Glenohumeral arthrodesis outcomes and complications: a systematic review.

BACKGROUND: The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis. METHODS: Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following shoulder arthrodesis from the years of 2000-2022. Functional outcomes that were collected included the Subjective Shoulder Value, American Shoulder and Elbow Surgeons shoulder index score, visual analog scale pain score, and Oxford Shoulder Score. Range-of-motion data were also collected. RESULTS: This review included 17 studies, with a total of 316 patients, that met the inclusion criteria. The majority of the patients were male (67.4%), and the average age was 38.4 years (range, 7-82 years). The overall fusion rate was 88.7%, and the time to fusion was on average, 3.9 months (range, 2-8 months). Shoulder arthrodesis resulted in improvement in each of the functional outcomes assessed: Subjective Shoulder Value (preoperatively, 18.8; postoperatively, 43.9; and percent change, 132.8%), American Shoulder and Elbow Surgeons shoulder index score (postoperatively, 62.1), visual analog scale pain score (preoperatively, 8.5; postoperatively, 3.03; and percent change, 62.4%), and Oxford Shoulder Score (preoperatively, 9.4; postoperatively, 30.9; and percent change, 328.7%). The abduction, forward flexion, external rotation, and internal rotation range-of-motion measurements postoperatively were 57°, 64°, 3°, and 48°, respectively. Complications were reported in 33.6% of patients, with fractures (20.9%) and infections (18.6%) being the most common sources of complication. CONCLUSION: Shoulder arthrodesis provides improvement in functional outcomes for end-stage glenohumeral injuries; however, it is also associated with high rates of complications.

Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI). We hypothesized that increased radiographic shoulder soft-tissue thickness would be a strong predictor of operative time, length of stay (LOS), and infection in elective RSA. MATERIAL AND METHODS: A retrospective review of patients undergoing RSA at an academic institution was conducted. Preoperative radiographic images were evaluated including measurements of the radius from the humeral head center to the skin (HS), deltoid radius-to-humeral head radius ratio (DHR), deltoid size, and subcutaneous tissue size. Different correlation coefficients were used to analyze various types of relationships, and the strength of these associations was classified based on predefined boundaries. Subsequently, multivariable linear and logistic regressions were performed to determine whether HS, DHR, deltoid size, and subcutaneous tissue size could predict LOS, operative time, or infection while controlling for patient factors. RESULTS: HS was the most influential factor in predicting both operative time and LOS after RSA, with strong associations indicated by standardized ß coefficients of 0.234 for operative time and 0.432 for LOS. Subcutaneous tissue size, deltoid size, and DHR also showed stronger predictive values than BMI for both outcomes. In terms of prosthetic joint infection, HS, deltoid size, and DHR were significant predictors, with HS demonstrating the highest predictive power (Nagelkerke R2 = 0.44), whereas BMI did not show a statistically significant association with infection. Low event counts resulted in wide confidence intervals for odds ratios in the infection analysis. CONCLUSION: Greater shoulder soft-tissue thickness as measured with concentric circles on radiographs is a strong predictor of operative time, LOS, and postoperative infection in elective primary RSA patients.

Subscapularis repair for reverse shoulder arthroplasty: a systematic review and meta-analysis.

BACKGROUND: The purpose of this study is to perform a systematic review of the literature evaluating the importance of subscapularis repair in patients who underwent reverse shoulder arthroplasty (RSA). METHODS: A systematic search of articles in PubMed, EMBASE, and the Cochrane Library databases was carried out according to the PRISMA guidelines. Cohort studies comparing RSA with subscapularis repair vs. RSA without subscapularis repair were included. All statistical analysis was performed using Review Manager. A P value of <.05 was considered to be statistically significant. RESULTS: Seventeen studies with 2620 patients were included. Subscapularis repair resulted in less instability compared to without subscapularis repair (0.8% vs. 4.2%, P = .04), and there were no significant differences in rate of instability with lateralization (0.6% vs. 1.6%, P = .40), revision rates (2.6% vs. 3.9%, P = .62), and complication rates (7.7% vs. 4.9%, P = .21). Subscapularis repair had improved American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores (83.6 vs. 80.2, P = .02) and Constant scores (72.6 vs. 68.9, P < .01) but there was not a significant difference in visual analog scale pain scores (1.2 vs. 1.6, P = .11). Subscapularis repair had a significant difference in forward flexion (140° vs. 137°, P = .04) and internal rotation score (5.5 vs. 4.6, P = .001); however, there was no significant difference in external rotation (35° vs. 35°, P = .80) and abduction (117° vs. 123°, P = .13). CONCLUSION: This study found that RSA with subscapularis repair demonstrated a reduction in the occurrence of implant instability with medialized implants. However, subscapularis repair did not yield improvements in revision rates, complications, or instability with lateralized implants. Additionally, other outcome measures such as ASES, Constant score, and range of motion exhibited statistically significant improvements with subscapularis repair but did not surpass clinically significant thresholds.

Applications of Antimicrobial Photodynamic Therapy against Bacterial Biofilms.

