Prospective, randomised clinical trial of four different presurgical hand antiseptic techniques in equine surgery.

BACKGROUND: Currently, the World Health Organization recommends the use of alcohol-based hand rubs (ABR) for surgical hand preparation in human surgery. When disinfecting soaps are used, a rubbing technique causes less skin irritation than brush scrubbing. Based on a recent survey, most equine surgeons still use disinfecting soap. The efficacy of scrubbing vs. rubbing and the use of sole ABR compared with chlorhexidine (CHx)- based products has not been evaluated in the equine surgical setting. OBJECTIVES: To compare four surgical hand antisepsis techniques in equine surgery for reduction of aerobic bacterial counts from pre- to post-preparation (immediate efficacy) and at the end of surgery (sustained efficacy). STUDY DESIGN: Randomised, prospective clinical trial. METHODS: A 4% CHx-based product applied with either a scrub or rub technique, one sole ABR (ET; 80% ethanol) and one CHx/alcohol-combination (CHx/ET; 1% CHx and 61% ethanol) product both applied with a rub technique were evaluated. Samples were collected by glove juice technique and cultured on 3M™ Petrifilm plates and counted using a 3M™ Petrifilm plate reader. RESULTS: Immediate mean bacterial log10 colony forming unit (CFU) reduction was 2.4 for CHx-scrub, 2.8 for CHx-rub, 3.1 for CHx/ET and 2.1 for ET. CHx/ET resulted in significantly lower bacterial counts than CHx-scrub (P<0.005) and ET (P<0.001) while CHx-rub resulted in significantly lower counts than ET (P<0.001). At the end of surgery bacterial counts were the lowest for CHx-rub, significantly lower than CHx/ET (P<0.001) and ET (P<0.001). There was no difference between CHx-rub and -scrub techniques (P = 0.7). MAIN LIMITATIONS: Bacterial counts were used as the outcome measure rather than prevalence of surgical site infection, and the effect of hand preparation on skin health was not assessed. CONCLUSIONS: ABR did not decrease bacterial log10 CFU counts more effectively than CHx products. When using CHx soaps in the equine setting, hand-rub is as effective as a hand-scrub-technique.

[Arthroscopic soft tissue stabilization of posttraumatic anterior shoulder instability : Techniques, limitations and long-term results]. / Arthroskopische Weichteilstabilisierung der posttraumatischen ventralen Schulterinstabilität : Techniken, Limitationen und Langzeitergebnisse.

Arthroscopic soft tissue stabilization is a well-established and broadly accepted procedure to treat posttraumatic shoulder instability. Advantages in comparison to open stabilization procedures include improved visualization of the structural damage and a less invasive approach. Technical developments in recent years have led to further improvement of the arthroscopic technique for shoulder instability. This article presents a description of principles and new developments as it contains basic techniques including patient positioning, access portals, preparation of the glenoid bone, soft tissue handling and shuttle techniques. Modern suture anchor systems to achieve arthroscopic stabilization with the corresponding advantages and disadvantages are also presented. Furthermore, the limitations and long-term results of arthroscopic soft tissue stabilization are discussed.

Physicochemical Approach to Determine the Mechanism for Acid-Base Disorders in 793 Hospitalized Foals.

BACKGROUND: The quantitative effect of strong electrolytes, unmeasured strong anions (UAs), pCO2, and plasma protein concentrations in determining plasma pH can be demonstrated using the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess UAs in different species. HYPOTHESES: Strong ions are a major factor influencing changes in plasma pH of hospitalized foals. AG and SIG accurately predict severe hyper-L-lactatemia ([L-lac(-)] > 7 mmol/L). ANIMALS: Seven hundred and ninety three hospitalized foals < 7 days old. METHODS: Retrospective study. The relationship between measured pH and physicochemical variables, and the relationship between plasma [L-lac(-)] and AG and SIG, were determined using regression analyses. Optimal AG and SIG cut points to predict hyper-L-lactatemia were identified using an ROC curve analysis. RESULTS: Combined, the measured strong ion difference and SIG accounted for 54-69% of the changes in the measured arterial pH of hospitalized foals. AG and SIG were significantly associated with plasma [L-lac(-)] (P < .0001). The receiver operator characteristics (ROC) AUC of AG and SIG for prediction of severe hyper-L-lactatemia were 0.89 (95%CI, 0.8-0.95; P < .0001) and 0.90 (95%CI, 0.81-0.96; P < .0001), respectively. Severe hyper-L-lactatemia was best predicted by AG > 27 mmol/L (sensitivity 80%, 95%CI, 56-94, specificity 85%, 95%CI, 73-93; P < .0001) and SIG <-15 mmol/L (sensitivity 90%, 95%CI, 68-98; specificity 80%; 95%CI, 68-90; P < .0001). CONCLUSION AND CLINICAL RELEVANCE: Altered concentrations of strong ions (Na(+), K(+), Cl(-)) and UAs were the primary cause of acidemia of hospitalized foals. AG and SIG were good predictors of hyper-L-lactatemia and could be used as surrogate tests.

[Reverse shoulder arthroplasty for primary fracture treatment. Displaced three and four part fractures of the proximal humerus in the elderly patient]. / Die primäre inverse Frakturprothese. Behandlung dislozierter 3- und 4-Fragment-Frakturen des proximalen Humerus beim älteren Patienten.

The treatment of comminuted three and four part fractures of the proximal humerus in elderly patients with degenerative rotator cuff tears is challenging. Primary reverse total shoulder arthroplasty (RSA) is an alternative; however, functional outcome is still unclear due to a lack of study results. The aim of this study was to examine the functional results of RSA and to compare them with the results after reconstruction and locking plate osteosynthesis 1 year after surgery.In this study 24 patients (mean age: 77.9±9.1 years) underwent RSA as primary treatment for three and four part fractures of the proximal humerus with either head split or rotator cuff tears >Bateman type II. The results obtained at 3, 6 and 12 months follow-up included shoulder range of motion (ROM), Constant score, age-adjusted and gender-adjusted Constant score and as a percentage when compared to the uninjured side. Data were compared to patients of matching age, gender and fracture pattern from a prospectively collected database of 526 patients treated by locking plate osteosynthesis.The mean shoulder ROM 1 year after surgery was 105±29° flexion, 99±31° abduction, 22±23° external rotation and 65±26° internal rotation. In 6 patients flexion-abduction was >130°. The mean Constant score (CS) 1 year postoperatively was 62.4±14, age and gender normalized CS was 79.2±20.5, CS compared to the uninjured side was 76.1% and there were no significant differences to matched individuals treated by open reduction and internal fixation using locking plates (p=0.360). There were no infections, dislocations, vascular or neural disorders and surgical revision was not necessary in any patient. RSA should be considered as an appropriate alternative for the primary treatment of comminuted three and four part fractures of the proximal humerus with head split or large rotator cuff tears in elderly patients. Although RSA can provide immediate shoulder stability for elderly patients with severe shoulder injuries, primary RSA needs investigation with regards to long-term outcome.