Antimicrobial efficacy of external fixator pins coated with a lipid stabilized hydroxyapatite/chlorhexidine complex to prevent pin tract infection in a goat model.

BACKGROUND: Pin tract infection is a common complication of external fixation. An antiinfective external fixator pin might help to reduce the incidence of pin tract infection and improve pin fixation. METHODS: Stainless steel and titanium external fixator pins, with and without a lipid stabilized hydroxyapatite/chlorhexidine coating, were evaluated in a goat model. Two pins contaminated with an identifiable Staphylococcus aureus strain were inserted into each tibia of 12 goats. The pin sites were examined daily. On day 14, the animals were killed, and the pin tips cultured. Insertion and extraction torques were measured. RESULTS: Infection developed in 100% of uncoated pins, whereas coated pins demonstrated 4.2% infected, 12.5% colonized, and the remainder, 83.3%, had no growth (p < 0.01). Pin coating decreased the percent loss of fixation torque over uncoated pins (p = 0.04). CONCLUSION: These results demonstrate that the lipid stabilized hydroxyapatite/chlorhexidine coating was successful in decreasing infection and improving fixation of external fixator pins.

Scleroderma in childhood: a 35-year history of cases and review of the literature.

Scleroderma is a connective tissue disease with a variety of clinical presentations. The purpose of our study was to review representative cases of scleroderma in childhood to determine the initial presentation, course of the disease, orthopaedic manifestations, and the necessity and success of surgical intervention. Records from the four medical centers were retrospectively reviewed to identify the patients who were diagnosed with scleroderma over the past 35 years. Data on disease presentation, course, treatment, and response were collected. Seventeen cases representing the variety of clinical presentations are presented. Scleroderma characteristically presents with asymmetric lesions involving the extremities and remains a diagnostic and therapeutic challenge. Treatment must be individualized to the patient and his or her specific limitations brought about by the disease. Early diagnosis, supportive care, and physical therapy combined with early orthopaedic surgical intervention to release joint contractures are among the most efficacious treatments.

An intra-articular bioabsorbable interference screw mimicking an acute meniscal tear 8 months after an anterior cruciate ligament reconstruction.

SUMMARY: Seven months after a quadrupled semitendinosus anterior cruciate ligament reconstruction, a 44-year-old active-duty soldier reported symptoms consistent with a medial meniscus tear. Preoperative magnetic resonance imaging showed an intra-articular bioabsorbable interference screw within his intercondylar notch. The screw was retrieved arthroscopically. The graft was intact and functional except for a small portion of the anterior fibers, which were debrided. The patient returned to full activities without complaints.

Ensuring accurate femoral guide pin placement in anterior cruciate ligament reconstruction.

The correct placement of the femoral tunnel is of critical importance in successfully reconstructing a knee with a deficient anterior cruciate ligament. By inserting the femoral guide pin through the anteromedial portal with the knee fully flexed, and subsequently withdrawing the pin from the anterior thigh until just the end of the pin remains at the insertion site at the posterior aspect of the intercondylar notch, the knee can then be safely extended and a thorough arthroscopic evaluation performed. In addition, the arthroscope can now be introduced into the medial portal to better evaluate the pin placement. Thus, visualization of the pin position and accurate placement based upon the intended tunnel size can be confirmed prior to drilling of the femoral tunnel, and more reproducibility in anterior cruciate ligament reconstructions can be achieved.