Combined two-centre experience of single-entry telescopic rods identifies characteristic modes of failure

2020 ◽  
Vol 102-B (8) ◽  
pp. 1048-1055
Author(s):  
India Cox ◽  
Louay Al Mouazzen ◽  
Sabri Bleibleh ◽  
Radu Moldovan ◽  
Fiona Bintcliffe ◽  
...  
Keyword(s):  
Future Generation ◽  
Deep Infection ◽  
Bisphosphonate Therapy ◽  
Coxa Vara ◽  
Tibial Fixation ◽  
Modes Of Failure ◽  
Characteristic Modes ◽  
Single Entry ◽  
Implant Retention ◽  
Distal Fixation

Aims The Fassier Duval (FD) rod is a third-generation telescopic implant for children with osteogenesis imperfecta (OI). Threaded fixation enables proximal insertion without opening the knee or ankle joint. We have reviewed our combined two-centre experience with this implant. Methods In total, 34 children with a mean age of five years (1 to 14) with severe OI have undergone rodding of 72 lower limb long bones (27 tibial, 45 femoral) for recurrent fractures with progressive deformity despite optimized bone health and bisphosphonate therapy. Data were collected prospectively, with 1.5 to 11 years follow-up. Results A total of 24 patients (33%) required exchange of implants (14 femora and ten tibiae) including 11 rods bending with refracture. Four (5%) required reoperation with implant retention. Loss of proximal fixation in the femur and distal fixation in the tibia were common. Four patients developed coxa vara requiring surgical correction. In total, 13 patients experienced further fractures without rod bending; eight required implant revision. There was one deep infection. The five-year survival rate, with rod revision as the endpoint, was 63% (95% confidence interval (CI) 44% to 77%) for femoral rods, with a mean age at implantation of 4.8 years (1.3 to 14.8), and 64% (95% CI 36% to 82%) for tibial rods, with a mean age at implantation of 5.2 years (2.0 to 13.8). Conclusion FD rods are easier to implant but do not improve on the revision rates reported for second generation T-piece rods. Proximal femoral fixation is problematic in younger children with a partially ossified greater trochanter. Distal tibial fixation typically fails after two years. Future generation implants should address proximal femoral and distal tibial fixation to avoid the majority of complications in this series. Cite this article: Bone Joint J 2020;102-B(8):1048–1055.

scholarly journals Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments

2021 ◽  
Vol 2 (11) ◽  
pp. 958-965
Author(s):  
Simon Craxford ◽  
Ben A. Marson ◽  
Jessica Nightingale ◽  
Adeel Ikram ◽  
Yuvraj Agrawal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Joint Infection ◽  
Binary Logistic Regression ◽  
Deep Infection ◽  
Success Rates ◽  
Implant Retention ◽  
Cemented Arthroplasty ◽  
Deep Surgical Site Infection ◽  
One Year ◽  
Excision Arthroplasty

Aims Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited. Methods Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year. Results A total of 3,966 patients were identified. The overall rate of SSI was 1.7% (51 patients (1.3%) with deep SSI, and 18 (0.45%) with superficial SSI). In all, 50 patients underwent revision surgery for infection (43 with DAIR, and seven with excision arthroplasty). After adjustment for other variables, only concurrent urinary tract infection (odds ratio (OR) 2.78, 95% confidence interval (CI) 1.57 to 4.92; p < 0.001) and increasing delay to theatre for treatment of the fracture (OR 1.31 per day, 95% CI 1.12 to 1.52; p < 0.001) were predictors of developing a SSI, while a cemented arthroplasty was protective (OR 0.54, 95% CI 0.31 to 0.96; p = 0.031). In all, nine patients (20.9%) were alive at one year with a functioning hemiarthroplasty following DAIR, 20 (46.5%) required multiple surgical debridements after an initial DAIR, and 18 were converted to an excision arthroplasty due to persistent infection, with six were alive at one year. The culture of any gram-negative organism reduced success rates to 12.5% (no cases were successful with methicillin-resistant Staphylococcus aureus or Pseudomonas infection). Favourable organisms included Citrobacter and Proteus (100% cure rate). The all-cause mortality at one year after deep SSI was 55.87% versus 24.9% without deep infection. Conclusion Deep infection remains a devastating complication regardless of the treatment strategy employed. Success rates of DAIR are poor compared to total hip arthroplasty, and should be reserved for favourable organisms in patients able to tolerate multiple surgical procedures. Cite this article: Bone Jt Open 2021;2(11):958–965.

Screw and Sheath Tibial Fixation Associated With a Higher Likelihood of Deep Infection After Hamstring Graft Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (4) ◽  
pp. 806-811
Author(s):  
Andrew P. Hurvitz ◽  
Heather A. Prentice ◽  
Tadashi T. Funahashi ◽  
Gregory B. Maletis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Reference Group ◽  
Cruciate Ligament ◽  
Deep Infection ◽  
Single Bundle ◽  
Hamstring Autograft ◽  
Kaiser Permanente ◽  
Level Of Evidence ◽  
Tibial Fixation ◽  
Anterior Cruciate

