Orthopaedics and Trauma最新文献

Surgical site infections (SSI) continue to represent a significant postoperative burden. SSI is associated with an increased risk of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) is used to reduce the risk of SSI. Several factors must be considered for appropriate antibiotic use: antibiotic selection, timing, and duration. The evidence and use of antibiotics differs between closed fractures, open fractures, arthroplasty and percutaneous fixation. The use of SAP is a balance between reducing the incidence of SSI whilst maintaining proper antibiotic stewardship to limit adverse effects and the emergence of antibiotic resistance. This paper will discuss the evidence for the use of SAP in orthopaedic surgery and the potential adverse effects of the injudicious use of antibiotics.

Traumatic injuries from civilian gunshot injuries represent a significant clinical burden to orthopaedic surgeons worldwide. Furthermore, the incidence of such injuries is increasing. Having a sound understanding of the pathophysiology associated with gunshot injuries and the appropriate management algorithm is vital. This chapter aims to review the current evidence regarding the incidence and prevalence of civilian ballistic trauma, the pathophysiological processes associated with these injuries, and the recommended management from emergent care at the time of injury to definitive surgery and rehabilitation.

In a male-dominated professional specialty, it is important to shine a light on the female pioneers in orthopaedics who have been the first of their kind in Britain. From Garrett Anderson to Clare Marx, these women have left a legacy contributing not only to the techniques and equipment used in surgery today but, by breaking through glass ceilings, have encouraged a change in the gender perception of orthopaedics. In an evolving profession, we celebrate these successful women and the incredible lengths they have gone to, in challenging the status quo and diversity issues. This article aims to highlight some of these role models, who may not thus far have received the recognition they deserve, and to encourage us to learn from their legacy to create a more inclusive culture in medicine.

Focal cartilage defects in the knee are a common and debilitating pathology. High arthroplasty revision rates in the <55-year-old population continue to make arthroplasty a limited primary surgical option. Advancements in surgical techniques and more robust long-term data on cartilage procedures have increased greatly in the last few years. Results vary and are dependent on matching suitable procedures to lesion and patient type. In this difficult-to-manage group, offering the right procedure to the right patient at the first instance has an important impact on outcomes. In this paper we review the evidence and new guidelines in the management of focal cartilage lesions of the knee.

Knee arthritis occupies a significant proportion of the musculoskeletal burden in the UK. Total knee arthroplasty currently comprises the mainstay of treatment. There has been a shift towards treating isolated unicompartmental osteoarthritis with bone-preserving surgical techniques, in the form of realignment osteotomy or unicompartmental arthroplasty. There are significant data regarding the survivorship of unicompartmental knee arthroplasty from the National Joint Registry data. Similar registry data are not available for osteotomy surgery yet, but the evidence suggests that unicompartmental knee arthroplasty has greater survivorship. Osteotomies can, however, deliver higher functional return. For both techniques to succeed, it is imperative that rigorous surgical decision-making, with regards to patient selection, should be followed. This paper discusses the basis for these principles and their importance in delivering optimal care. Often, these two surgical techniques are promoted as being mutually exclusive; this paper argues that, in fact, they are part of a complementary algorithm that can deliver the best outcome to the appropriately selected patient.

Paediatric knee surgery is a developing subspecialty in the UK. The rise in early participation of children in organized competitive sports has led to an increase in knee injury presentations, and brings unique challenges. Children's knee surgery encompasses varied and complex pathologies, and combines expertise in soft tissue and arthroscopic techniques with an understanding of the unique characteristics of children, their skeleton and growth potential. Children are inherently high-risk surgical candidates due to ligamentous laxity, growth potential, difficulties in rehabilitating post-surgery and risks of re-injury. Goals of treatment include management of instability and pain, restoration of function and rehabilitation, in order to preserve the knee for the child's future. This review will focus on the commonly presenting problems of cruciate, meniscal and patellofemoral pathology.

Orthobiologics therapies in the knee are a relatively new and rapidly evolving field that use biological treatments to help repair and regenerate damaged tissues in the knee. These therapies include stem cells, platelet-rich plasma (PRP) and other growth factors to promote healing and reduce inflammation. The use of orthobiologics has gained considerable interest in recent years for the treatment of a variety of musculoskeletal pathologies. As ‘natural’ treatments, they represent an attractive option for patients and surgeons that can be used in conjunction with traditional surgical procedures for augmentation, or in isolation as an alternative to surgery in a minimally-invasive manner. While orthobiologics therapies hold great promise in the treatment of knee conditions, there have been a variety of challenges to the widespread use of these therapies, including ambiguity in nomenclature, leading to confusion among consumers and providers, biologic heterogeneity, regulatory challenges and a lack of well-designed level one studies evaluating these agents that adequately report variables critical to outcome or assess purity/potency of treatments delivered. This article will provide an overview of the current orthobiologic options for the treatment of orthopaedic pathologies in the knee, as well as a discussion surrounding the current evidence and associated controversies.