The impact of COVID-19 on dynamic hip screw fixation and training.

COVID-19 has had a profound impact on orthopaedic services and surgical training. AIM: This study aims to identify changes in lag screw position and Tip Apex Distance (TAD) in dynamic hip screw fixation due to changes in practice during the coronavirus pandemic and determine whether the changes resulted in improved patient outcomes and enhanced training opportunities. MATERIALS AND METHODS: Retrospective evaluation of two patient cohorts - pre-covid (n=27) and during covid (n=26) - to evaluate the TAD and lag screw position for each patient and record the grade of operating surgeon. A total of 53 patients were included. RESULTS: A mean TAD of 19.78mm and 19.80mm was calculated for cohort 1 and 2 respectively with no significant difference identified. When considering both key risk factors for lag screw cut-out (lag screw position and TAD) the number of patients with both a "satisfactory position" of the screw and a TAD <20mm, were 8/27 (29.6%) and 11/26 (42.3%), respectively. In cohort 1 3/27 cases had a consultant documented as the primary surgeon, while no consultants were documented as being present for the remaining 24 cases. 21/26 cases in cohort 2 had a consultant present some capacity, either as primary surgeon (15/21) or assistant (6/21). CONCLUSIONS: Changes in practice due to the pandemic have had some positive effects for both patients and trainees. This study has highlighted the importance of Consultant led trauma lists for improving training and surgical outcomes with a demonstrated improvement when considering both key factors associated with screw cut-out together. Ultimately some of the changes in practice should be continued in the post-covid era.

Finegoldia magna the cause of hip revision surgery - a two case report.

The cause of septic arthritis in 20% of cases is anaerobic bacteria, including infections caused by Finegoldia magna. The occurrence of this pathogen in the etiology of postoperative post-implantive septic joint inflammations is estimated at 5-12% of all anaerobic infections, and 20-40% of all gram-positive anaerobic coccus (GPAC). CASE REPORTS: The 65-year-old male patient was admitted due to symptoms of pain in the left hip after having undergone arthroplasty three years prior. It was found that the relative length of the left lower limb was shortened by 1.5 cm and there was limited mobility of the left hip joint. The radiological image of the left hip indicated the loosening of the endoprosthesis, which qualified for a revision surgery. During hip revision surgery, the material was collected from the site, for microbiological examination, in which Finegoldia magna was detected, sensitive to Amoxicillin with Clavulanic acid, Clindamycin, Chloramphenicol, Imipenem, Metronidazole and Piperacillin with Tazobactam. Based upon the antibiogram, the patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, resulting in a clinical improvement. The 55-year-old female patient was admitted due to recurrent exudates in left trochlear bursa which arose 5 years after left hip arthroplasty. The patient had limited movements in the left hip. Ulrasound diagnostics showed a presence of a thick fluid reservoir located under the fascia in the lateral side of the left thigh measuring 160 x 42 x 25 mm, which had contact with the hip joint. In the radiographic image of the joint, a cyst around the bottom of the implanted acetabular component was revealed. The patient underwent hip revision surgery, and an anaerobic bacterium Finegoldia magna was isolated from a swab taken from the acetabulum. The patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, with good clinical effect. CONCLUSIONS: In both cases, the post-implantation septic infection was triggered by Finegoldia magna. Arthroplasty with subsequent antibiotic therapy resulted in an improvement of the patients' condition and joint reconstruction. In orthopedic practice it should be noted that infections due to the anaerobic bacteria Finegoldia magna may be the cause of complications after the arthroplasty of the joints.

Radiological evaluation of the Stoffella metatarsal I osteotomy in the treatment of hallux valgus.

The Stoffella surgical method is a reverse Chevron distal metatarsal osteotomy, typically used in younger patients, with good bone quality. The technique is suitable for a variety of cases, from mild to severe, since the head of the first metatarsal may be moved laterally to the edge of the first metatarsal bone, thereby allowing for a significant degree of correction. AIM: The aim of the paper is to review the radiological results of patients suffering from hallux valgus who underwent Stoffella metatarsal I osteotomy. MATERIALS AND METHODS: The study has been carried out using a sample of 23 patients, evaluating their pre and post-surgery radiographs. It seeks to examine the effectiveness of the Stoffella metatarsal I osteotomy by measurements of the HVA (Hallux Valgus Angle), IMA (Intermetatarsal Angle), DMAA (Distal Metaphyseal Articular Angle) both prior to and post-surgical correction. RESULTS: The study demonstrated that the Stoffella Metatarsal I osteotomy has a high rate of success, with correction of the HVA, IMA, DMAA angles, with pre- surgery HVA being 29.7°±6.1°, IMA - 12.9°±3.6°, DMAA - 13.7°±7.1°, Post-surgery results show a mean reduction of 51.28%, 51.13%, 50.56% respectively towards a mean HVA of 14.5°±7.4° (p<0.001), mean IMA of 6.3°±3.7° (p<0.001), mean DMAA of 6.8°±4° (p<0.001). All patients who underwent the surgery had HVA, IMA, DMAA angles within the normal physiological range post-surgery. CONCLUSIONS: It was concluded that the Stoffella Metatarsal I osteotomy is effective in the correction of the hallux valgus.