prevention

Issues

Host

Wound

Operating room environment

Antibiotics

Operative technique

Post operative

Host

Immunocompromised

RA (0.9 v 2.2%)

Psoriasis

DM (6%)

Poor nutrition

Obesity

UTI

Prednisone

Previous operation

Previous infection

Age

Incidence

10 -15%

Include

- marginal necrosis

- wound slough

- sinus tract formation

- dehiscence

- haematoma

- oozing knee wound

Blood supply

Anterior knee has no muscles to supply vessels directly 

Preoperative

Identify high risk groups

- immunocompromised

- diabetes

- RA

- malnutrition

Urine screen

- check for and treat UTi

Groin, nose, axilla swabs

- for MRSA

- if positive, treat

- need 3 consecutive free swabs

3 x chlorhexidine preoperative showers in 8 hours

Admit day of surgery

- check skin for lesions

Definition

Pathological bone formation in soft tissues

Epidemiology

In elbow

- 3% of trauma

- 89% if head injury + trauma

Types

Completely different

1.  Myosisitis Ossificans Circumscripta

- post traumatic

- more common

- recognised as a consequence of neurological injury

Definition

Extraskeletal bone formation in periarticular tissues 

- HA crystals within osteoid matrix

Different to calcification 

- osteoid matrix laid down

Types

1.  Myositis Ossificans

- post traumatic

ANZ Working Party on the Management and Prevention of Venous Thromboembolism 2007

Note

Top 6 conditions associated with DVT

- stroke

- THR

- multi trauma

- TKR

- hip fracture

- spinal cord injury

Not one of the 12 doctors was an orthopaedic surgeon

Agents

Heparin / LMWH / fondaparinux

- confirmed effectiveness

Definition

Acute disease

- characterised by generalized rigidity & convulsions

- caused by exotoxins/neurotoxins produced in Clostridia Tetani infections

Epidemiology

Annual world mortality is 1 million

West 15-100/year

Aetiology / Pathology

Clostridium Tetani

- anaerobic

- spore-bearing Gram positive Bacillus