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Treatment Options for Pin Site Infection during Kirschner Wires in Elective Forefoot Surgery

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Open Journal of orthopedics 2021年第2期11卷 47-66页

作者： Ismail Mohamed Hussein Lei Wang Bin Yu Department of orthopedic and Traumatology Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine Nanfang Hospital Southern Medical University Guangzhou China

The Kirschner wires (K-wires) are stiff and straight wires made of smooth stainless steel. These are used in surgery to aid in repairing the process of a fractured bone. In forefoot elective surgeries, these pins are mostly used for fixation of the phalangeal or metatarsal area. These wires are usually either buried or exposed, The exposed wires do not require another operation to remove them and are generally preferred. In using the forefoot surgery history of a single surgeon which was taken for 3 years. The purpose of this study is to evaluate the occurrence of infections following elective surgeries of the forefoot that were fixed using k-pins and to indicate an effective treatment option for resolving the infection. The inclusion criteria set for this study was to remove any patient having any disease except for diabetes. Moreover, the age limit was set to be 18 - 44, making a final sample of 50 people, prescribed prophylactic antibiotics or early removal of k-pins, where necessary. The researcher recorded demographic and biological data from the patients such as age, BMI, and smoking status were recorded. The researcher conducted a Univariate analysis via a Chi-square test. 50 Patients (82 K-wires) were analyzed. Results showed that surgery type, BMI, and smoking were three variables that affect the infection growth significantly while diabetes and type of cleaning disinfectant had marginal effects. Further study is required to clarify the best treatments in this area, as the treatment option antibiotics have nearly similar results.

关键词： Kirschner Wires Complications Risk Factors Disinfectant Forefoot Surgery Infection Risk Treatment Options

Is There Any Relationship between Total Hip Arthroplasty and Urinary Incontinent?

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International Journal of Clinical Medicine 2023年第4期14卷 197-205页

作者： Mariko Asahi Saiji Kondo Atsushi Kusaba Akihiko Maeda Koji Kanzaki Institute of Joint Replacement and Rheumatology Zama General Hospital Zama Japan Department of orthopedic Surgery Showa University Fujigaoka Hospital Yokohama Japan

Introduction: In my daily practice as a hip surgeon, I have observed some circumstances where urinary incontinence (UI) improves after total hip arthroplasty (THA). We investigated UI symptoms before and after THA at our facility and considered the factors that influence UI. Patients and Method: The subjects were 113 female patients who underwent primary THA in our facility. An anterior lateral approach was used in all cases. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), we conducted an investigation into the presence of UI before and 2 weeks after THA. An improvement in UI was defined as a decrease of 1 point or more, a worsening is defined as an increase of 1 point or more. Results: The responses from the 113 subjects were analyzed. Of the 113 patients, prior to THA, UI was prevalent among 59 patients and was absent among 54 patients. In the group where UI was prevalent, it improved after THA in 50 patients (85%), remained unchanged in 5 (8%) and worsened in 4 (7%). In the group where UI was absent, 49 patients (91%) remained unchanged and UI appeared in 5 (9%). Compared with the non-prevalence group (62 patients), the prevalence group (50 patients) had a noticeable improvement rate of internal rotation of the surgical hip side (P Conclusion: UI greatly reduces the quality of life (QOL). In this study, there is a possibility that THA improves UI.

关键词： Total Hip Arthroplasty Urinary Incontinence Obturator Internus

The Antero-Lateral Thigh Flap in Coverage of Extensive Post Traumatic Upper Limb Defects

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Surgical Science 2016年第7期7卷 309-315页

作者： Rasha Abdelkader Hossam El Mahdy Tamer Nagy Khairalla Ayman Mansour Nisar Haider Zaidi Plastic Surgery Department Kasr Alainy Hospital Cairo University Cairo Egypt Vascular Surgery Department Kasr Alainy Hospital Cairo University Cairo Egypt orthopedic Surgery Department Alexandria University Alexandria Egypt orthopedic Surgery Department Cairo University Cairo Egypt Department of Surgery King Abdulaziz University Hospital Jeddah Saudi Arabia