Background: Hamstring autograft anterior cruciate ligament reconstructions (ACLRs) have exhibited higher infection rates compared with bone–patellar tendon–bone (BPTB) autograft. The reason for this observed difference is unclear, warranting investigation. Purpose: To evaluate the association between tibial fixation, either with or without a sheath and screw construct, and the risk of deep infection after hamstring autograft ACLR, using BPTB autograft as a reference group for comparison. Study Design: Cohort study; Level of evidence, 3. Methods: Using the Kaiser Permanente ACLR Registry, we identified all primary isolated, unilateral, single-bundle ACLRs with a BPTB or hamstring autograft (January 1, 2008, to September 30, 2016). The exposure groups included the following: (1) BPTB ACLR, (2) hamstring ACLR using a screw and sheath construct for tibial fixation (HS with screw and sheath), and (3) hamstring ACLR using a method other than a screw and sheath construct for tibial fixation (HS without screw and sheath). We used logistic regression to evaluate the likelihood of 90-day postoperative deep infection using BPTB autograft as the reference group and adjusting for age, sex, and body mass index. The number needed to be exposed (NNE) was calculated. Results: Of 15,671 ACLRs, 6745 (43.0%) used a BPTB graft, 2852 (18.2%) used HS with screw and sheath tibial fixation, and 6074 (38.8%) used HS without screw and sheath tibial fixation. There were 38 (0.2%) 90-day deep infections: 11 (0.2%) for BPTB, 14 (0.5%) for HS with screw and sheath, and 13 (0.2%) for HS without screw and sheath. Staphylococcus aureus for the BPTB group and Staphylococcus epidermidis in both hamstring groups were the most common infecting organisms. HS with screw and sheath had a higher likelihood of 90-day deep infection compared with BPTB ACLR (odds ratio [OR], 2.87; 95% CI, 1.29-6.38). We failed to observe a difference for HS without screw and sheath compared with BPTB ACLR (OR, 1.23; 95% CI, 0.54-2.77). The NNE was 330 and 2701 for HS with and HS without screw and sheath, respectively. Conclusion: Although the overall infection rate after ACLR is low, the higher likelihood of infections when sheath and screw combined are used for tibial fixation of a hamstring autograft ACLR should be a consideration when this procedure is performed.

Carrying Capacity of Elastic-Plastic Shells With Various End Conditions, Under Hydrostatic Compression

1959 ◽  
Vol 26 (4) ◽  
pp. 553-560
Author(s):  
Burton Paul
Keyword(s):  
Carrying Capacity ◽  
Cylindrical Shells ◽  
Hydrostatic Compression ◽  
Simply Supported ◽  
Elastic Plastic ◽  
Modes Of Failure ◽  
Characteristic Modes ◽  
End Conditions

Abstract This paper considers the influence of the beam-column effect on the carrying capacity of hydrostatically loaded elastic-plastic cylindrical shells. Specific problems considered include shells with clamped ends, simply supported ends, and a combination thereof. It is shown that in all cases considered there exist two characteristic modes of failure corresponding, respectively, to long and short shells where the terms “long” and “short” are unambiguously defined. Detailed results are presented graphically along with general conclusions useful for design purposes.

Drug-Induced Agranulocytosis: A Mini Review

2016 ◽  
Vol 2 (1) ◽  
pp. 57-59
Author(s):  
Pavithra D ◽  
Praveen D ◽  
Vijey Aanandhi M
Keyword(s):  
Bone Marrow ◽  
Complete Blood Count ◽  
Genetic Manipulation ◽  
White Blood Cells ◽  
Deep Infection ◽  
Morbidity Rate ◽  
Drug Induced ◽  
Serious Adverse Event ◽  
Mortality And Morbidity ◽  
The Individual

Agranulocytosis is also known to be granulopenia, causing neutropenia in circulating blood streams .The destruction of white blood cells takes place which leads to increase in the infection rate in an individual where immune system of the individual is suppressed. The symptoms includes fever, sore throat, mouth ulcers. These are commonly seen as adverse effects of a particular drug and are prescribed for the common diagnostic test for regular monitoring of complete blood count in an admitted patient. Drug-induced agranulocytosis remains a serious adverse event due to occurrence of severe sepsis with deep infection leading to pneumonia, septicaemia, and septic shock in two/third of the patient. Antibiotics seem to be the major causative weapon for this disorder. Certain drugs mainly anti-thyroid drugs, ticlopidine hydrochloride, spironolactone, clozapine, antileptic drugs (clozapine), non-steroidal anti-inflammatory agents, dipyrone are the potential causes. Bone marrow insufficiency followed by destruction or limited proliferative bone marrow destruction takes place. Chemotherapy is rarely seen as a causative agent for this disorder. Genetic manipulation may also include as one of the reason. Agranulocytosis can be recovered within two weeks but the mortality and morbidity rate during the acute phase seems to be high, appropriate adjuvant treatment with broad-spectrum antibiotics are prerequisites for the management of complicated neutropenia. Drugs that are treated for this are expected to change as a resistant drug to the patient. The pathogenesis of agranulocytosis is not yet known. A comprehensive literature search has been carried out in PubMed, Google Scholar and articles pertaining to drug-induced agranulocytosis were selected for review.

PENDIDIKAN KARAKTER KAJIAN KONSEPTUAL DAN KEMUNGKINAN IMPLEMENTASI

2009 ◽  
Vol 10 (2) ◽  
pp. 85-94
Author(s):  
I G. A. K. Wardani
Keyword(s):  
Teacher Education ◽  
Character Education ◽  
Future Generation ◽  
Human Being ◽  
The Future ◽  
Good Manner ◽  
Changing World

Facing the rapid changing world, concern on the future of the nation is increasing. This is due to the fact that a lot of practices in schools, families, as welf as in society do not conform with the etical conduct, moral, and good manner that are universially accepted by human being. Therefore, all people who concern on the future of the nation, especially educators, should aware of the importance of character education, in order to save the future generation from moral degradation. Related to the problem, this aims at trigerring the awareness of educator to the importance of character education, by discussing the conceptual meanings ( what, why, and how) of character education, then followed by the possibility for implementation, and ended with the implication on education and teacher education.

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