Surgical Outcomes in Endoscopic Versus Open Bursectomy of the Septic Prepatellar or Olecranon Bursa.

In this study, the authors investigated the viability of endoscopic bursectomy as a treatment for septic prepatellar and olecranon bursitis. Conventional treatment of septic bursitis consists of aspiration, antibiotics, and rest. When conservative treatment fails, however, surgical intervention is sometimes required to resolve the infection. Typical surgical intervention consists of open bursectomy, in which the infected bursa is excised via an incision in the region of the skin directly above the bursa. The tenuous nature of the blood supply to this region of the skin results in a rather high rate of wound healing issues such as necrosis and wound dehiscence. Recently, endoscopy has been proposed as a less invasive means of bursectomy, although initially it was only recommended for cases of aseptic bursitis. A degree of uncertainty has persisted in the literature as to whether endoscopic bursectomy allows for sufficient debridement of the infected tissue to avoid recurrence of bursitis. The authors report on 27 cases in which endoscopic bursectomy was performed for recalcitrant septic bursitis. Fourteen of these cases were septic olecranon bursitis and 13 were septic prepatellar bursitis. The authors reported good results, with no wound healing complications and only 1 minor recurrence. They also reported much shorter hospital stays than have been reported both for more conservative treatments of septic bursitis and in other case series on endoscopic bursectomy. The authors conclude that endoscopic bursectomy is a superior alternative to open bursectomy for the treatment of recalcitrant septic prepatellar and olecranon bursitis. [Orthopedics. 2019; 42(4):e381-e384.].

A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone.

Several techniques are described for fixation of Vancouver B1 femoral shaft fractures after total hip arthroplasty. Twenty-four femurs were scanned by dual x-ray absorptiometry scanned and matched for bone mineral density. Femurs were implanted with a cemented simulated total hip prosthesis with a simulated periprosthetic femur fracture distal to the stem. Fractures were fixed with Synthes (Paoli, Pa) 12-hole curved plates and 4 different constructs proximally. Each construct was loaded to failure in axial compression. Constructs with locking and nonlocking screws demonstrated equivalent loads at failure and were superior in load at failure compared with cables. Cable constructs failed proximally. No proximal failures occurred in specimens fixed with screws and cables. A combination of locked or nonlocked screws and supplemental cable fixation is recommended for the treatment of Vancouver B1 periprosthetic femur fractures.