Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions

Postoperative infections after allograft implantation is a major concern in knee ligament reconstructions considering the theoretical risk of disease transmission and its potential severity. Here, we aimed to evaluate the postoperative infection rate after knee ligament reconstructions using aseptically processed allografts, and provide an overview of the allografts use in an academic tertiary hospital. A retrospective study was performed evaluating patients who underwent knee ligament reconstructions using aseptically processed allografts, including primary and revision surgeries, from 2005 to 2018. Demographic data, including the type of knee injury and trauma energy, and postoperative data were collected focusing on postoperative infections. Regarding these infected cases, further analyses were performed considering the presenting signs and symptoms, the isolated microorganism identified in culture, the time between graft implantation and diagnosis of infection (defined as acute, subacute, and late), and the need for graft removal. A total of 180 cases of ligament reconstructions were included. The mean follow-up was 8.2 (range: 2.1–15.6) years and the mean age at surgery was 34.1 (± 11.1) years. A total of 262 allografts were implanted in those 180 cases, 93 (35.5%) as bone plug allografts and 169 (64.5%) as soft tissue allografts. Common surgical indications included multiligament reconstruction (57.2%) and primary anterior cruciate ligament (ACL) reconstruction (15%). Seven cases (3.9%) presented postoperative infections. Knee pain (100%) and swelling (100%) were the most prevalent symptoms. Two cases (28.6%) presented sinus tract. Allografts were removed in two cases, the same cases that presented draining sinus (p = 0.04). High-energy trauma was the only statistically associated factor for infection (p = 0.04). No significant association between infection and the type of allograft (p > 0.99) or sex (p = 0.35) were observed. Four cases (57.1%) had monomicrobial staphylococcal infections. Based on that, the allograft-related infection rate was 1.7% (the remaining three infected cases). Nonirradiated, aseptically processed allografts have a low postoperative infection rate in knee ligament reconstructions, being a safe alternative for surgeries that require additional source, increased variety, and quantity of grafts.

Treatment of fractures of the proximal end and humeral shaft by locked intramedullary nailing in adults: Case series and literature review

Introduction: Intramedullary nailing is a good indication for stabilizing displaced fractures of the proximal end and shaft of the humerus in adults. Methods: This was a prospective series of 24 patient, over a period of 9 months. The aim of this study is to report the epidemiological and clinical aspects of patients treated with a locked humeral nail and to show the medium-term interest, of this therapeutic method, thus discussing the complications. Results: All patients had received intramedullary nailing of the humerus. The average age was 77.08 years. The female sex was more represented with 66.66% and the right side was frequently fractured with 83.33%. We distinguished 50% of cases involving the proximal end of the humerus, 45.87% of cases of the humeral shaft and one case of concomitant fracture of the proximal end and that of the humeral shaft. The postoperative infection rate is zero in our series and we reported 1 case of distal locking screw breakage, 1 case of iterative fracture on short Telegraph nail, 1 case of proximal screw retraction on long Telegraph nail and 1 case of perforation of the humeral head with a proximal locking screw. Conclusion: humeral intramedullary nailing is a good alternative in fixing proximal end and humeral shaft fractures without considerable complications or damages for the rotator cuff muscles.

Postoperative Infection Rate and Associated Factors Following Endoscopic Sinus Surgery

Objectives: There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. Methods: A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. Results: Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P = .018). Conclusion: The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold.

COMPARISION OF CLOSED EXPERT TIBIA NAILING WITH OPEN PLATE&SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES.

This study conducted at Index Medical College Hospital & Research Centre, Indore during the study period of 02 years. Patients were followed up for 01 year, evaluated radiologically and clinically with Tegnerlysholm knee scale, outcomes were used for comparison. Malreduction was defined as a deformity of 5 degree in any plane. Out of a total of 22 patients, 01 (1 in the plating group) was excluded from the study as pt was absent for follow-up, meaning that 21 patients were included in the final study Baseline data of 21 patients. Use of PTLCP is associated with more intra operative blood loss, higher postoperative infection rate and longer duration of hospital stay, whereas use of IMN associated with higher rates of malunion and nonunion. However there is no difference in functional outcome between IMN and PTLCP. But it is the surgical skill that is required in such fractures. To validate this issue further a large sample size of matching severity multicentric study done by equal level skill cadre is recommended. Overall proximal one third extraarticular tibia fracture is complicated and problematic fracture to deal with and is commonly associated with significant soft tissue damage. High grade of surgical skills are required to deal these fractures as fixation of proximal one third extraarticular tibia fracture is technically demanding surgery regardless of the implant.