Semenistyy Anton is a resident of the Program in Traumatology and Orthopaedics at Peoples’ Friendship University of Russia. He has graduated I M from Sechenov First Moscow State Medical University. He is actively engaged in scientific activities under the leadership of the famous Russian Surgeon Vladimir Obolenskiy. He has publications and presentations at conferences in Russia and overseas.
Development of septic complications (SC) following large joint replacement (LJR) results in large number of cases of severe disability in this group of patients. This is due to the fact that, faced with this problem the doctor cannot answer the question of what is the most appropriate tactic of treatment in each particular case. In the literature, there are studies pointing to the benefits of different methods in treatment of these patients, but not enough data to determine the most optimal management depending on the type of complications. Our aim was to evaluate the effectiveness of various tactics in treating septic complications following large joint replacement. We analyzed the outcomes of treatment of 171 patients with SC following LJR from 2010 to 2014. Depending on the type of complications, all patients were divided into 2 groups: those with superficial surgical site infections (SSSI) and deep surgical site infections (DSSI) associated with prosthesis. In the treatment of these patients we followed different tactics using method of negative pressure wound therapy (NPWT), the antibiotic impregnated collagen sponge (AICS) and antibacterial cement spacers (ACS). We obtained the results allowing assessing the impact of these methods on the effectiveness of treatment, recurrence rate and mortality in patients of different groups. By combining different methods were able to reduce the number of relapses from 20% to 0% in patients with SSSI and significantly improve treatment outcomes in patients with DSSI. This analysis helped us to determine the most appropriate tactics of treatment depending on the type of complications.
Abed Abdel Latif Mohammed Al Negery is a medical Practitioner at Mansoura University hospital and Abed Orthopedic Center, Egypt. He is a professional member of Egyptian Orthopaedic Association and Egyptian Oncology Association.
Purpose. To evaluate the use of fibular grafting and dynamic hip screws for fresh femoral neck fractures with posterior comminution in young patient less than 50 years. Methods: Between October 2011 and March 2015, 35 patients aged 20 to 50 years, 30 men and 5 women underwent fixation using DHS and fibular strut grafts for Garden grades III (25 patients ) and IV (10 patients) femoral neck fractures with posterior comminution. All fractures were reduced by closed methods, and no hip was aspirated. Clinical and radiological outcomes were evaluated. Results: All patients were in the age-group of 20 to 50 years (mean, 37years). The mean delay in presentation after injury was 1 day . The mean final follow-up for these 35 patients was 27.7 months. Healing of the femoral neck was attained in 34 cases, with an average time to union of 4.8 months (range 4 to 8 months). One patient (Case 18) underwent arthroplasty due to failure of fixation. According to the Harris hip score, outcome was good to excellent in 30 patients, fair in 4, and poor in 1. Conclusions: Posterior comminution of the femoral neck fracture is a major cause of delayed and non-union owing to the loss of the buttressing effect against the posterior rotation.When a femoral neck fracture with posterior comminution defect is anatomically reduced, only the anterior portions of the femoral neck fracture surfaces are brought into contact. In our study, no patient developed avascular necrosis of the femoral head. This could be attributed to many factors include, closed reduction , fibular grafts and DHS fixation