedic and plastic surgical procedures and the corresponding reimbursement. The primary goal was to establish the extra cost incurred by an infection, compared to treating an uninfected open tibial fracture. The cost efficiency saving of early soft tissue cover was also investigated. We analysed 45 injuries in 44 patients. All patients were treated with debridement, stabilization, prophylactic antibiotics and free flap cover. Infection increased the mean total LOS in hospital from 28.0 to 63.8 days. The presence of an infection increased the cost of treatment from a mean of €49.301 for uninfected fractures compared to a mean of €67.958 for infected fractures. Achieving skin cover within 7 days of injury decreased the infection rate from 60% to 27% (total series rate 48%). The provision of early soft tissue cover (before 7 days) for all patients would have saved an average of €18.658 per patient. The development of an infection after a severe open tibial fracture greatly increases the cost of treatment. Early soft tissue cover is one aspect of care which has been shown to improve clinical outcomes. This study confirms that it will also reduce the cost of treating these complex fractures – underscoring the need for rapid referral and an ortho-plastic setup to handle them. We have only calculated the direct costs of treatment. Infected fractures will also consume extra costs in rehabilitation and absenteeism from later infection recurrence and non-union. Therefore, our estimate of the potential saving is likely to be conservative.
All deceased were checked in the danish patient registration system for revision. 113 patients with 128 THR were operated with the Spotorno CLS stem, and 431 patients with 465 THR with the Mller straight stem. 270 patients with 297 THR were assessed radiographically and according to a modified Harris Hip Score (ROM was not used). Some were due to age or other illnes not able to attend the examination. If possible they were interviewed by telephone. The median age was 69,4 (range 18,3 – 88,1) for all, for the Spotorno CLS group 55 years (range 18–72) and for the Mller group 72 years (41–88). Male/female ratio: 0,56. Average follow-up was 13 years (range 9,1 -15.1). The primary diagnosis was osteoarthritis 538 hips, RA 10, fracture sequelae 15, congenital dislocation 14, others contributed with 16 hips. The survival rates were calculated using the Kaplan-Meier method.
After 13 years the survival rate for the cups was 96.8% including reoperations for polyethylene wear, for the femoral Mueller stem 90.7% and for Spotorno CLS 96.1 %
