scholarly journals Recent Strategies to Combat Infections from Biofilm-Forming Bacteria on Orthopaedic Implants

2021 ◽  
Vol 22 (19) ◽  
pp. 10243
Author(s):  
Emérito Carlos Rodríguez-Merchán ◽  
Donald J. Davidson ◽  
Alexander D. Liddle
Keyword(s):  
Surgical Procedures ◽  
Orthopaedic Surgery ◽  
Significant Risk ◽  
Surgical Excision ◽  
Definitive Treatment ◽  
Major Focus ◽  
Device Implantation ◽  
Prevention And Treatment ◽  
Fast Pace ◽  
Socioeconomic Cost

Biofilm-related implant infections (BRII) are a disastrous complication of both elective and trauma orthopaedic surgery and occur when an implant becomes colonised by bacteria. The definitive treatment to eradicate the infections once a biofilm has established is surgical excision of the implant and thorough local debridement, but this carries a significant socioeconomic cost, the outcomes for the patient are often poor, and there is a significant risk of recurrence. Due to the large volumes of surgical procedures performed annually involving medical device implantation, both in orthopaedic surgery and healthcare in general, and with the incidence of implant-related infection being as high as 5%, interventions to prevent and treat BRII are a major focus of research. As such, innovation is progressing at a very fast pace; the aim of this study is to review the latest interventions for the prevention and treatment of BRII, with a particular focus on implant-related approaches.

scholarly journals Preoperative Cyanoacrylate Embolization of Venous Malformations

2018 ◽  
Vol 02 (01) ◽  
pp. 042-050 ◽  
Author(s):  
Eric Monroe ◽  
Rush Chewning ◽  
Kevin Koo ◽  
Giri Shivaram
Keyword(s):  
Blood Loss ◽  
Surgical Margin ◽  
Surgical Excision ◽  
High Volume ◽  
Definitive Treatment ◽  
Incomplete Resection ◽  
Venous Malformations ◽  
Cyanoacrylate Glue ◽  
Multiple Treatment ◽  
Percutaneous Sclerotherapy

AbstractPercutaneous sclerotherapy and standalone surgical excision have historically been the mainstay of treatment for pediatric venous malformations (VMs). However, both approaches have significant limitations. Sclerotherapy often requires multiple treatment sessions, with each round adding additional procedural and anesthetic risks as well as radiation exposure. Standalone surgical excision of VMs can be complicated by high-volume blood loss, and indistinct lesion margins can lead to incomplete resection, resulting in recurrence. An alternative to these approaches is percutaneous cyanoacrylate glue embolization followed by immediate surgical excision, a single-stage procedure that allows for better surgical margin definition and reduced intraoperative blood loss, potentially leading to more definitive treatment. The authors describe the interventional radiology aspects of this combined procedure, emphasizing materials preparation and embolization technique.

scholarly journals Idiopathic retroperitoneal fibrosis: A report on 15 patients

2015 ◽  
Vol 72 (10) ◽  
pp. 928-931 ◽  
Author(s):  
Jovan Hadzi-Djokic ◽  
Tomislav Pejcic ◽  
Dragoslav Basic ◽  
Ivana Vukomanovic ◽  
Zoran Dzamic ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Retroperitoneal Fibrosis ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Omental Flap ◽  
Definitive Treatment ◽  
Pathological Examination ◽  
Idiopathic Retroperitoneal Fibrosis ◽  
The Mean

Background/Aim. Retroperitoneal fibrosis (RPF) represents a chronic pathological process characterized by fibrosis which entraps and compresses the ureters and the great blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vascular disease of unclear etiology. The series of 15 patients which underwent open surgical repair due to idiopathic RPF is presented herein. Methods. From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primary RPF. The ureters were entrapped unilaterally (7 patients), or bilaterally (8 patients). Major symptoms included low back pain due to hydronephrosis (9 patients), uremia (4 patients), and urinary tract infection (2 patients). The diagnosis was based on intravenous urography (IVU), retrograde ureteropyelography and computed tomography (CT). Results. Surgical procedures included intraperitoneal ureteral displacement (8 patients) and ureteral wrapping with omental flap (6 patients). One patient underwent bilateral ureteral stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The mean operative time was 3.5 h (range 2.5-4.5 h). The average intrahospital stay was 21 days (range 16-26 days). The mean follow up was 32 months (6-46 months). During the follow up, 12 patients had improvement on IVU. Conclusion. Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures, including ureteral wrapping with omental flap, or intraperitoneal ureteral displacement, usually represent definitive treatment.

scholarly journals Tumour induced osteomalacia: a diagnostic challenge and its implications in orthopaedic surgery

