Monitoring Method for Deep Infection after TKA: Significance of Intraoperative Synovial Fluid Culture and Postoperative Suction Drainage Tip Culture / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. MATERIALS AND METHODS: Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. RESULTS: 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). CONCLUSION: In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.

Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score 0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.

Management of Infection for Methicillin Resistant Staphylococcus aureusat an Orthopaedic Surgery Department / 대한정형외과학회잡지

PURPOSE: This study was undertaken to find two things. One was to reveal the infection route of methicillin resistant Staphylococcus aureus(MRSA) that causes serious nosocomial infection through epidemic study, and the other was to seek preventative methods through blocking the dispersion. MATERIALS AND METHODS: We cultured MRSA obtained by nasal cavity swabbing, from 82 doctors and 219 personnel in our hospital, between September 1997 and August 1999. In addition, swabs were taken from the nasal cavities and surgical sites of 57 orthopaedic surgery patients, who were free of wound infection. In this practice, we use the disc test for drug sensitivity, and pulse-field gel electrophoresis (PFGE) to separate colonies. RESULTS: MRSA was discovered in 8 doctors (10%) and in 13 personnels (6%) by nasal cavity sabbing, and these included 3 orthopaedic surgeons. MRSA was also found in the patients' group, there were 23 (40%) from nasal cavities and 14 ones (25%) from surgical sites. Their PFGE types of MRSA were of A type, which were also identified in two orthopaedic surgeons. SUMMARY: We noticed that nasal cavitiy infection could occur by cross infection between doctors and patients. Surgical wound infection may occur by infection from the nasal cavity. This study underlines the importance of MRSA infection and management.