X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture.

Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

A Single Positive Tissue Culture Increases the Risk of Rerevision of Clinically Aseptic THA: A National Register Study.

BACKGROUND: The diagnostic and prognostic value of unexpected positive intraoperative cultures remains unclear in diagnosing prosthetic joint infection (PJI) in THA revisions. QUESTIONS/PURPOSES: Therefore, we asked: (1) What is the clinical importance of bacterial growth in intraoperative tissue cultures taken during first-time revision of a clinically aseptic THA in terms of all-cause rerevision and rerevision for PJI specifically? (2) Is there a difference in outpatient antibiotic treatment patterns that is dependent on the number of positive intraoperative cultures? METHODS: This register-based study included all procedures reported to the Danish Hip Arthroplasty Register (DHR) as first-time aseptic loosening revisions performed during January 2010 to May 2016. DHR data were merged with that of the Danish Microbiology Database, which contains data from all intraoperatively obtained cultures in Denmark. Both registers have been validated and have a very high degree of completeness and very few patients are missing as a result of emigration. Revisions were grouped based on the number of unexpected positive cultures growing the same bacterial genus: zero, one, or two or more cultures. We defined a positive culture as "unexpected" if it was observed after a revision THA that had been reported to the DHR as aseptic. In Denmark, cultures are routinely obtained even in revisions coded as aseptic, and in this report, 91% (2090 of 2305) of the revision THAs coded as aseptic had cultures taken. The revisions were followed until rerevision, death, or end of the 1-year followup period. The relative risk for rerevision resulting from all causes and PJI was estimated. The Danish National Prescription Registry was reviewed for outpatient antibiotic prescription within 6 weeks of revision. We included 2305 first-time aseptic revisions. Unexpected growth was found in 282 THAs (12%), of which 170 (60%) had growth in only one culture or mixed microbial growth. Coagulase-negative Staphylococcus was the dominating bacteria in 121 revisions (71%). Rerevision was performed on 163 THAs (7%) with PJI being the indication for rerevision in 43 THAs (26%). RESULTS: The risk of all-cause rerevision was greater among first-time revisions with one positive culture (relative risk [RR], 1.73; 95% confidence interval [CI], 1.07-2.80; p = 0.020), but not in the two or more positive group (RR, 1.52; 95% CI, 0.82-2.80; p = 0.180) when compared with the culture-negative THAs. First-time revisions with one positive culture also had a higher risk of rerevision for PJI specifically (RR, 2.63; 95% CI, 1.16-5.96; p = 0.020), but this was not the case in the two or more positive group (RR, 2.28; 95% CI, 0.81-6.43; p = 0.120). Outpatient antibiotic prescription was more frequent after revisions with two or more positive cultures compared with culture-negative revision (50 of 112 [45%] versus 353 of 2023 [17%]; p < 0.001). This was not the case in revisions with one positive culture (36 of 170 [21%] versus 353 of 2023 [17%]; p = 0.220). CONCLUSIONS: First-time clinically aseptic THA revisions with unexpected growth in one biopsy culture had an increased risk for rerevision, both in terms of all-cause revision and revision for PJI. The predominant bacteria in revisions with later rerevision was coagulase-negative Staphylococcus. This emphasizes that unexpected bacterial growth with common bacteria may be clinically important, even if only one of five biopsy cultures is positive. LEVEL OF EVIDENCE: Level III, therapeutic study.

Prevalence and Impact of Diabetes Mellitus on the Frozen Shoulder.

OBJECTIVES: The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease. METHODS: Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who were not already diagnosed as having diabetes mellitus were invited to be tested with the hemoglobin A1c blood sample test. The study population was compared with a control group, consisting of five individuals from the general population matched on age and sex. The passive range of motion, Oxford Shoulder Score, and visual analog scale (VAS) for average and maximum daily pain was recorded for all of the patients in the study group. RESULTS: A total of 235 patients were included, 34 (14%) of whom were diagnosed as having diabetes mellitus before the examination. Of the remaining 201 patients, 122 (61%) agreed to be tested for diabetes mellitus. None of the tested patients had undiagnosed diabetes mellitus. This was not significantly different from the prevalence in the matched control population (P = 0.09). There was no difference between patients with and without diabetes mellitus in average daily VAS (P = 0.46) nor maximum daily VAS (P = 0.44). The Oxford Shoulder Score was similar in the two groups (P = 0.23) as was the range of motion. CONCLUSIONS: The prevalence of undiagnosed diabetes mellitus is low in patients with FS and does not differ from the general population. Diabetes mellitus does not seem to affect patients' perceived severity of an FS.