Trauma surgeons discuss their experiences treating shooting victims
An article in The New York Times includes comments from three military and two civilian trauma surgeons on treating patients who have been shot with military-style assault weapons. The article includes several radiographs highlighting damage to bones from gunshot wounds and discusses additional complications, such as soft-tissue damage caused by bone fragments radiating from the wound site and potential for amputation.
Study: Mixing of some surgical antiseptics may produce toxic products
Certain surgical antiseptics may yield potentially toxic byproducts when mixed, according to Poster P696, on display in Academy Hall B at the AAOS Annual Meeting. The investigators mixed all combinations of four antiseptic solutions commonly used in total joint arthroplasty: 4 percent chlorhexidine gluconate (CHX), Dakin’s solution (0.5 percent sodium hypochlorite, or NaOCl), povidone-iodine (BTD), and hydrogen peroxide (H 2O 2). They found that combinations of CHX and NaOCl, CHX and H 2O 2, and CHX and BTD reacted instantly and formed a precipitate, while NaOCl and H 2O 2 reacted to produce a gas. NaOCl and BTD did not react initially, but when additional NaOCl was added, a reaction (color change) was observed. At least two of the reactions tested—CHX + NaOCl and NaOCl + H 2O 2—yielded byproducts that could be toxic to human beings Only H 2O 2 and BTD did not react in a visible manner.
Study: Early mechanical failure of THA linked to increased risk of complication
Patients who must return to the operating room for mechanical failure after total hip arthroplasty (THA)—especially in the first two weeks after surgery—may be at increased risk of infection or wound complication requiring a subsequent operation, according to the authors of Paper 026, presented today at the AAOS Annual Meeting. Members of the research team conducted a retrospective study of 16,203 primary THA patients from a single institution and found that patients who underwent surgery for mechanical failure within 14 days after the initial THA had the highest rate of subsequent infection and wound complications, nearly five times higher than that of patients who had revision surgery 90 days or more after primary THA.
Study: Some patients who undergo simultaneous multilevel laminectomies may not need subsequent arthrodesis
A study presented in Poster P334, on display in Academy Hall B at the AAOS Annual Meeting, suggests that some patients who undergo spinal decompression of three or more consecutive levels without concomitant fusion may not require subsequent arthrodesis. The researchers reviewed data on 45 patients who underwent multilevel (three or more) lumbar decompressions without concomitant fusion at a single tertiary referral hospital and who had at least 11 months of follow-up. They found that three patients (7 percent) went on to subsequent arthrodesis at a previously decompressed level at mean 21 months, three patients (7 percent) underwent revision decompression at previously decompressed levels at mean 53 months, and one patient with follow-up greater than 100 months underwent revision decompression at 130 months.
AAOS Board approves new AUC on management of DDH in infants
The American Academy of Orthopaedic Surgeons (AAOS) Board of Directors has approved new Appropriate Use Criteria (AUC) for Management of Developmental Dysplasia of the Hip (DDH) in Infants up to Six Months of Age. This AUC is the first to provide two versions of an online diagnostic tool for management of DDH: one customized for generalists referring physicians, and one customized for orthopaedic specialists. The new AUC supports an existing AAOS Clinical Practice Guideline, “Management of Detection and Nonoperative Management of Pediatric DDH in Infants Up to Six Months of Age.”