2020 ◽  
Vol 6 (5) ◽  
pp. 1104
Author(s):  
Shivkumar Santpure ◽  
Ansari Muqtadeer Abdul Aziz ◽  
Gagandeep Mahi ◽  
Lokesh Kumar Yogi
Keyword(s):  
Orthopaedic Surgery ◽  
Fibroblast Growth Factor 23 ◽  
Surgical Excision ◽  
Fibroblast Growth ◽  
Diagnostic Challenge ◽  
Pathological Fractures ◽  
Suitable Treatment ◽  
Repeated Dosing ◽  
25 Oh Vitamin D ◽  
Convoluted Tubules

<p class="abstract">Tumor-induced osteomalacia (TIO) is a paraneoplastic phenomenon which encompasses a wide array of clinical features ranging from musculoskeletal pain to pathological fractures. An excess of fibroblast growth factor 23 (FGF23) is produced which is a parahormone with its target receptors in proximal convoluted tubules of glomeruli. This results in decreased blood phosphate levels and decreased hydroxylation of 25-OH vitamin-D, ultimately leading to osteomalacia. Compliance with medical treatment is unsatisfactory and tedious owing to repeated dosing schedules and overwhelming side effects. Surgical excision of the lesion is the only suitable treatment.</p>

scholarly journals The effect of patient, fracture and surgery on outcomes of high energy neck of femur fractures in patients aged 15–50

2018 ◽  
Vol 29 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Wayne Hoskins ◽  
Johnny Rayner ◽  
Rohan Sheehy ◽  
Harry Claireaux ◽  
Roger Bingham ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Outcome Measures ◽  
Surgical Procedures ◽  
Young Patients ◽  
Significant Risk ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Secondary Outcome ◽  
Femur Fractures

Introduction: High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. Methods: A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15–50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. Results: 32 patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980–3,048 days). 3 patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. Conclusions: At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

scholarly journals Juvenile Nasopharyngeal Angiofibroma - Excision Through Lateral Rhinotomy and Sublabial Approach - A Case Report

1970 ◽  
Vol 20 (1) ◽  
pp. 78-81
Author(s):  
NK Sinha ◽  
MH Rashid ◽  
MM Shaheen ◽  
DC Talukder ◽  
MAY Fakir ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Complete Removal ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Complete Excision ◽  
Nasopharyngeal Angiofibroma ◽  
Male Adolescents ◽  
Large Size ◽  
Complete Surgical Excision ◽  
Sublabial Approach

Juvenile angiofibroma is a rare hypervascular, locally aggressive benign tumour which is exclusively found in the nose and paranasal sinuses of male adolescents. The definitive treatment for this tumour is complete surgical excision. Different surgical approaches are used for complete excision. Most recent development is excision of the tumour using endoscopes. But in certain cases with large size and different extensions, open transfacial approaches are the choice for complete removal and for less operative bleeding, which are the main challenges for surgical excision of this tumour. DOI: http://dx.doi.org/10.3329/jdmc.v20i1.8587 J Dhaka Med Coll. 2011; 20(1) :78-81

scholarly journals Fibrous dysplasia and cherubism

2015 ◽  
Vol 48 (03) ◽  
pp. 236-248 ◽  
Author(s):  
Surajit Bhattacharya ◽  
R K Mishra
Keyword(s):  
Optic Nerve ◽  
Fibrous Dysplasia ◽  
Fibrous Tissue ◽  
Genetic Research ◽  
Young Patients ◽  
Disease Process ◽  
Surgical Excision ◽  
Nerve Compression ◽  
Active Management ◽  
Definitive Treatment

