External Validation of the Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH) Classification for Predicting Outcome in Periprosthetic Joint Infections: A Cohort of 653 Patients.

BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication in hip and knee joint arthroplasty. The "Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH)" classification system was developed in 2021 to stratify the complexity of PJI, and more importantly, to act as a tool to guide referrals to specialist centers. The "JS-BACH" classification has not been validated in an external cohort. This study aimed to do so using a large prospective cohort from Australia and New Zealand. METHODS: We applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use. Individual cases were classified as per JS-BACH into "1: uncomplicated" (n = 268), "2: complex" (n = 330), and "3: limited options" (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort. RESULTS: The risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02). CONCLUSIONS: Despite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort.

Corrigendum: Risk of reoperation due to surgical site infection in 74,771 hip fracture patients: a Danish nationwide cohort study.

Corrigendum of Acta Orthop 2022; 93: 760-766. doi: https://doi.org/10.2340/17453674.2022.4580.

Risk of reoperation due to surgical site infection in 74,771 hip fracture patients: a Danish nationwide cohort study.

BACKGROUND AND PURPOSE: Surgical site infection (SSI) after hip fracture surgery is a feared condition. We examined the trend in incidence of reoperation due to SSI up to 1 year following hip fracture surgery from 2005 to 2016 and risk factors of SSI by age, sex, comorbidity, type of fracture, and surgery. PATIENTS AND METHODS: We conducted a population-based, nationwide cohort study using data from the Danish Multidisciplinary Hip Fracture Register (DMHFR). We included 74,771 patients aged 65 and up who underwent surgery from 2005 to 2016 for all types of hip fracture. We calculated net risk of reoperation using Kaplan­Meier method, and, with Cox regression, adjusted hazard ratios (HRs) with a 95% confidence interval (CI) for reoperation due to SSI. RESULTS: Overall, the 1-year net risk of reoperation due to SSI was 1.6%. The HR was higher for patients undergoing total/hemiarthroplasty surgery versus internal fixation (HR = 1.5; 95%CI 1.3­1.8) and lower for patients with per-/subtrochanteric fracture versus femoral neck fracture (HR = 0.6; CI 0.6­0.7). The risk of reoperation due to SSI decreased over time; HR was 0.7 (CI 0.5­0.8) for 2015­2016 compared with 2005­2006. Risk of reoperation decreased with increasing age; the HR was 0.8 (CI 0.7­1.0) in the more than 85-year-olds compared with 65­74-year-old patients. Charlson Comorbidity Index of ≥ 3 was associated with a higher risk of reoperation due to SSI, HR was 1.3 (CI 1.1­1.6). INTERPRETATION: The net risk of reoperations due to SSI in our study was lower than previously assumed. We identified several risk factors for increased risk of reoperation due to SSI, most noticeably treatment with arthroplasty vs. internal fixation, as well as younger age, high comorbidity burden, and femoral neck fracture diagnosis.

[When the pig escaped, the cattle gun hit the knee].

Injuries sustained from a cattle gun are typically more severe than they appear. Fractures and infection are the primary concerns due to a coupling of a sustained penetrating impact, contamination of the bolt and residual foreign material left after penetration. This is a case report of an injury caused by a cattle gun. The initial assessment did not match the actual magnitude of the injury. Due to the severity of injuries of this kind they require a thorough assessment as well as specialized treatment in terms of debridement and high-yield antibiotics, as well as the possible fracture treatments.

[Children with obvious fractures may have sustained multiple injuries].

In this case report, a rare case of a distal forearm fracture in conjunction with an initially overlooked ipsilateral Monteggia Bado type III injury highlights the learning objectives of this case report. Multiple fractures occur in approximately 1% of all fracture cases in children and adolescents, and meticu-lous physical and appropriate radiographic examinations are mandatory in order to diagnose all injuries. Arthrography is a viable option for dynamic evaluation of joint congruity and stability intraoperatively.

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

BACKGROUND: In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. METHODS: Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. RESULTS: In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). CONCLUSION: The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. TRIAL REGISTRATION: ISRCTN43004323.

Work environment satisfaction and employee health: panel evidence from Denmark, France and Spain, 1994-2001.

This paper investigates whether a satisfactory work environment can promote employee health even after controlling for socioeconomic status and life style factors. A dynamic panel model of health is estimated from worker samples from Denmark, France and Spain, employing both self-assessed general health and the presence of a functional limitation. In all three countries and for both types of health measures, a good perceived work environment is found to be a highly significant determinant of worker health even after controlling for unobserved heterogeneity and minimizing reverse causality. The marginal effect is, however, larger in France and Denmark than in Spain. Several potential explanations for this finding are discussed. Further, a satisfactory working environment is found to be at least as important for employee health as socioeconomic status. Thus, investing in giving workers a satisfying work environment could be a low-cost way of improving employee health.