Proximal femoral nail failures in extracapsular fractures of the hip.

PURPOSE: To review patients with proximal femoral nails (PFNs) in our hospital that developed complications and needed revision. METHODS: Between January 2000 and June 2006, records of 216 patients with PFN fixations for traumatic extracapsular trochanteric fractures (n=160), pathological fractures (n=23), and as a prophylactic measure for metastasis (n=33) were retrospectively reviewed. The injury mechanism, reduction technique and quality, and time to and cause of implant failure were recorded. RESULTS: 12 PFNs failed: 8 in the trauma group, 3 in the pathological group, and one in the prophylactic nailing group. Two PFNs broke at the proximal lag screw level at a later stage secondary to non-union of the pathological fractures. One broke at the level of the distal locking screw at an early stage, as the locking holes were too close to the fracture. CONCLUSION: Poorly reduced fractures tend to fail early, whereas late failures are due to non-union. Good reduction with minimal dissection, the use of appropriate nail length, and proper positioning of the nail and screws are necessary to avoid failure or revision.

Rhys-davies exsanguinator: a haven for bacteria.

Serial swabs were taken from the inner and outer surfaces of a new Rhys-Davies exsanguinator before and after use on the limbs of patients to exsanguinate limbs prior to tourniquet inflation and surgery. Both surfaces of the exsanguinator showed increasing levels of contamination with bacterial colonisation with use starting from the first use. The organisms grown included potentially harmful bacteria such as Pseudomonas sp. The Rhys-Davies exsanguinator can harbour potentially harmful organisms and, thus, may raise the risk of infection transmission between patients when used without cleaning between uses. Methods of effective cleaning of the exsanguinator between uses are discussed.

The risk of cross-infection when marking surgical patients prior to surgery - review of two types of marking pens.

INTRODUCTION: Two types of marker pens were compared to find whether they produced different risks of infection transmission over different time intervals. PATIENTS AND METHODS: Twenty-four patients were marked according to the type of surgery: each had a set of new dry white-board marker (DWM) and a permanent marker (PM) pen. Once used, their tips were used to inoculate blood agar plates at different time intervals. RESULTS: At 0 min, 96% of the DWM pens and 29% of the PM pens were positive of growth. At 3 and 10 min, all of the DWM pens remained positive. The rate dropped to 16.67% in 3 min down to none at 10 min for the PM pens. CONCLUSIONS: DWM pens carry a significant risk of transmitting infection between patients. It is recommended that they are not used in marking. PM pens should not be used between patients in less than a 10-min interval.