No decrease in infection rate with the use of local vancomycin powder after partial hip replacement in elderly patients with comorbidities

Introduction The goal of this study was to evaluate the effects of local intra-wound vancomycin powder (VP) administration to decrease surgical site infections (SSIs), particularly in elderly patients with comorbidities, after having undergone partial hip replacement in the treatment of intertrochanteric (ITF) or femoral neck fractures (FNF). Methods We retrospectively reviewed patients who underwent partial hip replacement in the treatment of ITF or FNF in one year. We divided the patients into two groups. The non vancomycin-treated group received standard systemic prophylaxis only (1 gr cefazolin IV), while the vancomycin-treated group received 1 gr of VP in the surgical wound just before surgical closure in addition to the systemic prophylaxis. We included patients of 64 years or older who also had one or more comorbidities. We compared the post-operative SSI rates between the non vancomycin-treated group and the vancomycin-treated group. Results A total of 93 patients were included in the study. We detected post-operative wound infection in six patients (6.4%). The rate of SSI was found to be 5.7% in the vancomycin-treated group and 6.9% in the non vancomycin-treated group respectively, which showed no statistically significant difference (p:0.498). The incidence of SSI was statistically higher in the patients who had a follow-up in the post-operative intensive care unit than the patients who had not any follow-up in the intensive care unit. Conclusion Local application of VP in the surgical wound was found to be ineffective in reducing the incidence of SSI after partial hip replacement in elderly patients with comorbidities

Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion: Clinical and Radiological Results of Mean 46-Month Follow-Up

Background. Spinal fusion has been shown to be the preferred surgical option to reduce pain, recover function, and increase quality of life in the treatment of a variety of lumbar spinal disorders. The main goal of the present study is to report our clinical experience and results of percutaneous transforaminal endoscopic lumbar interbody fusion (PELIF) applications using the expandable spacer in a single institution. Methods. We performed a retrospective review of 18 patients with >12-month follow-up who had been operated on PELIF using expandable spacer from 2001 to 2007. Their clinical and radiological data were collected and analyzed. Results. The mean follow-up period was 46 months. The mean DH before the surgery was 8.3 mm which improved to 11.4 mm at the early postoperative period and regressed to 9.3 mm at the last follow-up visit. The VAS-B, VAS-L, and ODI scores at the last follow-up showed a 54%, 72%, and 69% improvement from the preoperative period, respectively. Conclusions. The presented PELIF technique with the expandable spacer seems to be a promising surgical technique for the treatment of a variety of lumbar spinal disorders. Conversely, radiological results including disc space subsidence make the stand-alone application of the expandable spacer debatable

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects

Treatment of thoracic disc herniations with posterior transforaminal thoracic interbody fusion

Giriş: Torakal disk hernileri (TDH)'nin tedavisi servikal ve lomber disk hernilerine oranla daha az görülmelerine bağlı olarak hala tartışmalıdır. Bu retrospektif çalışmanın amacı TDH nedeni ile posterior transforaminal torasik interbody füzyon (TTIF) ve diskektomi ile birlikte posterior enstrümantasyon ve füzyon yapılan hastaların sonuçlarını açıklamaktır.Metot: TDH'ne bağlı kronik ağrı şikayeti nedeni ile TTIF yöntemiyle tedavisi yapılan ve en az 1 yıllık takibi olan 10 hasta çalışmaya dâhil edildi. 10 hastadan bir tanesinde iki seviyeli TDH mevcuttu. Diskler santral ve parasantral olarak sınıflandırıldı. Cerrahi sırasındaki ortalama yaş 53.5 yıl, ortalama takip süresi 32.6 ay olarak kaydedildi. Pre- ve postoperatif ağrı durumu Visual Analog Score (VAS) sistemine göre değerlendirildi. Serimizdeki tüm hastalarda sonuçlar ve komplikasyonlar retrospektif olarak kaydedildi. Füzyon durumu düz grafi ve bilgisayarlı tomografi kullanılarak değerlendirildi. Sonuçlar: Tüm hastalarda takip süresinin sonunda radyolojik olarak füzyon elde edildi. Hiçbir hastada enstrüman yetmezliği saptanmadı. Ortalama VAS skoru preoperatif 7.4, postoperatif 1.9 olarak saptandı. Bir hastada postoperatif yara yeri enfeksiyonu gelişti ve cerrahi debridman ile tamamen iyileşti. Çıkarım: Transforaminal torasik interbody füzyon ve segmental enstrümantasyon eşzamanlı dekompresyon ve stabilizasyonu temin eden ve tüm TDH tiplerinde uygulanabilen efektif bir metottur.Introduction: Treatment of thoracic disc herniations (TDH) remains controversial due to its lower incidence than herniations in the cervical or lumbar spine. The objectives of this retrospective study are to demonstrate the surgical outcomes of the patients with TDH undergoing posterior transforaminal thoracic interbody fusion (TTIF) and discectomy with posterior instrumentation and fusion.Materials and methods: We enrolled 10 patients who underwent TTIF for chronic pain due to TDH and were followed for at least 1 year. Of the 10 patients, one had TDHs at two levels. Discs were classified as central or paracentral. The mean age at surgery was 53.5 years and the average period of follow up was 32.6 months. The pre- and postoperative pain status was evaluated according to the Visual Analog Score (VAS). Outcomes and complications were retrospectively assessed in this patient series. Status of fusion was evaluated using plain radiographs and computed tomography.Results: None of the patients with follow-up showed any signs of instrument migration or failure, and each went on to radiographic fusion. Average pre- and postoperative VAS scores were 7.4 and 1.9 points. One patient developed postoperative wound infection requiring additional operative debridement. Conclusions: A transforaminal thoracic interbody fusion combined with segmental fusion offers a means of achieving concurrent decompression and segmental stabilization and is an option for certain subtypes of TDH