Fang-Yao Chiu

Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees.

Background: A prospective, randomized study was conducted to evaluate the efficacy of cefuroxime-impregnated cement in the prevention of deep infection after primary total knee arthroplasties performed without so-called clean-air measures, such as laminar flow and body-exhaust suits. Methods: Three hundred and forty primary total knee arthroplasties were performed with cementless fixation of the femoral component and cement fixation of the patellar and tibial components. The knees were randomly divided into two groups. In Group 1 (178 knees), cefuroxime-impregnated cement was used for fixation, whereas in Group 2 (162 knees), the cement did not contain cefuroxime. There was no significant difference between the two groups regarding demographic variables, the preoperative or postoperative knee score, the duration of the operation or of the use of the tourniquet, or the amount of blood transfused perioperatively. The average duration of follow-up was forty-nine months (range, twenty-six to eighty months). Results: No deep infection developed in the 178 knees in Group 1, whereas a deep infection developed in five (3.1%) of the 162 knees in Group 2 (p = 0.0238). Two superficial wound infections developed in each group. Conclusions: Cefuroxime-impregnated cement was shown to be effective in the prevention of early to intermediate deep infection after primary total knee arthroplasty performed with use of perioperative systemic antibiotic prophylaxis but no so-called clean-air measures.

Closed humeral shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVEnWe tried to define the roles of the rigid dynamic compression plate (DCP) and the semi-rigid Ender nail (EN) in the treatment of closed humeral shaft fractures.nnnDESIGNnA prospective, randomized clinical study was performed with detailed comparison parameters.nnnMATERIALS AND METHODSnNinety-one closed humeral shaft fractures were treated. Randomly, 30 humeri were treated with open reduction and internal fixation with DCP and no bone grafting (BG), 29 were treated with the same procedure but with BG, and 32 were treated with closed reduction and internal fixation with Ender nails. The average follow-up period was 32 months (range, 13-54 months).nnnMEASUREMENTS AND MAIN RESULTSnIn the group with DCP without BG, the average blood loss was 270 mL, operation time was 92 minutes, hospital length of stay was 6.5 days, and union time was 12.5 weeks. In the group with DCP with BG, the average blood loss was 325 mL, operation time was 108 minutes, hospital length of stay was 6.9 days, and union time was 9.4 weeks. In the EN group, the average blood loss was 114 mL, operation time was 54 minutes, hospital length of stay was 5.6 days, and union time was 9.9 weeks. Analysis of variance and Fishers exact test were used to evaluate the statistical significance.nnnCONCLUSIONnIn our experience, for humeral shaft fractures fixed surgically, EN is better than DCP without BG. When DCP is chosen for the means of fixation, prophylactic BG is recommended, especially in cases with more comminution.

Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees.

BACKGROUNDnDeep infection following total knee arthroplasty is a devastating complication, and it is very important to prevent it. A prospective cohort study was conducted to evaluate the effect of vancomycin-impregnated cement on the prevention of deep infection after revision total knee arthroplasty performed in a setting in which so-called clean-air measures such as laminar flow and space suits were not available.nnnMETHODSnFrom 1993 to 2004, 183 first-time revision total knee arthroplasties were performed with fixation of all components with cement. The knees were divided randomly into two groups to evaluate the effect of vancomycin-impregnated cement in the prevention of postoperative infection. In Group 1 (ninety knees), the cement was not mixed with antibiotics; in Group 2 (ninety-three knees), vancomycin-impregnated cement was used for fixation. All of the patients were evaluated preoperatively and intraoperatively and found to be without infection at those times.nnnRESULTSnAt an average of eighty-nine months postoperatively, no deep infection had developed in the ninety-three knees in Group 2, whereas a deep infection had developed in six (7%) of the ninety knees in Group 1. This difference between Groups 1 and 2 was significant (p = 0.0130). One superficial wound infection developed in Group 1.nnnCONCLUSIONSnVancomycin-impregnated cement was shown to be effective in the prevention of postoperative deep infection after revision total knee arthroplasty performed with antibiotic prophylaxis but not with so-called clean-air measures. This study provides preliminary evidence to justify larger trials.

