Osteosynthesis in Schatzker v and vi tibial plateau fractures in patients older than 65 years — one or two plates?

Background: Bicondylar tibial plateau fractures in elderly patients are rare. Indications for new locking precontoured plates with angular stability are increasing because of the powerful fixation in osteoporotic bone and possibility of percutaneous use. However, literature is lacking regarding these specific fractures.Purpose: To analyze the results of surgical management of bicondylar tibial plateau fractures (Schatzker classification types V and VI) in patients older than 65 years, comparing those treated with one locking plate and those with two plates.Methods: 19 patients were analyzed regarding these parameters: hemoglobin decrease, plates used, preoperative CT, loss of reduction or coronal alignment, time to consolidation, apparition of osteoarthritis, complications, visual analog scale and Oxford Knee Score (OKS).Results: Mean OKS was 36.8 (19–48), with 4 patients (21.05%) having excellent function and 13 (68.4%) moderate. There were only 2 wound infections and 2 varus collapses in the preoperative period. Eleven patients developed radiological osteoarthritis that was not present at the time of trauma.Conclusion: Precontoured locking plates of bicondylar tibial plateau fractures in elderly patients provide mild to good function in approximately 90% of cases, although complications are observed in approximately 21% of patients.

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective