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Controversies in the microbiological diagnosis and treatment of bone and joint infections 骨关节感染微生物诊断与治疗的争议
Orthopaedics and Trauma Pub Date : 2023-10-13 DOI: 10.1016/j.mporth.2023.09.003
Ruth Alexandra Corrigan, Bridget L Atkins
{"title":"Controversies in the microbiological diagnosis and treatment of bone and joint infections","authors":"Ruth Alexandra Corrigan,&nbsp;Bridget L Atkins","doi":"10.1016/j.mporth.2023.09.003","DOIUrl":"10.1016/j.mporth.2023.09.003","url":null,"abstract":"<div><p><span><span>Recently, bone and joint infections such as fracture-related infection (FRI) and prosthetic joint infections (PJI) have been defined for clinical and research purposes. National and international guidelines are being produced to guide clinicians towards what is considered best practice. However, much of what we do regarding the microbiological diagnosis and management of </span>orthopaedic infection is based on expert opinion, rather than evidence-based medicine. This is largely because, prior to the publication of the clinical definitions of orthopaedic infection, studies included a heterogeneous population making comparisons between them difficult. More recently the publication of large </span>clinical trials<span> in the antimicrobial management of orthopaedic infection has demonstrated that such clinical research is possible, and can both challenge the existing dogma in this field and lead to universal changes in clinical practice. There is robust evidence for microbiological sampling techniques and their interpretation in diagnosis of orthopaedic infection, as well as the choice of empiric broad-spectrum antibiotics and the non-inferiority of oral versus intravenous systemic antibiotics. For other elements of the diagnosis and management of orthopaedic infection this is not the case. For example, there are limited or no data to support recommendations regarding time off antibiotics prior to microbiological sampling, systemic antibiotic duration, when to do a joint aspirate in PJI revisions or the timing of definitive joint implantation in the two-stage management of PJI. In summary, this review highlights what is currently considered best practice within the field of orthopaedic infection and discusses both the evidence behind it and where there is controversy or where further research is warranted.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 336-343"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135761241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Classification of prosthetic joint infection and fracture-related infection 假体关节感染与骨折相关感染的分类
Orthopaedics and Trauma Pub Date : 2023-10-12 DOI: 10.1016/j.mporth.2023.09.002
Andrew J. Hotchen, Martin A McNally
{"title":"Classification of prosthetic joint infection and fracture-related infection","authors":"Andrew J. Hotchen,&nbsp;Martin A McNally","doi":"10.1016/j.mporth.2023.09.002","DOIUrl":"10.1016/j.mporth.2023.09.002","url":null,"abstract":"<div><p><span>Bone and joint infections can present in many ways. It is important to understand the features of the infection which contribute to the complexity of the condition and affect the outcome of </span>treatment for the patient. Classification systems can do this but are often ignored in clinical decision-making and design of research projects. Recent work has better documented the key features of the patient and limb which must be considered when treatment is planned. This paper reviews the available classifications and their application to clinical practice. The Cierny and Mader and JS-BACH classifications offer useful information for stratifying cases and provide evidence-based advice on outcome from treatment for patients. Both have been validated in well-defined patient cohorts.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 330-335"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135708107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Infections of the hand and wrist: anatomical problems with surgical solutions 手和手腕感染:手术解决的解剖学问题
Orthopaedics and Trauma Pub Date : 2023-10-12 DOI: 10.1016/j.mporth.2023.09.006
Patrick Garfjeld Roberts, Nicholas Riley
{"title":"Infections of the hand and wrist: anatomical problems with surgical solutions","authors":"Patrick Garfjeld Roberts,&nbsp;Nicholas Riley","doi":"10.1016/j.mporth.2023.09.006","DOIUrl":"10.1016/j.mporth.2023.09.006","url":null,"abstract":"<div><p>Infections of the hand and wrist are thankfully rare, but they present esoterically dependent on the specific structures involved. When underappreciated, they lead to delayed or incomplete management and destruction of highly specialized functional anatomy<span> in the hand which results in significant disability. The general signs, symptoms and investigations for infections in the hand mirror infections elsewhere, but the variety of potential spaces in the hand mean there is no single sensitive indicator clinically, biochemically or radiologically. A high index of suspicion and understanding of the anatomy which affects the presentation, progression, treatment and complications of hand infections is required. This review describes the specific anatomy to be aware of to diagnose and manage hand infections completely, and highlights the near universal requirement for surgery to adequately clear infections in the hand.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 359-365"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135708108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Managing fracture-related infection 处理骨折相关感染
Orthopaedics and Trauma Pub Date : 2023-10-12 DOI: 10.1016/j.mporth.2023.09.007
Asanka Wijendra, Jerry Tsang, Jamie Ferguson, Martin A McNally
{"title":"Managing fracture-related infection","authors":"Asanka Wijendra,&nbsp;Jerry Tsang,&nbsp;Jamie Ferguson,&nbsp;Martin A McNally","doi":"10.1016/j.mporth.2023.09.007","DOIUrl":"10.1016/j.mporth.2023.09.007","url":null,"abstract":"<div><p>Fracture-related infection (FRI) is a serious complication that can result in poor outcomes, delayed bone-healing, soft tissue compromise, and prolonged hospitalization. FRI can present in various ways, largely depending on the timepoint after fracture. Management of this condition can be challenging. In this article we consider how to approach this condition and look at the rationale for decision-making in managing cases with complex infection.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 366-378"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135705794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Soft-tissue reconstruction in bone and joint infection 骨关节感染的软组织重建
Orthopaedics and Trauma Pub Date : 2023-10-12 DOI: 10.1016/j.mporth.2023.09.008
Alex J Ramsden, Terry Ann Curran
{"title":"Soft-tissue reconstruction in bone and joint infection","authors":"Alex J Ramsden,&nbsp;Terry Ann Curran","doi":"10.1016/j.mporth.2023.09.008","DOIUrl":"10.1016/j.mporth.2023.09.008","url":null,"abstract":"<div><p><span>Bone and joint infection are commonly associated with disruption of the soft tissue envelope around the </span>skeleton<span><span>. Respect and consideration must be given to the soft tissue when treating orthopaedic infection<span> as this can be the most challenging part of reconstruction during effective eradication of infection. Failure to plan for soft tissue problems will increase the risk of treatment failure. We describe the role of plastic surgeons and modern approaches to timely and effective joint working to deliver patient-centric care. Reconstructive options for soft tissues are described and the rationale behind our </span></span>clinical approach.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 379-385"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135708094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Answers to the CME questions on Shoulder Trauma 关于肩部创伤的CME问题解答
Orthopaedics and Trauma Pub Date : 2023-10-11 DOI: 10.1016/j.mporth.2023.09.009
{"title":"Answers to the CME questions on Shoulder Trauma","authors":"","doi":"10.1016/j.mporth.2023.09.009","DOIUrl":"10.1016/j.mporth.2023.09.009","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Page 388"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135705880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
CME questions on Bone and Joint Infection 关于骨和关节感染的CME问题
Orthopaedics and Trauma Pub Date : 2023-10-11 DOI: 10.1016/j.mporth.2023.09.010
{"title":"CME questions on Bone and Joint Infection","authors":"","doi":"10.1016/j.mporth.2023.09.010","DOIUrl":"10.1016/j.mporth.2023.09.010","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 6","pages":"Pages 386-387"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessment of the acutely injured shoulder 急性肩部损伤的评估
Orthopaedics and Trauma Pub Date : 2023-10-01 DOI: 10.1016/j.mporth.2023.07.002
Oliver Bagshaw, Vijay Deore
{"title":"Assessment of the acutely injured shoulder","authors":"Oliver Bagshaw,&nbsp;Vijay Deore","doi":"10.1016/j.mporth.2023.07.002","DOIUrl":"10.1016/j.mporth.2023.07.002","url":null,"abstract":"<div><p>Trauma of the shoulder encompasses a wide range of potential injuries. The shoulder forms the articulation between the upper limb and trunk, with a close anatomical relationship to the neck and brachial plexus. Acute injuries can have large overlaps of presenting symptoms and many of the special tests we use are imperfect, and must be applied and interpreted in the context of the injury. It is important that a holistic approach is taken to the assessment of acutely injured shoulders in order to ensure injuries are adequately recognized and to guide appropriate further investigations and management. The purpose of this article is to provide a systematic approach to assessment of acute shoulder injuries and summarize the evidence base for special clinical tests that aid in diagnosis.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 5","pages":"Pages 271-275"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43918109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurovascular injury in shoulder girdle trauma 肩带外伤中的神经血管损伤
Orthopaedics and Trauma Pub Date : 2023-10-01 DOI: 10.1016/j.mporth.2023.07.003
Robert J. Burton, Anna R. Barnard, David Copas, Charlie Talbot
{"title":"Neurovascular injury in shoulder girdle trauma","authors":"Robert J. Burton,&nbsp;Anna R. Barnard,&nbsp;David Copas,&nbsp;Charlie Talbot","doi":"10.1016/j.mporth.2023.07.003","DOIUrl":"10.1016/j.mporth.2023.07.003","url":null,"abstract":"<div><p><span><span>Trauma to the shoulder girdle<span> has known associations with neurological and/or vascular injury. The presentation of these can be subtle and could potentially be missed, particularly if the clinician does not maintain a high index of suspicion and clinically examine and investigate appropriately. A missed injury could be detrimental for the patient, both increasing morbidity and affecting long-term outcome. This is especially true for neurological injury, in which missing the window for effective </span></span>reinnervation procedures can have a lifelong negative impact. Nerve injuries can be difficult to classify clinically in the initial stages and it is crucial to know when </span>nerve conduction studies<span> and imaging are useful, and when early nerve exploration is warranted. Injuries to neurological or vascular structures generally benefit from a multidisciplinary approach to achieve the best outcomes. This article describes common nerve and vascular injuries associated with shoulder girdle trauma, along with approaches to assessment, investigation and timely management.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 5","pages":"Pages 276-284"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41676043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Update on management options for the humeral shaft 肱骨干管理方案的最新进展
Orthopaedics and Trauma Pub Date : 2023-10-01 DOI: 10.1016/j.mporth.2023.07.006
Maheshi P. Wijesekera, Paul Cowling
{"title":"Update on management options for the humeral shaft","authors":"Maheshi P. Wijesekera,&nbsp;Paul Cowling","doi":"10.1016/j.mporth.2023.07.006","DOIUrl":"10.1016/j.mporth.2023.07.006","url":null,"abstract":"<div><p>Fractures of the humeral shaft<span> are relatively common and can occur in any age group. The anatomy<span><span> of the humeral shaft is vital to understand, in order to plan management of these fractures: the relationship of the radial nerve<span> with the humeral shaft in particular, plays an important role in these fractures. Though non-operative measures are employed for humeral shaft fractures<span> routinely, there are some indications for operative management. There remain a variety of operative interventions available to the surgeon, all with associated pros and cons. This review aims to look in detail at the fracture types, the evidence and surgical methods including a discussion about the complications, particularly a </span></span></span>radial nerve palsy.</span></span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 5","pages":"Pages 303-313"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48354266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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