Antimicrobial photodynamic therapy and allied photodynamic antimicrobial chemotherapy have shown remarkable activity against bacterial pathogens in both planktonic and biofilm forms. There has been little or no resistance development against antimicrobial photodynamic therapy. Furthermore, recent developments in therapies that involve antimicrobial photodynamic therapy in combination with photothermal hyperthermia therapy, magnetic hyperthermia therapy, antibiotic chemotherapy and cold atmospheric pressure plasma therapy have shown additive and synergistic enhancement of its efficacy. This paper reviews applications of antimicrobial photodynamic therapy and non-invasive combination therapies often used with it, including sonodynamic therapy and nanozyme enhanced photodynamic therapy. The antimicrobial and antibiofilm mechanisms are discussed. This review proposes that these technologies have a great potential to overcome the bacterial resistance associated with bacterial biofilm formation.

Warfarin-induced skin necrosis: a rare condition.

Warfarin induced skin necrosis is a rare debilitating and, in some cases, life-threatening complication. A 47-year-old male on life-long anticoagulation omits his medication and develops extensive skin necrosis of the left leg complicated by acute renal failure three days after restarting warfarin. Investigations reveal possible Protein S deficiency which is known to be a predisposing condition. Various mechanisms have been proposed as the underlying cause. He was managed on heparin, wound debridement and skin grafting. Warfarin was restarted concurrently with heparin. Knowledge of this complication will enable timely diagnosis and treatment. FUNDING: None declared.

The influence of physicians' specialty on prescribing patterns at a general medicine out-patients clinic.

BACKGROUND: Several factors have been identified that influence physicians' prescribing habits. The influence of physician's specialty has not been studied. This study is to determine if there are differences in the prescribing patterns amongst these various specialities that run a general medicine clinic at a tertiary hospital in Ghana. METHODS: Data collected from the out-patients clinic attendance records were analysed using WHO Rational Use of Medicines indicators. Analysis of Variance Test was carried out to establish if there was any variance in the prescribing indicators amongst 4 units of Physicians. RESULTS: 678 patient encounters were utilised for this study. The average number of drugs prescribed per encounter was 4.4, drugs prescribed by generic name was 86.9%, patient encounters in which antibiotics prescribed were 6.5% (n= 44) and injections were prescribed in 3.2% (n=22) of patient encounters. 64.0% of all drugs prescribed were from the Ghanaian EML. The unit of the physician did not have a significant effect on the average number of medicines prescribed per patient encounter (F (3, 674) = 2.19, p = 0.088), and the percentage of medicines that were prescribed from the Essential Medicines List (F (3, 674) = 1.52, p = 0.207). The unit the physician belonged to however did have a significant effect at p < 0.05 on the prescription of generic medications (F (3, 674) = 4.79, p = 0.003). CONCLUSION: The physician units did not differ in their prescribing patterns at the general medicine clinic except for prescription of drugs by their generic names. FUNDING: None declared.

The influence of physicians' specialty on prescribing patterns at a general medicine out-patients clinic

Background: Several factors have been identified that influence physicians' prescribing habits. The influence of physician's specialty has not been studied. This study is to determine if there are differences in the prescribing patterns amongst these various specialities that run a general medicine clinic at a tertiary hospital in Ghana. Methods: Data collected from the out-patients clinic attendance records were analysed using WHO Rational Use of Medicines indicators. Analysis of Variance Test was carried out to establish if there was any variance in the prescribing indicators amongst 4 units of Physicians. Results: 678 patient encounters were utilised for this study. The average number of drugs prescribed per encounter was 4.4, drugs prescribed by generic name was 86.9%, patient encounters in which antibiotics prescribed were 6.5% (n= 44) and injections were prescribed in 3.2% (n=22) of patient encounters. 64.0% of all drugs prescribed were from the Ghanaian EML. The unit of the physician did not have a significant effect on the average number of medicines prescribed per patient encounter (F (3, 674) = 2.19, p = 0.088), and the percentage of medicines that were prescribed from the Essential Medicines List (F (3, 674) = 1.52, p = 0.207). The unit the physician belonged to however did have a significant effect at p < 0.05 on the prescription of generic medications (F (3, 674) = 4.79, p = 0.003). Conclusion: The physician units did not differ in their prescribing patterns at the general medicine clinic except for prescription of drugs by their generic names

Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey.

