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Microbial identification of orthopedic implant-associated infections using sonication fluid (SF) submitted to a concentration step by membrane filtration (SMF) was compared with the standard centrifugation (SC) method. Among 33 retrieved infected implants, sonication identified microorganisms in 26 (78.8%). The sensitivity of SC was higher than that of SMF (78.8% versus 30.3%; P < 0.001). Several authors have applied a sonication technique as an adjunctive diagnostic tool to increase the identification of causative agents of different orthopedic implant-associated infections (OIAIs) (1-3). However, sonication may also give false-negative results in at least 10% to 20% of cases when applying only phenotypic methods (4). We hypothesized that submitting the sonication fluid (SF) to a validated method of sample concentration, such as membrane filtration, in which the total volume of SF is submitted to filtration through a membrane filter with a pore size smaller than the bacterial size, would improve the microbial diagnosis of orthopedic implant-associated infection.We prospectively included 35 patients who underwent surgical removal of infected prosthetic joints (knee and hip) and internal fracture-fixation devices, including different sizes of plates and screws, between March 2013 and July 2014 at the orthopedic department of the Santa Casa de São Paulo School of Medical Sciences (Brazil). Subjects were excluded when clear contamination occurred during implant removal, transportation, or processing in the microbiology laboratory or if membrane obstruction was observed. Subject demographics, type of orthopedic implants, and indication for surgical removal were recorded. The study protocol was reviewed and approved by the Institutional Review Board. OIAI was diagnosed if at least one of the following criteria was present: open wound exposing fractured bone and/or osteosynthesis and prosthetic joint devices with gross evidence of purulence, intraoperative tissue with visible purulence, presence of a draining fistula communicating with the internal implant, and/or acute inflammation in intraoperative osteosynthesis/prosthetic joint tissue detected by histopathology (3).In the operating room, surgically removed orthopedic implants were placed in sterile polyethylene containers to which 650 ml of Ringer solution was added and then sealed with an airtight cover for transportation. The time limit for processing samples was 6 h. In the microbiology laboratory, containers with the retrieved implants were vortexed for 30 s at maximum power using the Vortex Genie 2 (Scientific Industries, Inc., Bohemia, NY, USA) and then sonicated (BactoSonic ultrasound bath; Bandelin GmbH, Berlin, Germany) for 5 min at a frequency of 40 Ϯ 2 kHz and power density of 0.22 Ϯ 0.04 W/cm 2 , followed by an additional 30 s of vortexing.In order to concentrate the SF, centrifugation was performed with 50-ml aliquots at 2,500 ϫ g for 5 min. The supernatant was aspirated, leaving 0.5 ml (100-fold concentration). Aliquots of 0.1 ml of concentrated SF w...

The proximal femoral fracture in the elderly is a serious public health problem. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy. The objective was to conduct a systematic review of physical therapy protocols in postoperative for fractures of the proximal femur in elderly. We selected randomized controlled trials in elderly in the past 10 years, in Portuguese and English. There were 14 articles in the literature. Physical therapy has an important role in functional recovery of the elderly. Level of Evidence I, Systematic Review RCTs (Study results were homogenous).

Objective To minimize the occurrence of missed injuries, the tertiary evaluation was introduced consisting of reassessment of the patient, 24 hours after admission, with: complete history, physical examination, review of exams and diagnostic testing if necessary. Methods Observational study evaluating trauma patients admitted to a teaching hospital in São Paulo, according to a protocol for tertiary evaluation. Results Between February and May 2012, for 12 weeks, 182 patients were submitted to tertiary evaluation, 100 (55%) polytraumatized and 82 (45%) were victims of low-energy trauma. Neglected lesions were observed in 21 (11.5%) patients, who had 28 missed injuries. Of these 28 lesions, seven (25%) required surgical treatment. Conclusion Strategies including formal tertiary evaluation, the protocol applied for assessing trauma victims, seem to be beneficial in these patients, regardless of the mechanism of trauma. The method is easily applied, effective and has low cost in identifying missed injuries in the victims of trauma.

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