Duration of surgical antibiotic prophylaxis and surgical site infection in orthopaedic surgery: A prospective cohort study.

BACKGROUND: The optimal duration for surgical antibiotic prophylaxis (SAP) for preventing surgical site infection (SSI) in orthopaedic surgeries remains poorly supported by high-level evidence. This study aimed to assess the association between SAP duration and the occurrence of SSI within one year postoperatively. METHODS: This prospective cohort study was based on the database from Surgical Site Infection Surveillance and Improvement Project (SISIP) of a tertiary orthopaedic university hospital from October 2014 to December 2020. The main outcome was SSI, defined according to the CDC/NHSN criteria, determined by review of index hospitalization medical records, microbiology laboratory reports, and readmission records for SSI treatment within one-year after discharge. Adjusted Generalized additive models (GAMs) were performed to assess the relationships between SAP duration and SSI, determined the cut-off point of SAP duration, and estimate the relative contribution of each included variable, across the overall cohort and the three subgroups (open fracture, closed fracture, and non-traumatic group). Multivariable logistic regression models were used to estimate the association between prolonging SAP duration based on the cut-off point and SSI. RESULTS: There were 37,046 patients (55.1% male) included, with the overall SSI incidence of 2.35% (871/37,046). In adjusted GAMs, no statistically significant relationships were observed in overall cohort and open or closed group (P>0.05), but a nonlinear relationship was exhibited non-traumatic group (P=0.03); the cut-off point were 2.4 days for overall cohort and 3.6 days (open), 2.6 days (closed), 1.1 days (non-trauma) for three subgroups. In adjusted logistic regression, prolonging SAP duration did not demonstrate a statistically significant protective effect in overall cohort (aOR=0.868; 95% CI, 0.746-1.011) and three groups (open: aOR=0.867; 95% CI, 0.668-1.124; closed: aOR=0.925; 95% CI, 0.754-1.135; non-trauma: aOR=1.184; 95% CI, 0.832-1.683). The relative contribution ranks of SAP duration were 21st overall among 34 factors, 14th for open fractures, 28th for closed fractures, and 3rd for non-traumatic group among 33 factors. CONCLUSION: Prolonged postoperative SAP duration has no protective effect against SSI in orthopaedic surgery. Our findings support current guidelines against the practice of continuing SAP postoperatively.

A new surgical strategy for the treatment of tibial pilon fractures with MIPO facilitated by double reverse traction repositor.

The present study aims to introduce a technique combining double reverse traction repositor (DRTR) with minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of pilon fractures and to observe the efficiency of this approach during a short-term follow-up period. From January to December 2018, patients with pilon fractures who were treated by MIPO with DRTR were reviewed. The demographic and fracture characteristics, surgical data, and prognostic data of 24 patients were extracted. In all 24 patients, closed reduction was achieved with the MIPO technique, and excellent functional and radiological outcomes were observed. The average duration of surgery and intraoperative blood loss were 95.0 ± 14.2 min and 152.1 ± 52.1 ml, respectively. A mean of 16.0 ± 1.9 intraoperative fluoroscopies were conducted. At the 12-month follow-up evaluation, the average AOFAS score was 85.2 ± 5.1. Anatomic or good reduction was observed in 23 (95.8%) patients. The mean ranges of motion of dorsiflexion and plantarflexion were 11.0 ± 2.7 and 32.7 ± 11.1, respectively. Two patients with deep venous thrombosis and one patient with wound non-purulent exudate were noted. Additionally, the wounds healed after routine dressing change. No other complications, including skin necrosis or delayed, non-union or malunion, were observed. The new strategy combining DRTR with MIPO in the treatment of pilon fractures allowed excellent radiological and clinical outcomes and a low postoperative complication rate to be achieved in a short-term follow-up period. Further large sample and comparative studies should be conducted to validate our results.

Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults.

PURPOSE: The aim of this study was to quantify the incidence of and identify independent risk factors for decreased range of motion (ROM) of the knee joint after surgery for closed tibial plateau fractures in adults. METHODS: This retrospective study was performed at the trauma centre in our hospital from January 2018 to December 2019. Data from adult patients with tibial plateau fractures treated by surgery were extracted from the electronic medical records. A total of 220 tibial plateau fracture patients were enrolled. We extracted the patients' demographic characteristics, fracture characteristics, and surgery-related variables. Univariate and multivariate logistic regression models were used to investigate the potential independent risk factors. RESULTS: Fifty-seven patients developed decreased ROM of the knee joint at the 1-year follow-up in this study. The overall incidence was 25.9%. The independent predictors of decreased ROM after surgery, as identified in the multivariate analysis, were orthopedic polytrauma (odds ratio = 3.23; 95% CI = 1.68-6.20; p = 0.000), fracture type (Schatzker V-VI) (odds ratio = 2.52; 95% CI = 1.16-5.47; p = 0.019), and an open reduction and internal fixation approach (odds ratio = 2.10; 95% CI = 1.07-4.12; p = 0.031). CONCLUSIONS: The study confirmed that patients with orthopaedic polytrauma, more complex fractures and those treated with open reduction and internal fixation (ORIF) surgery were more likely to suffer decreased ROM of the knee joint 1 year after surgery.

Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study.

