Implementation and impact of an audit and feedback antimicrobial stewardship intervention in the orthopaedics department of a tertiary-care hospital: a controlled interrupted time series study.

A prospective audit and feedback antimicrobial stewardship intervention conducted in the Orthopaedics Department of a university hospital in Portugal was evaluated by comparing an interrupted time series in the intervention group with a non-intervention (control) group. Monthly antibiotic use (except cefazolin) was measured as the World Health Organization's Anatomical Therapeutic Chemical defined daily doses (ATC-DDD) from January 2012 to September 2016, excluding the 6-month phase of intervention implementation starting on 1 January 2015. Compared with the control group, the intervention group had a monthly decrease in the use of fluoroquinolones by 2.3 DDD/1000 patient-days [95% confidence interval (CI) -3.97 to -0.63]. An increase in the use of penicillins by 103.3 DDD/1000 patient-days (95% CI 47.42 to 159.10) was associated with intervention implementation, followed by a decrease during the intervention period (slope = -5.2, 95% CI -8.56 to -1.82). In the challenging scenario of treatment of osteoarticular and prosthetic joint infections, an audit and feedback intervention reduced antibiotic exposure and spectrum.

Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure-A case report.

Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion-pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé-Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation-supination was 58-0-48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score-Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593-597, 2016.

Peroneal Tendon Impingement due to Bulky Osteochondroma: A Case Report.

UNLABELLED: Osteochondromas are the most common benign bone tumors. Although many are asymptomatic, they can produce a mass effect impinging against soft tissues or interfering with joint function. The authors present a case report and review of literature of an ankle osteochondroma successfully treated by excision. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case Report.

Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures.

INTRODUCTION: Intertrochanteric fractures incidence has been increasing over the past few years and therefore so have all the problems associated with it. It is important to search for possible ways to reduce comorbidities as well as postoperative mortality. We decided to assess the impact of some routine pre-operative analytical values on post-operative mortality of patients with inter-trochanteric fractures 65 years or older. MATERIAL AND METHODS: From all intertrochanteric fracture admissions between January 2007 and May 2012, 160 patients were included in this study. The variables studied were age, gender, length of hospital stay, and analytical data such as hemoglobin, total leucocyte count, platelets, urea, creatinin and plasma sodium. Follow-up data on mortality were obtained from the civil registry and, considering 6 months as the cut-off point, patients were divided into 2 groups based on their survival. Mann-Whitney and Chi square statistics were used to study the association between our variables and patients survival. RESULTS: Our population showed a median age of 82 years old and a majority of women (79.4%). Within the first 6 months after surgery, 27 patients of the initial 160 (16.1%) died. Mortality was associated with low hemoglobin, high platelets, high creatinin and low plasma sodium. CONCLUSIONS: Postoperative mortality of hip surgery is high. Our findings could be used to reduce this rate by correcting some analytical values preoperatively.

Introdução: A incidência das fraturas intertrocantéricas tem aumentado ao longo dos últimos anos, bem como todos os problemas a elas associados. É importante pesquisar possíveis formas de reduzir quer co-morbilidades, quer a mortalidade pós-operatória. Decidimos avaliar o impacto de alguns valores analíticos pré-operatórios na mortalidade pós-operatória de doentes com fractura intertrocantérica, com idade igual ou superior a 65 anos.Material e Métodos: De todas as fracturas intertrocantéricas admitidas entre Janeiro de 2007 e Maio 2012, 160 doentes foram incluídos no estudo. As variáveis estudadas foram idade, género, tempo de internamento, e dados analíticos, como hemoglobina, contagem de leucócitos e plaquetas, níveis de ureia e creatinina e concentração de sódio plasmática. Informação relativa à mortalidade foi obtida através do registo civil e, considerando um ponto de corte de seis meses após a cirurgia, os doentes foram divididos em dois grupos de acordo com a sua sobrevida. Os testes de Mann-Whitney e Chi-quadrado foram utilizados para estudar a associação entre as nossas variáveis e a sobrevida dos doentes.Resultados: A nossa população apresentava uma idade mediana de 82 anos de idade e uma maioria de mulheres (79,4%). Nos primeiros 6 meses após a cirurgia, 27 doentes dos iniciais 160 (16,1%) faleceram. A mortalidade estava relacionada com valores baixos de hemoglobina, elevados de plaquetas, elevados de creatinina e baixa concentração de sódio plasmático.Conclusão: A taxa de mortalidade pos-operatória da cirurgia da anca é elevada. Os nossos resultados podem ser utilizados parareduzir esta taxa, corrigindo valores analíticos pré-operatórios.

Upside-down radial head: a rare complication after an unrecognized Jeffery Type 2 lesion.

We report a case of an unrecognized Jeffery Type 2 lesion in a child complicated by a complete reversal of the radial head during closed manipulation.