[Possible routes of infection in hip replacement]. / Vozmozhnye puti infitsirovaniya pri endoprotezirovanii tazobedrennogo sustava.

OBJECTIVE: To evaluate the probability of direct inoculation of pathogens into the bone bed by surgical instruments and implants. MATERIAL AND METHODS: The study included 22 patients who underwent surgery at the Vreden National Medical Research Center of Traumatology and Orthopedics. Mean age was 73.3±3.7 years. These patients underwent total hip replacement. Intraoperative skin scrapings within the wound edge were made. Pressure on the scalpel was applied in two fashions. In 10 cases, scraping was performed by minimally pressure on the skin (superficial contact). In 12 cases, scalpel was pressed with force (skin deformation to a depth of 3-4 mm). Next, microbiological analysis of scrapings was performed. RESULTS: There was no growth of microorganisms in samples obtained by minimal pressure on the scalpel. Analysis of 12 scrapings in the second group (tight contact simulating damage to the skin with surgical instruments) revealed growth of microflora in all cases. CONCLUSION: Contact of cutters, rasps and implants with skin can be a mechanism for direct inoculation of pathogens into the bone tissue and potentially cause periprosthetic infection.

[Management of complex acetabulum fractures and their consequences]. / Lechenie slozhnykh perelomov vertluzhnoi vpadiny i ikh posledstvii.

In the structure of pelvic bone injuries, acetabular fractures are the most complex type and, according to different authors, account for up to 20% [1]. The severity of these injuries is confirmed by the fact that early descriptions of acetabular fracture were based only on the results of autopsies of patients who had suffered a combined injury. Thus, as early as 1788, Callisen reported an acetabular fracture, but without a detailed description of the nature of the injury. In 1909, Schroeder provided a detailed report of 49 cases of acetabular fractures reported in the literature. Most of them were described during autopsies of patients who died from complications associated with hemorrhagic shock or the onset of sepsis [2]. Fractures of the acetabulum in most observations are the result of high-energy impacts, usually as a result of traffic accidents; therefore, the mechanism of injury determines the combined and multiple nature of the injuries in the victims. A significant proportion of acetabular fractures (up to 60%) are accompanied by fragment displacement and dislocation of the femoral head, in which the most severe tissue changes occur [3].