OBJECTIVE: To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. METHODS: Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. RESULTS: Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43-6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12-3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21-4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01-1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34-4.83; p = 0.004). CONCLUSION: These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study.

BACKGROUND: Surgical site infection (SSI) was the most common complication of tibial plateau fracture after open reduction and internal fixation (ORIF). Severe infections even required repeat surgeries, which would cause serious psychological harm to patients and increased the economic burden of treatment. In order to identify the characteristics of the SSI and to avoid the occurrence of SSI, we conducted a prospective study to investigate the incidence and independent risk factors of SSI after ORIF for closed tibial plateau fractures in adults. METHODS: This study was performed at a first-level trauma center. From October 2014 to December 2018, the study subjects were adult patients with closed fractures of the tibial plateau, all of whom underwent open reduction and internal fixation (ORIF) treatment. Finally, a total of 1108 patients were followed up. We collected patient demographics information, surgery-related variables, and indexes from preoperative laboratory examinations. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors. RESULTS: Twenty-five patients (2.3%, 25/1108) developed SSI. A total of 15 of 25 infections (60.0%) were due to Staphylococcus aureus and 3 (12.0%) were due to MRSA. Independent risk factors of SSI identified by multivariate logistic analysis model were bone grafting: autograft (OR 6.38; 95% CI 2.155-18.886; p = 0.001) and allograft (OR 3.215; 95% CI 1.009-10.247; p = 0.048), fracture type (Schartzker V-VI) (OR 8.129; 95% CI 2.961-22.319; p < 0.001), aspartate aminotransferase (>40 U/L) (OR 5.500; 95% CI 2.191-13.807; p < 0.001), white blood cell (>10*109/L) (OR 2.498; 95% CI 1.025-6.092; p = 0.044), and anion gap (>16 mmol/L) (OR 8.194; 95% CI 1.101-60.980). CONCLUSIONS: We should pay enough attention to patients who carried one or more of these factors at admission and adopt more reasonable treatment strategies to reduce or avoid the occurrence of SSI.

[Epidemiological characteristics of geriatric hip fractures in Hebei Province between 2010 and 2011].

OBJECTIVE: To investigate epidemiological characteristics of geriatric hip fractures between 2010 and 2011 in Hebei province. METHODS: The digital radiography image data and basic information of patients above 60 years old with hip fractures (femoral neck fracture, femoral intertrochanteric fracture, and femoral head fracture) in 5 hospitals of Hebei province between January 2010 and December 2011 were analyzed retrospectively. All the data including patients' gender, age, and AO types were abstracted and analyzed to investigate the epidemiologic characteristics of geriatric hip fractures in Hebei province. RESULTS: A total of 4 207 hip fracture patients above 60 years old were included, accounting for 59.61% of all patients with hip fractures and 26.24% of all fractures patients over 60 years old in the same period. There were 1 703 (40.48%) males and 2 504 (59.52%) females (M∶F=1∶1.47). The patients ranged in age from 61 to 99 years, with an average of 75.4 years; the majority of patients aged 70-79 years (43.97%) and the minority of the patients aged 90-99 years (2.02%); women of all ages were more than men, but the difference was not significant ( P>0.05). According to AO classification, there were 2 118 cases (50.34%) of type 31-A, 2 004 case (47.63%) of type 31-B, and 85 cases (2.02%) of type 31-C. Except for the type 31-A1, 31-A3, and 31-C1 of 60-69 age group, and the type 31-A3 of 80-89 age groups, women were significantly more than men. CONCLUSION: There are more women than men in hip fractures in Hebei province, and 70-79 age group is the high-risk age group of geriatric hip fractures. Among them, intertrochanteric comminuted fractures are common types.

The association of matrix metalloproteinase-9 promoter polymorphisms with gastric cancer risk: a meta-analysis.

PURPOSE: A variety of studies have observed that the single nucleotide polymorphisms (SNPs) matrix metalloproteinase-9 (MMP-9) gene may be associated with the risk of gastric cancer(GC), and a cytosine (C) to thymine (T) mutation at the -1562 site of the MMP-9 gene promoter is reported to be closely related to the susceptibility. However, because of the conflicting results of these studies, we undertook a systematic meta-analysis to assess the association between the SNPs and the risk of gastric cancer. MATERIALS AND METHODS: A computerised literature search was conducted within the databases of PubMed, EMBASE, and ISI Web of Knowledge for studies on the genetic association of MMP-9-1562C/T and gastric cancer published from 2004 to 2015. The pooled odds ratio (OR) and 95% confidence intervals (CI) were estimated for each genotype using the dominant, recessive, co-dominant, and allelic models of the matrix metalloproteinase 9. RESULTS: Our analysis indicated a significant association of MMP-9-1562C/T with gastric cancer (dominant model [CT+TT/CC]: OR = 1.121, 95% CI = 0.965-1.304; recessive model [CC+CT/TT]: OR = 1.663, 95% CI = 1.148-2.408; co-dominant model [TT/CC]: OR = 1.666, 95% CI = 1.127-2.461; [CT/CC]: OR = 1.078, 95% CI = 0.923-1.259; allelic model [T/C]: OR = 1.150, 95% CI =1.014-1.304). CONCLUSIONS: Our meta-analysis results demonstrated that MMP-9-1562C/T promoter polymorphisms increase the risk of developing gastric cancer.