Background: The global rise and spread of antibiotic resistance is limiting the usefulness of antibiotics in the prevention and treatment of infectious diseases. The use of antibiotic stewardship programs guided by local data on prescribing practices is a useful strategy to control and reduce antibiotic resistance. Our objective in this study was to determine the prevalence and indications for use of antibiotics at the Korle-Bu Teaching Hospital Accra, Ghana. Methods: An antibiotic point prevalence survey was conducted among inpatients of the Korle-Bu Teaching Hospital between February and March 2016. Folders and treatment charts of patients on admission at participating departments were reviewed for antibiotics administered or scheduled to be administered on the day of the survey. Data on indication for use were also collected. Prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of survey by the total number of patients on admission. Results: Of the 677 inpatients surveyed, 348 (51.4%, 95% CI, 47.6-55.2) were on treatment with antibiotics. Prevalence was highest among Paediatric surgery where 20/22 patients (90.9%, 95% CI, 70.8-98.9) were administered antibiotics and lowest among Obstetrics patients with 77/214 (36%, 95% CI, 29.5-42.8). The indications for antibiotic use were 245/611 (40.1%) for community-acquired infections, 205/611 (33.6%) for surgical prophylaxis, 129/611 (21.1%) for healthcare associated infections and 33/611 (5.4%) for medical prophylaxis. The top five antibiotics prescribed in the hospital were metronidazole 107 (17.5%), amoxicillin-clavulinic acid 82 (13.4%), ceftriaxone 17(12.1%), cefuroxime 61 (10.0%), and cloxacillin 52 (8.5%) respectively. Prevalence of meropenem and vancomycin use was 12(2%) and 1 (.2%) respectively. The majority of patients 181 (52%) were being treated with two antibiotics. Conclusion: This study indicated a high prevalence of antibiotic use among inpatients at the Korle-Bu Teaching Hospital. Metronidazole was the most commonly used antibiotic; mainly for surgical prophylaxis. There is the need to further explore factors contributing to the high prevalence of antibiotic use and develop strategies for appropriate antibiotic use in the hospital.

Physicians' knowledge, attitudes, and perceptions concerning antibiotic resistance: a survey in a Ghanaian tertiary care hospital.

BACKGROUND: Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians' knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana. METHODS: We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives. RESULTS: The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE. CONCLUSIONS: Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians.

Calcific myonecrosis of the upper extremity: case report.

Calcific myonecrosis is an uncommon late sequela of limb trauma that results in calcification and necrosis of damaged muscle. It almost exclusively occurs in the lower extremity. We present a second case of calcific myonecrosis in the upper extremity.

Multiple-ligament knee injuries: a systematic review of the timing of operative intervention and postoperative rehabilitation.

BACKGROUND: Traumatic knee dislocations that result in multiple-ligament knee injuries are unusual and are poorly studied. We are not aware of any prospective data regarding their treatment. Both the optimum timing of surgery for repair or reconstruction and the aggressiveness of rehabilitation are debated. The purpose of this systematic review was to compare the outcomes of early, delayed, and staged procedures as well as the subsequent rehabilitation protocols. METHODS: We surveyed the literature and retrieved twenty-four retrospective studies, involving 396 knees, dealing with the surgical treatment of the most severe multiple-ligament knee injuries (those involving both cruciate ligaments and either or both collateral ligaments). Data were extracted, and surgical timing was categorized as acute, chronic, or staged. Early postoperative mobility and immobilization were also compared. RESULTS: We found that acute treatment was associated with residual anterior knee instability when compared with chronic treatment (odds ratio, 2.58; 95% confidence interval, 1.2 to 5.8; p = 0.018). Significantly more patients who were managed acutely were found to have more flexion deficits when compared with those who were managed chronically (odds ratio, 5.18; 95% confidence interval, 1.5 to 17.5; p = 0.004). Staged treatments yielded the highest percentage of excellent and good subjective outcomes (79%; 95% confidence interval, 62.2% to 89.3%). Additional treatment for joint stiffness was significantly more likely in association with acute treatment (17%; 95% confidence interval, 13.0% to 22.4%; p < 0.001) and staged treatment (15%; 95% confidence interval, 7.6% to 28.2%; p = 0.001) when each was compared with chronic treatment (0% [zero of seventy-one]; 95% confidence interval, 0.0% to 5.1%). Early mobility was not associated with increased joint instability in acutely managed patients. Early mobility yielded fewer range-of-motion deficits but did not reduce the rate of follow-up manipulation or arthrolysis. CONCLUSIONS: This review of the available literature suggests that delayed reconstructions of severe multiple-ligament knee injuries could potentially yield equivalent outcomes in terms of stability when compared with acute surgery. However, in the acutely managed patient, early mobility is associated with better outcomes in comparison with immobilization. Acute surgery is highly associated with range-of-motion deficits. Staged procedures may produce better subjective outcomes and a lower number of range-of-motion deficits but are still likely to require additional treatment for joint stiffness. More aggressive rehabilitation may prevent this from occurring in multiple-ligament knee injuries that are treated acutely.

Controversies and techniques in the surgical management of patellofemoral arthritis.

Historically, the patellofemoral articulation has been a topic of less interest among orthopaedists and has been subject to fewer studies when compared with other major joints in the body. Patellofemoral arthritis is a common and debilitating condition, and greater awareness of this has led to a new interest and recent increase in the number of clinical investigations pertaining to this condition. It is hoped that an overview of patellofemoral kinematics, forces, and contact patterns will help in understanding the progression of patellofemoral arthritis. Furthermore, this understanding will ultimately allow the surgeon to apply these basic principles to more effective nonsurgical and surgical treatment options. Treatment methods for patellofemoral arthritis include both conservative as well as surgical interventions. Specifically, these treatments range from stretching and water exercises to patellar realignment procedures and the recently developed procedure of custom patellofemoral arthroplasty. In addition, many new and innovative treatments are on the horizon. This renewed interest in the patellofemoral articulation bodes well for patients who suffer from this condition.