ABSTRACTFibrous dysplasia (FD) is a non-malignant fibro-osseous bony lesion in which the involved bone/bones gradually get converted into expanding cystic and fibrous tissue. The underlying defect in FD is post-natal mutation of GNAS1 gene, which leads to the proliferation and activation of undifferentiated mesenchymal cells arresting the bone development in woven phase and ultimately converting them into fibro-osseous cystic tissue. Cherubism is a hereditary form of fibrous dysplasia in which the causative factor is transmission of autosomal dominant SH3BP2 gene mutation. The disease may present in two distinct forms, a less severe and limited monostotic form, and a more aggressive and more widespread polyostotic form. Polyostotic form may be associated with various endocrine abnormalities, which require active management apart from the management of FD. Management of FD is not free from controversies. While total surgical excision of the involved area and reconstruction using newer micro-vascular technique is the only definitive treatment available from the curative point of view, but this can be only offered to monostotic and very few polyostotic lesions. In polyostotic varieties on many occasions these radical surgeries are very deforming in these slow growing lesions and so their indication is highly debated. The treatment of cranio-facial fibrous dysplasia should be highly individualized, depending on the fact that the clinical behavior of lesion is variable at various ages and in individual patients. A more conservative approach in the form of aesthetic recontouring of deformed bone, orthodontic occlusal correction, and watchful expectancy may be the more accepted form of treatment in young patients. Newer generation real-time imaging guidance during recontouring surgery adds to accuracy and safety of these procedures. Regular clinical and radiological follow up is required to watch for quiescence, regression or reactivation of the disease process. Patients must be warned and watched for any sign of nerve compression, especially visual impairment due to optic nerve compression. Rather than going for prophylactic optic canal decompression (which does more harm than good), optic nerve decompression should be done in symptomatic patients only, and preferably be done via minimal invasive endoscopic neuro-surgical approach than the conventional more morbid open craniotomy approach. There is growing research and possibilities that newer generation bisphosphonate medication may change the management scenario, as these medications show encouraging response in not only reducing the osteoclastic activity, but simultaneously also stimulating the osteoblastic and osteocytic activities. The explosion of genetic research and stem cell therapy may lead to better understanding and subsequently better treatment of FD in future.

scholarly journals Comparing Medium-Term Clinical Outcomes following XEN® 45 and XEN® 63 Device Implantation

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Aitor Fernández-García ◽  
Ying Zhou ◽  
Mercedes García-Alonso ◽  
Henry D. Andrango ◽  
Francisco Poyales ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Outcomes ◽  
Surgical Procedures ◽  
Primary Open Angle Glaucoma ◽  
Treatment Approach ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Medium Term ◽  
Device Implantation ◽  
The Mean

Purpose. To evaluate medium-term clinical outcomes with XEN® 45 or XEN® 63 Gel Stent (Allergan, Dublin, Ireland) for treatment of primary open angle glaucoma (POAG). Materials and Methods. Retrospective, descriptive, and observational study involving 40 patients implanted with a XEN® 45 Gel Stent and 34 implanted with a XEN® 63 Gel Stent who had undergone POAG surgery and had been followed up and controlled between 12 and 36 months. Results. IOP dropped from 18.02 ± 5.23 mmHg preop to 13.81 ± 1.88, 14.80 ± 2.23, and 14.62 ± 1.90 at 1, 2, and 3 years after surgery (p<0.001) consecutively with XEN® 45 and from 19.00 ± 6.11 mmHg preop to 15.47 ± 2.45, 14.66 ± 2.45, and 15.46 ± 2.48 at 1, 2, and 3 years after surgery (p<0.001) with XEN® 63. The number of drugs used by patients to treat their glaucoma decreased after undergoing surgery in both groups. Within the XEN® 45 group, mean changes at 1 year, 2 years, and 3 years amounted to 70%, 74.3%, and 37.5%, respectively, whereas within the XEN® 63 group, the mean reduction was 75%, 79.8%, and 71.9%. When comparing the outcomes for two groups, the differences did not prove to be statistically significant. More than 90% of the procedures included in the study (using either gel-stent device) were completed without any noteworthy complications. Conclusion. POAG surgical procedures with either XEN® 45 or XEN® 63 Gel Stent implantation could be a safe and effective treatment approach.

scholarly journals 30-day outcome after orthopaedic surgery in patients assessed as negative for COVID-19 at the time of surgery during the peak of the pandemic

2020 ◽  
Vol 1 (8) ◽  
pp. 474-480
Author(s):  
Andrew Price ◽  
Alexander D. Shearman ◽  
Thomas W. Hamilton ◽  
Abtin Alvand ◽  
Ben Kendrick ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Orthopaedic Surgery ◽  
Assessment Tool ◽  
Significant Risk ◽  
Risk Groups ◽  
Morbidity And Mortality ◽  
Nasopharyngeal Swab ◽  
Related Complication ◽  
Time Of Surgery ◽  
Medium Risk