Objective: To assess the role of antero-lateral thigh flaps in coverage in cases with traumatic injury to the upper limb. Methods: A total of fifteen cases of upper limb trauma were studied between May 2014 and February 2016. Antero-lateral thigh flaps were performed to cover post traumatic upper limb soft tissue defects. Brachial interposition grafts were used in all cases. Harvesting was performed using saphenous vein graft. A 10% larger than defect, flap was used to cover defect. Results: The age range was 15 to 46 years. All 15 cases were male. The indication for soft tissue reconstruction was trauma all patients. Each procedure was performed by a “two team” approach with an experienced surgeon raising the flap and a team preparing the recipient vessels. Flap size ranged from 15 to 25 cm in length and from 8 to 10 cm in width. Ischaemic time ranged from 91 to 157 min. We experienced a 100% flap success rate, with good cosmesis and return to function in all cases. Only two anastomoses required explorations or revision. Minor complications were seen in two patients including a superficial wound infection and a small wound dehiscence. The donor site was closed directly all cases, light dressing with slab support was utilized in all patients Early postoperative management warming the patient, half-hourly flap observations, and ensuring adequate hydration and urinary output. All patients received antithrombotic therapy. Conclusion: The anterolateral thigh flap is one of the most versatile and useful perforator flaps for multidimensional reconstructions for head and neck, limb, trunk, and perineal region. It can be ultrathin flap for resurfacing and filling dead spaces with superior functional and aesthetic outcomes.

关键词： Anterolateral Thigh Flap Perforator Trauma Defects

Lateral or medial approach for valgus knee in total knee arthroplasty, which one is better? A systematic review

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Lateral or medial approach for valgus knee in total knee art...

Management of postoperative spinal infections

2019楚天骨科高峰论坛暨第二十六届中国中西医结合骨伤科学术年会

作者： Bin Wang Dan Xing Jiao Jiao Li Yuanyuan Zhu Shengjie Dong Bin Zhao orthopedic Department Second Hospital of Shanxi Medical University Arthritis Clinic & Research Center Peking University People’s Hospital Peking University Kolling Institute University of Sydney Pharmaceutical Department Second Hospital of Shanxi Medical University orthopedic Department Yantaishan Hospital

Objective: To identify whether the medial or lateral approach is superior for patients with valgus knee undergoing primary total knee arthroplasty(TKA). Methods: Studies evaluating the two approaches were sourced from PUBMED, EMBASE, Web of Science and OVID databases. The quality of included studies was assessed using a modified quality evaluation method, and differences between approaches were systematically reviewed. Results: Seventeen observational studies were included. The studies were published between 1991 and 2016, comprising 5 retrospective studies and 12 prospective *** evaluation methods for the study outcomes were identified. Twelve and eight complication types were identified by studies reporting the lateral and medial approaches for valgus knee, *** studies showed that pain scores and knee function were superior using a lateral ***: Lateral approach is useful and safe in the treatment of patients with valgus knee undergoingTKA. Most of the available evidence supports the use of a lateral approach provided that the surgeon was familiar with the pathological anatomy in valgus knee.

关键词： genu valgum lateral approach medial approach total knee arthroplasty

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World Journal of orthopedics 2012年第11期3卷 182-189页

作者： Vishal Hegde Dennis S Meredith Christopher K Kepler Russel C Huang Department of orthopedic Surgery Weill Cornell Medical CollegeNew YorkNY 10021United States Department of orthopedic Surgery Spine and Scoliosis ServiceHospital for Special SurgeryWeill Cornell Medical CenterNew YorkNY 10021United States Department of orthopedic Surgery Rothman InstituteThomas Jefferson UniversityPhiladelphiaPA 19107United States

Postoperative surgical site infection(SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention,diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories:(1) microbiological factors;(2) factors related to the patient and their spinal pathology; and(3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique,prophylactic antibiotics,avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinalinstrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure.

关键词： Surgical site infection Spine surgery Discitis Postoperative infection

Positioning and design by computed tomography imaging in neuroendoscopic surgery of patients with chronic subdural hematoma

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World Journal of Clinical Cases 2023年第14期11卷 3204-3210页

作者： Xue-Jian Wang Yu-Hua Yin Long-Yao Zhang Zhi-Feng Wang Cheng Sun Zhi-Ming Cui Department of Neurosurgery Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Neurosurgery Renji HospitalShanghai Jiao Tong UniversityShanghai 200000China Jiangsu Provincial Key Laboratory of Nerve Regeneration Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of orthopedic Affiliate Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina

BACKGROUND Neuroendoscopy is a very useful technique to Chronic Subdural Hematoma(CSH).But how to achieve the goal of treatment more minimally invasive?AIM To develop a simple,fast and accurate preoperative planning method in our way for endoscopic surgery of patients with *** From June 2018 to May 2020,forty-two patients with CSH,admitted to our hospital,were performed endoscopic minimally invasive surgery;computed tomography(CT)imaging was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic *** clinical data and treatment efficacy were *** According to the learning of CT scanning images,the surgeon can accurately design the best minimally invasive neuroendoscopic surgical approach and realize the precise positioning and design of the drilling site of the skull and the size of the bone window,so as to provide the most effective operation space with the smallest bone *** this group,the average operation time was only about 1 h,and the clearance rate of hematoma was about 95%.CONCLUSION Patients with CSH can achieve good therapeutic effect by using our way to positioning and design to assist the operation of CSH according to CT scan and image,and our way is very useful and necessary.

