Low-Intensity Pulsed Ultrasound in the Treatment of Nonunions and Fresh Fractures: A Case Series

It is estimated that approximately 5% to 10% of fractures will evolve into nonunions. Nonunions have a significant impact on patient quality of life and on socioeconomic costs. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive therapy widely used within the orthopedic community to accelerate the healing of fresh fractures, to minimize delayed healing, and to promote healing of nonunions. In this case series, 46 nonunions and 19 fresh fractures were treated with LIPUS for at least three months or until fracture healing. Bone healing was assessed both at a radiological and a functional level. Of the nonunions healed, 89% had a mean healing time of 89 ± 53 days. In the group of fresh fractures, the healing percentage was 95% with a mean healing time of 46 ± 28 days. LIPUS treatment is proven to be safe and well tolerated; there were no adverse events related to the use of the device, even in the presence of internal fixations and infections. LIPUS therapy should be considered a low-risk option both as an adjunct to surgery or as a standalone therapy in the management of nonunion and fresh fractures

Prevenzione delle infezioni peri-protesiche mediante rivestimento riassorbibile anti-batterico: un nuovo approccio?

Currently studied antibacterial coatings are far from having large-scale applications, due to various limitations. A recently developed fast resorbable, antibacterial-loaded, hydrogel coating may provide a new approach to offer an effective antibacterial and antibiofilm protection to orthopedic implants

Staphylococcal IgM Enzyme-Linked Immunosorbent Assay for Diagnosis of Periprosthetic Joint Infections ▿ ‖

Delayed orthopedic joint prosthesis infections (DOJP-Is) due to staphylococci frequently result in prosthetic revision. Specific and noninvasive diagnostic tests are unavailable, and DOJP-Is are commonly diagnosed at advanced stages of disease. An enzyme-linked immunosorbent assay (ELISA) was developed to detect serum antibodies against staphylococcal slime polysaccharide antigens. Using a cutoff of 0.35 ELISA units, the test showed a specificity of 95.1% (95% confidence interval [CI], 85.4 to 98.7%) and a sensitivity of 89.7% (71.5 to 97.3%) on a sample of 90 individuals

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

<p>Abstract</p> <p>Background</p> <p>Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.</p> <p>Methods</p> <p>Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score).</p> <p>Results</p> <p>The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment.</p> <p>Conclusions</p> <p>Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.</p