Approaches to Septic Arthritis of the Knee Post Anterior Cruciate Ligament Reconstruction.

PURPOSE OF REVIEW: Septic arthritis of the knee following anterior cruciate ligament reconstruction is a rare but potentially deleterious complication. The main approach to the management of this potentially devastating complication in recent years has involved a more aggressive attempt at preventing graft contamination during surgery with the adoption of the pre-soaking of the graft in broad-spectrum antibiotic solution, and early and adequate treatment of established cases of knee sepsis, with or without retention of the graft. However, what constitutes an early and adequate initial treatment may be a challenging decision for the surgeon to make in certain instances. RECENT FINDINGS: Graft pre-soaking in vancomycin has been noted to significantly reduce the incidence of septic arthritis of the knee following anterior cruciate ligament reconstruction. Other studies have recorded similar satisfactory results with graft pre-soaking in gentamycin. In established cases of infection, irrigation and debridement with either graft retention or graft excision with delayed re-construction of the anterior cruciate ligament have both given satisfactory results in well-selected patients. Septic arthritis of the knee following anterior cruciate ligament reconstruction can be prevented by careful patient selection, use of prophylactic antibiotics, strict asepsis during surgery, and graft pre-soaking in antibiotic solution. The choice of antibiotic solution for graft pre-soaking is influenced by the surgeon's preference, tissue penetrance, effect on graft tensile strength, local bio-gram of the micro-organisms, and the sensitivity pattern. The treatment option in established cases would depend on the stage of infection, state of the graft, and the extent of bony involvement.

The radiographic quality of conservatively managed distal radius fractures in adults using haematoma block versus intravenous sedation.

OBJECTIVE: We compared the radiographic quality of initial reduction of distal radius fractures reduced using haematoma block to those reduced with intravenous sedation. The overall rate of re-manipulation and complications were noted. METHODS: A prospective study carried out at the emergency unit of our hospital between 1st September, 2017 and 31st December, 2018. Patients were consecutively recruited into Haematoma Block (HB) and Sedation(S) groups using the simple balloting method. After 5-10 min of administering anaesthesia, the fracture was reduced and immobilized in a below-to-elbow Plaster of Paris (P.O.P) cast for 6 weeks. The pre- and post-reduction radiographs were reviewed for volar tilt, radial angulation, radial deviation and radial shortening. RESULTS: Sixty-seven patients completed the study with 33 patients in HB group and 34 patients in S group. There was no significant difference in the radiographic quality of initial reduction between the two groups using the Sarmiento's modification of Lindström criteria (p = 0.49). Five out of 34 patients among the sedated group had gastrointestinal symptoms. The overall rate of re-manipulation was low and the complications recorded were wrist stiffness and residual wrist deformity. CONCLUSION: Our study revealed that there was no significant difference in the radiographic quality of initial reduction between the groups. Excellent to good reduction was achieved with both anaesthetic options. The choice of anaesthesia should be individualized and based on surgeons' preference.

Comparison of postoperative alignment using fixed angle versus variable angle distal femoral resection in uncomplicated total knee replacement.

PURPOSE: This study aimed to compare the postoperative alignment of the lower limbs using fixed angle versus variable valgus angle distal femur resection in uncomplicated total knee replacement (TKR) and to determine the mean valgus correction angle (VCA) in the study population. METHODS: This was a prospective comparative study conducted between July 2018 and December 2019 in patients with osteoarthritic knees who underwent primary TKR. Forty-nine patients with 54 knees completed the study. They were randomized into fixed valgus angle (group A) and variable valgus angle (group B) groups. Twenty-four patients with 26 knees were in group A who had distal femur resection with 5-degree valgus correction, while 25 patients with 28 knees were in group B who had distal femur resection with individualized valgus correction angle calculated from hip-knee-ankle scanogram. RESULTS: The demographic data were comparable in the two groups. There was no statistically significant difference between the groups in the mean preoperative mechanical femorotibial angle (MFTA). The fixed angle group had a mean postoperative MFTA of 2.0 ± 2.8°, while variable angle group had a mean of 1.6 ± 2.4°. However, the difference between the groups did not reach statistical significance (p = 0.60). The mean VCA in the study population was 5.8 ± 1.2° (Range 4-9°). CONCLUSION: Our study has shown that the use of variable valgus angle for distal femur resection in uncomplicated TKR did not significantly improve the accuracy of restoring the postoperative coronal alignment within 0 ± 3°.

Traumatic Hip Dislocations in an Orthopedic Center in Lagos.

BACKGROUND: Hip dislocations are one of the orthopedic emergencies. They may result from a high-energy transfer as in a road traffic crash. Prompt recognition and treatment can reduce the long-term morbidity associated with delayed reduction. The goal of this study was to evaluate the epidemiology and outcome of treatment. PATIENTS AND METHODS: This was a retrospective study that involved cases of traumatic hip dislocations seen at the National Orthopedic Hospital, Lagos, Nigeria, between January 1, 2010 and June 30, 2014. Biodemographic characteristics, mechanism of injury, and type of dislocations were retrieved from case files. Thompson and Epstein type of the dislocated hips as well as the presence of pre- and post-reduction complications was noted. RESULTS: Forty-five patients had hip dislocations in the study period. Only 27 had the relevant information to be included in the study. All cases were posterior hip dislocations. The median follow-up was 9 months (range 6-30 months). More dislocations occurred on the left [18 (67.0%)] than on the right [9 (33.0%)]. The median age of patients was 37 years (range 21-73 years). Twenty-six dislocations (96.3%) were due to road traffic crash and a case (3.7%) was due to an industrial accident. Grade IV Epstein was the most common injury recorded. Twenty-four (89.0%) cases were managed with closed reduction, whereas the remaining 3 (11.0%) cases had open reduction. The associated complications observed were sciatic nerve injury, avascular necrosis of the head of the femur, and protrusio acetabuli. CONCLUSION: Road traffic crash remains a leading cause of traumatic hip dislocation. Severity of injury and delay in reduction contributes to the complications of treatment.