Suction drainage fluid culture during septic orthopaedic surgery, a retrospective study.

We evaluated the usefulness of suction drainage fluid culture after septic orthopaedic surgery to predict early surgical reintervention. We conducted a retrospective observational study, at the Groupe Hospitalier Paris Saint-Joseph between 2014 and 2019. All the patients undergoing septic orthopaedic surgery, with perioperative samples and a postoperative suction drainage device, were enrolled. We compared the group with positive or negative postoperative drainage fluid cultures, respectively, on surgical outcome. We included 246 patients. The drainage fluid culture was positive in 42.3% of the cases. Early surgical reintervention concerned 14.6% of the cases (n = 36), including 61.1% of patients with positive drainage fluid culture (n = 22/36). The risk factors associated with positive drainage fluid cultures were the debridement of the infected site (without orthopaedic device removal), an infection located at the spine, perioperative positive cultures to Staphylococcus aureus. The complete change of the orthopaedic device, and coagulase-negative staphylococci on the preoperative samples, was associated with negative drainage fluid cultures. Positive drainage fluid culture was predictive of early surgical reintervention, and coagulase-negative staphylococci in the preoperative samples and knee infection were predictive of surgical success. Postoperative drainage fluid cultures were predictive of early surgical reintervention. Randomized multicentric studies should be further conducted.

Application of 3D printing for treating fractures of both columns of the acetabulum: Benefit of pre-contouring plates on the mirrored healthy pelvis.

Acetabular fractures can be challenging to treat, in part because the shape of the fixation plates needs to be adjusted during the surgical procedure. One possibility is to generate a model of the uninjured half of a fractured pelvis with 3D printing, and then pre-contour the fixation plates preoperatively on this model. The purpose of this technical note is to describe how we used 3D printing as an aid to treat acetabular fractures. The quality of the fracture reduction, fracture fixation and time savings were evaluated. Three-dimensional reconstructions of the preoperative CT scan of the pelvis were exported with OsiriX™ software, mirrored with Meshmixer™ software and then printed in polylactic acid (PLA). Two fracture fixation plates were pre-contoured on the printed hemipelvis and then sterilized. No additional intraoperative contouring was needed. Anatomical reduction was obtained with an estimated 30-minute time saving and € 6 consumables cost.

Improved acetabular fracture diagnosis after training in a CT-based method.

BACKGROUND: Acetabular fractures remain challenging to diagnose, particularly when they are complex. An accurate diagnosis is nevertheless crucial to select the best surgical strategy. None of the training methods described to date relies on the Letournel classification with a detailed analysis of each abnormality seen by computed tomography (CT). We therefore prospectively assessed a CT-based diagnostic method by (1) determining the rate of correct diagnoses by orthopaedic surgeons before and after training in the method, (2) comparing the times needed to read the CT images before and after training, (3) and assessing the repeatability of the method. HYPOTHESIS: Training in the CT-based diagnostic method significantly increases the rate of correct diagnoses. METHOD: The CT-based diagnostic method involves analysing eight anatomical landmarks in the anterior, posterior, and no man's land zones. From our institutional database (450 cases between 2007 and 2016), we selected 35 acetabular fractures that replicated the overall distribution of fracture types. The images were reviewed by 10 inexperienced and 3 experienced readers before and after they received training in the CT-based diagnostic method. The rates of correct diagnoses and times needed to read the images were compared. Finally, an additional reading was performed to allow an assessment of reproducibility. RESULTS: After training, the rate of correct diagnoses by the unexperienced readers improved by 16.64% for all fractures combined (from 212/350, 60.5% [37-83%] to 270/350, 77.14% [63-86%]; P=0.001) and by 25.9% for associated fractures (from 90/180, 50% [11-89%] to 114/140, 75.6% [61-90%]; P=0.003). Mean time required by the inexperienced readers to interpret the 35 sets of images decreased after training, from 66.1 to 47.6min (i.e., a 1.22-minute decrease per patient, P=0.001). None of the study variables changed significantly after training of the experienced readers (P>0.05). Reproducibility among the inexperienced readers was 0.78. CONCLUSION: Analysing the eight anatomical landmarks located in the anterior, posterior, and no man's land zones is a simple and reproducible method for diagnosing all fracture patterns defined by the Letournel classification. LEVEL OF EVIDENCE: Level III, non-randomised prospective case-control diagnostic study.

The added value of intraoperative CT scanner and screw navigation in displaced posterior wall acetabular fracture with articular impaction.

Posterior wall with transverse acetabular fractures represents the most common type of acetabular fractures and is generally associated with poorer outcomes. This is caused by improper visualization of the fragments leading to imperfect reductions. Navigation in pelvic and acetabular trauma is reserved nowadays to non-displaced or mildly displaced fractures. To add to that, perioperative control of reduction is difficult using the conventional X-ray. The described 3D imaging method allowed proper reduction control. On the other hand, screw navigation of acetabular screws enabled better control of screw position as well as screw placement in otherwise inaccessible zones. In conclusion, peroperative 3D imaging and screw navigation optimize fracture reduction promoting better radiological and functional results.

Indications and technical challenges of total hip arthroplasty in the elderly after acetabular fracture.

INTRODUCTION: With people living longer and healthier lives, acetabular fractures in the elderly are becoming more common. But these fractures are still much less common than proximal femur fractures. Because of an insufficient number of cases, prospective studies with good statistical power have not yet been performed. Nevertheless, a collective, multicentre analysis of these injuries and their prognosis would help to define clinical practice recommendations. MATERIAL AND METHODS: As with younger subjects, the initial assessment for acetabular fractures in the elderly must be comprehensive and include detailed radiological evaluation and precise analysis of the fracture. Accurate diagnosis of the fracture type and displacement will allow the surgeon to follow a decision tree, with options ranging from functional treatment to emergency total hip arthroplasty (THA), depending on the patient's condition. CONCLUSION: THA treatment of these fractures is challenging for the surgeon in several aspects. These include determining the waiting time before the procedure, selecting the surgical approach, problems related to any existing hardware, need for bone grafting, primary fixation of the cup, dislocation risks, and the patient's ability to recover from an extensive and often complex surgery. LEVEL OF PROOF: Level V: expert opinion.