Revision With Dynamic Compression Plate and Cancellous Bone Graft for Aseptic Nonunion After Surgical Treatment of Humeral Shaft Fracture

BACKGROUNDnWe evaluated the effect of revision with dynamic compression plate (DCP) and cancellous bone graft for aseptic nonunion after surgical treatments of humeral shaft fracture.nnnMETHODnEighty-six patients with aseptic nonunion of humeral shaft fracture after various surgical treatments were reviewed and analyzed retrospectively between January 1982 and August 2006. There were 59 men and 27 women with the average age of 42 years (range, 19-81 years). Thirty-one fractures were defined as atrophic nonunion, 45 fractures were hypertrophic nonunion, and 10 fractures could not be defined clearly. All the fractures were managed with removal of previous implants, open reduction and internal fixation with DCP, supplemented by cancellous bone graft. The follow-up period was 38 months in average (range, 12-288 months). Functional evaluations were done by Mayo Elbow Performance Index and the modified scale of Constant and Murley.nnnRESULTSnAll the nonunions united with the average union time of 18 weeks (range, 14-26 weeks). Complications included five temporary radial nerve palsies and two wound infections. In final follow-up, the shoulder and elbow functions of the operated limbs were all noted to be good or excellent.nnnCONCLUSIONnDCP with cancellous bone graft is a reliable and an effective treatment for revision of aseptic nonunion of humeral shaft fracture after surgical treatment.

Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients.

BACKGROUNDnWe elucidate the effect of surgical treatment of acute basicervical fractures of femur by closed reduction and internal fixation with dynamic hip screw (DHS).nnnMETHODSnFrom 1992 to 2004, 269 patients who had acute unilaterally basicervical fractures of femur were collected and evaluated prospectively. All the fractures were managed with closed reduction and internal fixation with DHS. The follow-up period was 74.7 months on average (range: 24-150 months). Finally, 241 patients were available for evaluation of union condition and 200 patients were available for evaluation of functional results and late complication.nnnRESULTSnFive patients (1.66%) of nonunion and two patients (0.83%) of screw cutout were met. The other 235 patients had uneventfully union with the average union time of 16.5 weeks (range:14-24 weeks). No avascular necrosis of femoral head was noted.nnnCONCLUSIONnSurgical treatment of acute basicervical fractures of femur by closed reduction and internal fixation with DHS was shown to be very effective.

Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment.

OBJECTIVEnTo define the roles of the rigid interlocking nail and the semirigid Ender nail in the treatment of closed unstable tibia] shaft fractures.nnnDESIGNnRandomized, clinical, prospectively study with detailed comparison of parameters.nnnMATERIALS AND METHODSnData on 116 unstable closed tibial shaft fractures were collected. Randomly, 60 tibiae were fixed with interlocking nails and 56 tibiae were fixed with Ender nails. The follow-up period was 24 (16-32) months.nnnMEASUREMENTS AND MAIN RESULTSnIn the interlocking nail group, the average blood loss was 189 cc, operation time was 51 minutes, length of hospital stay was 7 days, and union time was 14.2 weeks. In the Ender nail group, the average blood loss was 95 cc, operation time was 30 minutes, length of hospital stay was 5.0 days, and union time was 16.9 weeks. Students t test was used for statistical significance.nnnCONCLUSIONSnFor more comminuted unstable tibial shaft fractures, an interlocking nail is undoubtedly a better choice, but an Ender nail still is effective in some aspects of treatment in the less comminuted unstable tibial shaft fractures.

Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus

We have performed a prospective single-blinded randomised study to evaluate the role of antibiotic-impregnated cement in the prevention of deep infection at primary total knee arthroplasty (TKA) in patients with diabetes mellitus. We studied prospectively 78 arthroplasties performed for osteoarthritis in such patients. They were randomly separated into two groups. In group 1 (41 knees), cefuroxime-impregnated cement was used while in group 2 (37 knees) cefuroxime was not added to the cement. The preoperative, intraoperative and postoperative management was the same for both groups. The mean follow-up was 50 months (26 to 88). There were no cases of deep infection in group 1, but five (13.5%) occurred in group 2 (p = 0.021). We conclude that cefuroxime-impregnated cement is effective in the prevention of deep infection at primary TKA in patients with diabetes mellitus.