No abstract

Both anterior and posterior approaches can be used for open reduction of pure sacroiliac dislocations, each with specific areas for assessing reduction. In light of current plate dimensions, fractures more than 2.5 cm lateral to the anterior iliolumbar ligament footprint are amenable to anterior plate fixation, whereas those more medial may be better addressed through a posterior approach.

We would like to congratulate Yang et al for their recent work showing that routine cephalosporin testing is not clinically beneficial in predicting anaphylaxis. 1 This paper has been a useful addition to general medical knowledge and preoperative patient management. Surgical site infection (SSI) is an important metric in modernhealth care and has a significant impact on quality and cost. New interventions aimed at reducing SSI have been introduced, including the Enhanced Recovery After Surgery (ERAS) pathway. 2 Of these evidence-based interventions, timely antibiotic administration is a critical step in reducing SSI. Cephalosporins are considered the firstline choice for preoperative prophylactic antibiotics across multiple surgical specialties. 3 In patients with documented penicillin allergies, cephalosporin administration is avoided due to concern for cross-reactivity. Vancomycin is a common second-line alternative; however, data show its use as a prophylactic antibiotic is associated with increased adverse events. These include a rise in antibiotic-resistant pathogens and increased SSI. 4 In an effort to identify true allergies to reduce these adverse events linked to nonoptimal antibiotic administration, preoperative penicillin allergy testing has been used.These testing measures have been effective in decreasing secondline vancomycin use. 5 Historically, only 2%-3% of patients with a positive penicillin allergy test developed a reaction after receiving cephalosporins. 6 It has been proposed that focused cephalosporin allergy testing may be a more efficacious method for patient risk stratification as it is cephalosporins, not penicillins, that are first-line prophylaxis for many surgical procedures. This paper has shown otherwise. Until newer testing methods and data support routine testing, perioperative SSI reduction pathways will continue to focus on penicillin allergy testing over focused cephalosporin testing. CO N FLI C T S O F I NTE R E S T SMr. Fox has no conflicts of interest to declare. Dr. Scott has received honorarium and travel expenses from Edwards Lifesciences, Baxter, and Deltex Medical outside this submitted work. O RCI D Wade E. Fox

No abstract