关键词： Chronic subdural hematoma Neurosurgery neuroendoscopy Positioning and design Bone window design

Usefulness of Hammering Sound Frequency Analysis as an Evaluation Method for the Prevention of Trouble during Hip Replacement

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Journal of Biomedical Science and Engineering 2020年第5期13卷 74-80页

作者： R. Sakai K. Uchiyama N. Takahira M. Kakeshita Y. Otsu K. Yoshida M. Ujihira Department of Biomedical Engineering and Technology Kitasato University School of Allied Health Sciences Kanagawa Japan Department of orthopedic Surgery Kitasato University School of Medicine Kanagawa Japan Mark Electronics Co. Ltd. Kanagawa Japan

In total hip arthroplasty, judgment of the appropriateness of stem hammering is dependent on the experience and feelings of the surgeon and no objective evaluation method has been established. In this study, a frequency analysis of the hammering sounds in total hip arthroplasty was performed to investigate objective judgment criteria capable of preventing problems during surgery. Stem hammering was applied following the surgeon’s feelings as usual in an operating room. A directional microphone was placed at a distance about 2 m from the surgical field and the peak frequency reaching the maximum amplitude was determined by Fourier analysis. It was clarified that the same peak frequency repeats when appropriate fixation is acquired during surgery, suggesting that intraoperative fracture and postoperative loosening can be prevented by stopping hammering at the time the peak frequency converged. Investigation of changes in the hammering sound frequency may serve as objective judgment criteria capable of preventing problems during surgery.

关键词： Hip Replacement Total Hip Arthroplasty Hammering Sound Frequency Analysis Intraoperative Fracture Loosening

One-stage total hip arthroplasty and“light-bulb”procedure for bilateral non-traumatic osteonecrosis of femoral head in different stages

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Chinese Medical Journal 2019年第23期132卷 2883-2885页

作者： Pei Liu Qi-Dong Zhang Yang Wang Zi-Qi Xia Fei-Fan Lu Zhao-Hui Liu Wei-Guo Wang Wan-Shou Guo Beijing University of Chinese Medicine Beijing 100029China Department of orthopedic Surgery Beijing Key Lab Immune-Mediated Inflammatory DiseasesChina-Japan Friendship HospitalBeijing 100029China China-Japan Friendship School of Clinical Medicine Peking UniversityBeijing 100029China

To the Editor:Clinically,it is not rare for patients with bilateral non-traumatic osteonecrosis of femoral head(NONFH)first presenting to an orthopedic surgeon with one hip that requires total hip arthroplasty(THA)and... 详细信息

关键词： femoral traumatic arthroplasty

Radial head subluxation in pediatric clinics and emergency departments in China

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Chinese Journal of Traumatology 2019年第6期22卷 340-344页

作者： You-Xin Wang Ge Zhang Bo Song Ming Li Department of orthopedic Center Ministry of Education Key Laboratory of Child Development and DisordersNational Clinical Research Center for Child Health and DisordersChina International Science and Technology Cooperation Base of Child Development and Critical DisordersChongqing Key Laboratory of PediatricsChildren's Hospital of Chongqing Medical UniversityChongqing 400014China

Purpose:To investigate the characteristics of the onset and treatment of radial head subluxation(RHS)in pediatric clinics and emergency ***:A retrospective study was performed on 11,404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December *** patients who with history of trauma and fracture of the affected limb were *** following factors were examined:the mechanisms of RHS,the type of manual reduction,the attending physician's clinical background(emergency surgeon,junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon),and the epidemiological features(gender,age,climate and location)of the ***:The mean age of the patients was 27.93±17.94 months(range 0.93-214.53 months),with a peak incidence of 10.73-44.53 *** two-thirds of RHS cases occurred in cold weather from January to March and from September to *** accounted for 53.81%(n=6137)of the cases,and left injuries were predominant(56.87%,n=6485)in all *** of injury were classified as"pull"(90.57%,n=10,339),"fall"(1.56%,n=178),"hit"(0.75%,n=86)and"unknown"(7.02%,n=801).The overall success rate of manual reduction was 99.47%,and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons(p<0.05).However,there was still a recurrence rate of 12.16%in the 9827 ***:Younger children are predisposed to RHS,and there is a possibility of *** emergency doctors can handle it well,but it is essential to refer patients to specialists when manual reduction failed.

关键词： Radial head subluxation Pediatric emergency Recurrence