Although preoperative antibiotics are used routinely in ankle fracture surgery, there is considerable variability in postoperative antibiotic dosing regimens amongst surgeons. The aim of this study is to compare the rate of surgical site infection (SSI) in patients receiving one dose of preoperative antibiotics to patients who received more than one dose of antibiotics. A single-center Level I Trauma Center retrospective review of patients with isolated closed ankle fractures who underwent open reduction internal fixation over a 10- year period was performed. Demographics data and risk factors were obtained from the electronic medical record. SSI was detected using a text-mining algorithm on all postoperative clinic notes. Factors associated with the development of SSI or increased antibiotic dosing were evaluated. Eight-hundred and twenty-six patients were included in the analysis. There was no correlation between infection rate and any of the potential risk factors evaluated. Two-hundred and ninety-two patients received only one dose of antibiotics preoperatively and 534 patients received more than one antibiotic dose. The rate of SSI was not significantly different between the single-dose cohort (5.8 %) and the multi-dose cohort (3.9 %) (p=0.215). Routine use of postoperative antibiotics in open reduction internal fixation of closed ankle fractures did not decrease the rate of SSI, regardless of associated comorbidities. (c) 2024 by the American College of Foot and Ankle Surgeons. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundNative glenoid bone loss presents technical challenges in shoulder arthroplasty. The purpose of this study is to report the mid-term clinical and radiographic outcomes of patients treated with structural humeral head autograft reconstruction of glenoid bone loss in the setting of reverse total shoulder arthroplasty (rTSA).MethodsRetrospective review of 30 shoulders in 28 patients undergoing rTSA with a structural humeral head autograft to correct glenoid bone loss. Demographics, comorbidities, anatomic details, and patient-reported outcome measures were collected for analysis.ResultsRange of motion and patient-reported outcome measures were all significantly improved postoperatively (P < .001). Bone grafts were found to incorporate into 100% of shoulders, with no protheses displaying signs of loosening or other structural concerns. No revision procedures were performed, and all patients were satisfied with their shoulder postoperatively. Two patients developed scapular notching on follow-up.DiscussionThe use of a humeral head autograft to reconstruct glenoid bone loss in patients undergoing rTSA is a safe and effective procedure. It allows for a local graft source to be utilized thus avoiding potential comorbidity and complications associated with the use of alternative site autografts or allografts and has the advantage of nearly congruent fit within the defect.

Introduction: Lipohypertrophy is the most reported cutaneous complication of insulin injection. In cases refractory to conservative management, liposuction has been proposed as a treatment. This review aims to evaluate the use of liposuction for the treatment of insulin-induced lipohypertrophy. Methods: A literature search was conducted to identify case reports and case series that met inclusion criteria. Demographic, procedural, and outcome data were collected and summarized. Results: Ten case reports and 1 case series met eligibility criteria; 18 patients (16 female) with a mean age of 31 years were included for analysis. The primary indication for lipectomy was cosmetic (100%), followed by pain (16.7%), injection difficulty (16.7%), and poor glycemic control (11.1%). Ten patients (55.6%) underwent general anesthesia for their procedure, while 8 (44.4%) received local anesthesia. Thighs (53.8%) were the most common anatomical site of liposuction, followed by the upper arm (19.2%), abdomen (15.4%), buttocks (7.7%), and the flank (3.8%). The median volume of adipose tissue removed per site was 300 mL (range: 25-600 mL), while the total volume per patient was 910.8 mL (range: 200-2900 mL). The average postoperative follow-up time was 5.3 months (range: 2-10 months). Three patients reported postoperative improvement of glycemic control; 100% of patients were satisfied with their procedure. Small surface irregularities were reported in 2 patients. Conclusion: Although future investigations are warranted, these results may indicate that the use of liposuction to treat insulin-induced lipohypertrophy is a safe and effective procedure that achieves improved cosmetics with high patient satisfaction and enhanced glycemic control.

BACKGROUND:Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. METHODS:The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. RESULTS:Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. CONCLUSIONS:This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.