Supracondylar Fractures: A Retrospective Chart Review Comparing Infection Rate, Antibiotic Use, Surgical Time and Cost of Full Surgical Preparation and Draping vs "Semi-Sterile" Technique.

BACKGROUND: Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques. METHODS: A retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared. RESULTS: Of the 336 patients, 1/168 (0.1%) in the full preparation and draping group developed an infection compared to 0/168 (0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168 (23%) patients in the full preparation and draping group and 0/168 (0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4±2.0 minutes and the full preparation and draping group was 9.9 ±4.2 minutes (p <0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups. CONCLUSION: Risk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.

Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: early outcomes.

BACKGROUND: In the setting of severe glenohumeral dysplasia secondary to brachial plexus birth palsy, external rotation osteotomy of the humerus has traditionally been used to transpose the existing arc of shoulder motion to a more functional position. Here we introduce a surgical alternative, the aim of which is to gain stable reduction of the shoulder and restore active external rotation. METHODS: All patients with brachial plexus birth palsy and Waters type-III, IV, or V glenohumeral dysplasia who underwent glenoid anteversion osteotomy combined with tendon transfers between 2006 and 2009 were identified. The Mallet score, Active Movement Scale, and active and passive ranges of motion were used to assess functional outcomes. Axial imaging was used to measure glenoid version, the degree of subluxation, and the Waters type. RESULTS: Thirty-two patients with a median age of 6.8 years (range, 2.1 to 16.2 years) were followed for a mean of twenty months (range, twelve to twenty-nine months). On average, passive external rotation with the shoulder in neutral increased by 43° (95% confidence interval [CI], 26° to 60°), passive internal rotation decreased by 22° (95% CI, 12° to 31°), active external rotation with the shoulder in neutral increased by 82° (95% CI, 66° to 98°), and active internal rotation decreased by 26° (95% CI, 14° to 38°). The aggregate Mallet score improved by a mean of 4.0 points (95% CI, 3.0 to 4.9). Glenoid retroversion improved by a mean of 26° (95% CI, 20° to 32°). The percentage of the humeral head anterior to the midscapular line improved by a mean of 35% (95% CI, 30% to 40%). CONCLUSIONS: In patients with severe glenohumeral dysplasia, glenoid realignment osteotomy in conjunction with soft-tissue rebalancing permits maintenance of joint reduction and functional improvement in the short term. In our view, external rotation osteotomy of the humerus is no longer the only surgical option for these cases.

Noise levels in adult and pediatric orthopedic cast clinics.

Prolonged exposure to high-intensity noise has been associated with noise-induced hearing loss, hypertension, psychological stress, and irritability. The National Institute of Occupational Safety and Health considers levels above 85 decibels (dB) as harmful. In the study reported here, we sought to determine whether noise levels in orthopedic cast clinics were within safe limits. A calibrated noise dosimeter was worn by cast technologists during 7 adult and 7 pediatric cast clinics, and noise levels were recorded. Mean equivalent continuous noise levels were 77.8 dB (adult clinics) and 76.5 dB (pediatric clinics), mean noise levels adjusted for an 8-hour day were 76.6 dB (adult) and 75.9 dB (pediatric), and mean peak noise levels were 140.0 dB (adult) and 140.7 dB (pediatric). Mean noise levels in cast clinics were within safe limits and there was no statistical difference in noise levels between adult and pediatric clinics. However, peak noise levels in all clinics exceeded recommended limits, and even brief exposure to noise of this intensity may be hazardous.

Surgical hip dislocation for removal of intraarticular exostoses: report of two cases.

Exostoses or osteochondromas are the most common benign bone tumors in children. The proximal femur is affected in approximately 30% of individuals and may lead to growth disturbances, acetabular dysplasia, and possible subluxation. Intraarticular lesions may also occur but are rarer. We present 2 cases of intraarticular exostoses that were successfully treated by surgical dislocation of the hip and complete excision of the lesion. However, despite successful excision, both hips are still abnormal because of the long standing inherent growth disturbance and residual acetabular dysplasia and may still require further surgery.

Can chronic recurrent multifocal osteomyelitis predispose to lymphoma of bone? A case report.

Chronic recurrent multifocal osteomyelitis (CRMO) and B-cell lymphoma are fairly uncommon conditions that are seen in children. Although CRMO can leave patients with residual deformities and disabilities, it is a benign condition. We describe an unusual situation in which a site adjacent to a biopsy-documented site of CRMO presented 3.5 years later with B-cell lymphoma. B-cell lymphoma can behave in an indolent manner and reports suggest that this condition can initially be mistaken for CRMO. This case presented here underscores the importance of vigilance in the short and long-term management of patients initially diagnosed with CRMO, and raises the possibility that the pathogenesis of the two conditions is related.

Ultrasound screening in developmental hip dysplasia: do all scanned hips need to be followed up?

Many ways of detecting hip instability in the newborn infant exist, including a history of risk factors, clinical examination and ultrasound. We investigated our practice of 'at risk' screening using subjective, dynamic and static, ultrasound, followed by radiographic evaluation at 12 months. We found that the average age at presentation was 71 days, with the most common reason for referral being a clicking hip. None of the hips deemed stable under review deteriorated, and all those considered normal at first visit had a normal radiograph at 12 months. Abnormal radiographs were found in all the other groups.