ABSTRACT
PURPOSE: This systematic review and meta-analysis aimed to study surgical site infection of wound closure using staples versus sutures in elective knee and hip arthroplasties. METHODS: A systematic literature review was performed to search for randomized controlled trials that compared surgical site infection after wound closure using staples versus sutures in elective knee and hip arthroplasties. The primary outcome was surgical site infection. The risk of bias was assessed with the Cochrane risk of bias assessment tool. The relative risk and 95% confidence interval with a random-effects model were assessed. RESULTS: Eight studies were included in this study, including 2 studies with a low risk of bias, 4 studies having 'some concerns', and 2 studies with high risk of bias. Significant difference was not found in the risk of SSI for patients with staples (n = 557) versus sutures (n = 573) (RR: 1.70, 95% CI: 0.94-3.08, I2 = 16%). The results were similar after excluding the studies with a high risk of bias (RR: 1.67, 95% CI: 0.91-3.07, I2 = 32%). Analysis of studies with low risk of bias revealed a significantly higher risk of surgical site infection in patients with staples (n = 331) compared to sutures (n = 331) (RR: 2.56, 95% CI: 1.20-5.44, I2 = 0%). There was no difference between continuous and interrupted sutures (P > 0.05). In hip arthroplasty, stapling carried a significantly higher risk of surgical site infection than suturing (RR: 2.51, 95% CI: 1.15-5.50, I2 = 0%), but there was no significant difference in knee arthroplasty (RR: 0.87, 95% CI: 0.33-2.25, I2 = 22%; P > 0.05). CONCLUSIONS: Stapling might carry a higher risk of surgical site infection than suturing in elective knee and hip arthroplasties, especially in hip arthroplasty.
ABSTRACT
An anterior cruciate ligament (ACL) rupture is a common injury. The ACL usually tears in its mid-substance, an avulsion fracture of the ACL mostly occurs at the tibial attachment. In few cases, an avulsion fracture occurs proximally from the ACL attachment to the lateral femoral condyle. This is a rare finding, especially in elderly patients. We report a case of an avulsion fracture of the ACL attachment to the lateral femoral condyle after a traumatic injury in a 60-year-old female. Injury was not recognized during initial assessment, but was later detected during knee arthroscopy because of persisting mechanical complaints with catching of the knee. This emphasizes the importance of a thorough physical examination and magnetic resonance imaging. As rare as this condition is, it is important for the orthopaedic surgeon in treating these patients to include femoral end avulsion injuries of the ACL in the differential diagnosis.
ABSTRACT
In this case study, we describe the clinical presentation and treatment of 36 patients with periosteal chondrosarcoma collected over a 59-year period by the archive of the Netherlands Committee on Bone Tumours. The demographics, clinical presentation, radiological features, treatment and follow-up are presented with the size, location, the histological grading of the tumour and the survival. We found a slight predominance of men (61%), and a predilection for the distal femur (33%) and proximal humerus (33%). The metaphysis was the most common site (47%) and the most common presentation was with pain (44%). Half the tumours were classified histologically as grade 1. Pulmonary metastases were reported in one patient after an intra-lesional resection. A second patient died from local recurrence and possible pulmonary and skin metastases after an incomplete resection. It is clearly important to make the diagnosis appropriately because an incomplete resection may result in local recurrence and metastatic spread. Staging for metastatic disease is recommended in grade II or III lesions. These patients should be managed with a contrast-enhanced MRI of the tumour and histological confirmation by biopsy, followed by en-bloc excision.
