No abstract

Patients with an elevated venous lactate following hip trauma should be identified as being at increased risk of death and may benefit from targeted medical therapy.

Aims This study aimed to compare the effect of antibiotic-loaded bone cement (ALBC) versus plain bone cement (PBC) on revision rates for periprosthetic joint infection (PJI) and all-cause revisions following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods MEDLINE, Embase, Web of Science, and Cochrane databases were systematically searched for studies comparing ALBC versus PBC, reporting on revision rates for PJI or all-cause revision following primary elective THA or TKA. A random-effects meta-analysis was performed. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42018107691). Results Nine studies and one registry report were identified, enabling the inclusion of 371,977 THA and 671,246 TKA. Pooled analysis for THA demonstrated ALBC was protective against revision for PJI compared with PBC (relative risk (RR) 0.66, 95% confidence interval (CI) 0.56 to 0.77; p < 0.001), however, no differences were seen for all-cause revision rate (RR 0.62, 95% CI 0.35 to 1.09; p = 0.100). For TKA, there were no significant differences in revision rates for PJI or all causes between ALBC and PBC (RR 0.92, 95% CI 0.59 to 1.45; p = 0.730, and RR 0.73, 95% CI 0.53 to 1.02; p = 0.060, respectively). Conclusion ALBC demonstrated a protective effect against revision for PJI compared with PBC in THA with no difference in all-cause revisions. No differences in revision rates for PJI and all-cause revision between ALBC and PBC for TKA were observed. Cite this article: Bone Joint J 2021;103-B(1):7–15.

The Severn Deanery offers a compulsory human-factors training course for surgeons at the start of their career. Given the importance of reducing human error, maintaining patient safety and the introduction of competency-based training with an emphasis on simulation, human-factors training has a vital place in surgical training, and is highly recommended to others involved in training junior surgical trainees.

Objectives: To develop a post-traumatic bone defect classification scheme and complete a preliminary assessment of its reliability. Design: Retrospective classification. Setting: Tertiary referral trauma center. Patients/Participants: Twenty open fractures with bone loss. Intervention: Assignment of a bone defect classification grade. Main Outcome Measurements: Open fractures were classified based on orthogonal radiographs, assessing the extent and local geometry of bone loss, including D1—incomplete defects, D2—minor/subcritical (complete) defects (<2 cm), and D3—segmental/critical-sized defects (≥2 cm). Incomplete defects (D1) include D1A—<25% cortical loss, D1B—25%–75% cortical loss, and D1C—>75% cortical loss. Minor/subcritical (complete) defects (<2 cm) (D2) include D2A—2 oblique ends allowing for possible overlap, D2B—one end oblique/one end transverse, and D2C—2 transverse ends. Segmental/critical-sized Defects (≥2 cm) include D3A—moderate defects, 2 to <4 cm; D3B—major defects, 4 to <8 cm; and D3C—massive defects, ≥8 cm. Reliability was assessed among 3 independent observers using Fleiss' kappa tests. Results: Interobserver reliability demonstrated the classification scheme has very good agreement, κ = 0.8371, P < 0.0005. Intraobserver reliability was excellent, κ = 1.000 (standard error 0.1478–0.1634), P < 0.00001. Interobserver reliability for the distinction between categories alone (D1, D2, or D3) was also excellent, κ = 1.000 (standard error 0.1421–0.1679), P < 0.00001. Conclusions: This classification scheme provides a robust guide to bone defect assessment that can potentially facilitate selection of the most appropriate treatment strategy to optimize clinical outcomes.