BackgroundSurgical site irrigation during total hip (THA) and total knee (TKA) arthroplasty is a routine practice among orthopaedic surgeons to prevent periprosthetic joint infection. The purpose of this study was to evaluate the effect of chlorhexidine gluconate (CHG) irrigation on infection rates following THA and TKA.MethodsArthroplasties performed before September 2014 served as controls. THA performed before September 2014 (N = 253) underwent intraoperative irrigation with 0.9% saline followed by a 2-minute soak with <2% dilute povidone-iodine. TKA (N = 411) patients underwent only intraoperative saline irrigation. After October 2014, all patients (248 TKA and 138 THA) received intraoperative irrigation with 0.9% saline and periodic 0.05% CHG solution followed by a final 1-minute soak in CHG with immediate closure afterward.ResultsIn this 2:1 comparison of consecutive patients, there were no differences in patient demographics between the 2 groups. No difference was noted in wound healing concerns subjectively, and no statistically significant association in nonsurgical site infections, superficial surgical site infection, and deep surgical site infection rates between the 2 groups (nonsurgical site infections [THA: P = .244, TKA: P = .125]; superficial surgical site infection [THA: P = .555, TKA: P = .913]; and deep surgical site infection [THA: P = .302, TKA: P = .534]).ConclusionsWe were unable to discern a difference in infection rates between chlorhexidine irrigation and our prior protocols using dilute Betadine for THA and 0.9% saline for TKA. The theoretic advantages of dilute CHG retention during closure appear to be safe without infectious concerns.

The purpose of this retrospective cohort study was to evaluate whether there is an increased rate of short-term medical complications following short vs long cephalomedullary nails for the treatment of intertrochanteric hip fractures. A total of 899 patients treated surgically with cephalomedullary nails from January 1, 2005, to September 1, 2014, were included. Patients who received short nails (n=334) were older and had a higher incidence of coronary artery disease and diabetes mellitus compared with patients who received long nails (n=565). The incidences of 30-day medical complications, including myocardial infarction, stroke, deep venous thrombosis, pulmonary embolism, blood transfusion, non-surgical site infection, surgical site infection, and mortality, were recorded. The orthopedic complications of periprosthetic fracture of the ipsilateral hip and implant failure through the latest outpatient follow-up were recorded. No significant difference was found between nails for any studied medical complication (63.5% short vs 66.0% long, P=.4393) or mortality (6.9% short vs 5.3% long, P=.3322). There was also no significant difference in the incidence of orthopedic complications (P=.70). Longer operating room time was associated with superficial surgical site infection. [Orthopedics. 2018; 41(5):e636-e642.].

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: The naviculocuneiform (NC) joint has a role in numerous pathologies of the foot and ankle. There is little in the published literature quantifying the cartilage of the articulating surface and its unique anatomical features. The purpose of this study was to quantify and describe the articular surface of the NC joint. Our hypothesis was that the cartilage surface would have anatomic features that would guide surgeons when performing procedures such as joint preparation and screw placement. Methods: Twenty cadaver NC joints were dissected, and the articular cartilage quantified by calibrated digital imaging software. Results: The mean dorsal to plantar height of the navicular facets was 18mm, with a maximum height not exceeding 21mm. The mean height of the medial, middle, and lateral cuneiform facets was 15mm, 17mm, and 15mm, respectively. The mean length from the medial to middle navicular facet was 14mm, approximately 41.3% the mean length across all three navicular facets (34mm). For the distal navicular articulation, 75.4% of the mean surface area was articular cartilage. For the proximal medial, middle, and lateral cuneiform articulations, 69.6%, 75.7%, and 75.8% of the mean surface areas were articular cartilage, respectively. Conclusion: This study provides an anatomic description of the NC joint to guide surgeons when operating on the NC joint. Two clinical observations can be made from this data. First, when preparing the NC joint for arthrodesis from a dorsal approach, the surgeon should be aware that the cartilage of the NC joint can extend up to 21mm from dorsal to plantar. This is also a useful estimate of screw length in the subchondral bone. Second, the central third of the navicular, where the majority of navicular stress fractures occur, lies in the inter-facet ridge between the medial and middle facets.