Introduction The aim of this study is to report the 30 day COVID-19 related morbidity and mortality of patients assessed as SARS-CoV-2 negative who underwent emergency or urgent orthopaedic surgery in the NHS during the peak of the COVID-19 pandemic. Method A retrospective, single centre, observational cohort study of all patients undergoing surgery between 17 March 2020 and 3May 2020 was performed. Outcomes were stratified by British Orthopaedic Association COVID-19 Patient Risk Assessment Tool. Patients who were SARS-CoV-2 positive at the time of surgery were excluded. Results Overall, 96 patients assessed as negative for SARS-CoV-2 at the time of surgery underwent 100 emergency or urgent orthopaedic procedures during the study period. Within 30 days of surgery 9.4% of patients (n = 9) were found to be SARS-CoV-2 positive by nasopharyngeal swab. The overall 30 day mortality rate across the whole cohort of patients during this period was 3% (n = 3). Of those testing positive for SARS-CoV-2 66% (n = 6) developed significant COVID-19 related complications and there was a 33% 30-day mortality rate (n = 3). Overall, the 30-day mortality in patients classified as BOA low or medium risk (n = 69) was 0%, whereas in those classified as high or very high risk (n = 27) it was 11.1%. Conclusion Orthopaedic surgery in SARS-CoV-2 negative patients who transition to positive within 30 days of surgery carries a significant risk of morbidity and mortality. In lower risk groups, the overall risk of becoming SARS-CoV-2 positive, and subsequently developing a significant postoperative related complication, was low even during the peak of the pandemic. In addition to ensuring patients are SARS-CoV-2 negative at the time of surgery it is important that the risk of acquiring SARS-CoV-2 is minimized through their recovery. Cite this article: Bone Joint Open 2020;1-8:474–480.

Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

2018 ◽  
Vol 46 (02) ◽  
pp. 81-86 ◽  
Author(s):  
Klaus Failing ◽  
Marc Koene ◽  
Kerstin Fey ◽  
Sabita Stöckle
Keyword(s):  
Postoperative Complications ◽  
Septic Arthritis ◽  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Complication Rate ◽  
Clinical Relevance ◽  
Orthopaedic Surgery ◽  
Complication Rates ◽  
Perioperative Antibiotics ◽  
Type Of Surgery

Summary Objective: Retrospective analysis of postoperative complications in equines after clean, orthopaedic surgical procedures in order to detect differences between animals treated with antibiotics and horses without receiving these drugs. Material and methods: Details on 652 patients, surgical procedures and surgery-associated complications were compiled from horses being operated between June 2011 and January 2015. Antibiotic-receiving patients (n = 259) were tested for differences in complication rates and characteristics to controls (n = 393). Results: The total complication rate was 39.1 %. Increased swelling was observed most often (25.6 %), followed by exudation (7.5 %), fever without incisional alterations (2.3 %), suture dehiscence (1.8 %), and seroma (0.8 %). Seven patients (five treated, two controls) developed septic arthritis within a total of 463 arthroscopies (1.5 %). There were no significant differences in the development of postoperative complications, which were seen in 97/259 (37.5 %) antibiotic receiving patients and in 158/393 (40.2 %) controls. The application of perioperative antibiotics was significantly influenced by surgeon (p < 0.0001) and type of surgery (p = 0.0007) and increased with the number of surgical lesions (p = 0.03). In patients undergoing tendovaginoscopy/ bursoscopy, fasciotomy and neurectomy (n = 98), antibiotic prophylaxis was initiated less frequently than in other surgeries, e. g. combinations of surgeries, splint bone extraction, tenotomy, and arthroscopy (n = 554). Conclusion: Severe complications in equine clean orthopaedic surgery are rare and complication rates in patients either receiving perioperative antibiotics or not were not significantly different. Clinical relevance: Based on the results the use of antibiotics appears to be non-essential in uncomplicated elective orthopaedic interventions in the horse.

scholarly journals Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Michael A. Cohen
Keyword(s):  
Significant Risk ◽  
Signs And Symptoms ◽  
Lateral Position ◽  
Surgical Anatomy ◽  
Pineal Region ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Vein Of Galen ◽  
Straight Sinus ◽  
Microsurgical Resection

Falcotentorial meningiomas are rare tumors of the pineal region that arise from the dural folds where the falx and tentorium meet and are often intimately related to the vein of Galen and straight sinus. These lesions often present with signs and symptoms related to hydrocephalus and brainstem compression. Surgical resection of falcotentorial meningiomas remains the definitive treatment, with a variety of surgical approaches used to resect these lesions. The choice of approach depends on several factors, including the size and location of the tumor relative to the vein of Galen complex. Falcotentorial meningiomas can be technically challenging to remove with significant risk of morbidity because of the close proximity to and occasional invasion of the vein of Galen and straight sinus. In this operative video, the authors demonstrate an illustrative step-by-step technique for endoscopic-assisted microsurgical resection of a falcotentorial meningioma using the posterior interhemispheric retrocallosal transfalcine approach for a superiorly positioned falcotentorial meningioma. The surgical nuances are discussed, including the surgical anatomy, gravity-assisted interhemispheric approach in the lateral position, retrocallosal dissection, transfalcine exposure, tumor removal, and preservation of the vein of Galen complex. In summary, the posterior interhemispheric retrocallosal transfalcine approach is a useful surgical strategy for select superiorly positioned falcotentorial meningiomas.The video can be found here: https://youtu.be/d8mdunsRacs.

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