The judet quadricepsplasty: Long-term outcome of 21 cases.

BACKGROUND: The lack of knee flexion represents a possible complication in severe femur fractures. In 1956, Judet proposed a quadricepsplasty technique that allowed for a graded release without the disruption of the vastus medialis obliqus, vastus lateralis, or rectus femoris. METHODS: This article reports the clinical outcome of 21 cases of Judet quadricepsplasty after an average follow-up of 101.0 months (range, 21-204 months). The definitive flexion gain was classified as excellent, good, fair, or poor. Excellent when >100 degrees, good when >80 <99 degrees, fair when >50 degrees <79 degrees, poor when <50 degrees. The flexion and extension strength were graded from 0 to 5, according to the Daniel's scale. RESULTS: The average strength score was 4.71 in flexion, 4.81 in extension. The average definitive flexion was 95.67 degrees (range, 54-128 degrees) and the average definitive flexion gain was 72.43 degrees (range, 40-122 degrees). When the patients were grouped on the basis of the definitive flexion, excellent results were observed in eight cases (38.10%), were good in nine (42.86%), and fair in four (19.05) with zero poor results. CONCLUSIONS: Our experience has shown that, even if first proposed in 1956, the Judet procedure still gives a reproducible amount of good results.

Osteomyelitis caused by Enterobacter cancerogenus infection following a traumatic injury: case report and review of the literature.

We report a case of osteomyelitis caused by Enterobacter cancerogenus resistant to aminopenicillins in a 56-year-old male who had a motorcycle accident and suffered from multiple bone fractures with abundant environmental exposure. E. cancerogenus has rarely been associated with human infections, and its clinical significance remains unclear.

Prevention of pin track infection in external fixation with silver coated pins: clinical and microbiological results.

Pin tract infection is a frequent complication of external fixation; according to literature its frequency ranges from 2-30%. The recent introduction of silver coating of polymeric materials was found to decrease bacterial adhesion; its clinical use with Foley catheters and central venous catheters led to significant results. To verify the ability of the same silver coating to decrease the bacterial colonization on external fixation screws, a prospective randomized study was carried out on 24 male patients; a total of 106 screws were implanted in the lower limb to fix femoral or tibial diaphyseal fractures: 50 were coated with silver and 56 were commercially available stainless steel screws. Although the coated screws resulted in a lower rate of positive cultures (30.0%) than the uncoated screws (42.9%), this difference was not statistically significant (p = 0.243). The clinical behavior of the coated screws did not differ from that of the uncoated ones. Furthermore, the implant of silver-coated screws resulted in a significant increase in the silver serum level. These results led us to consider it ethically unacceptable to continue this investigation.