High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

Background

Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion shoulder arthroplasty performed for failed fracture fixation.

Questions/Purposes

This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for re-operation at 4.6-year follow-up.

Methods

Twenty-eight patients who underwent conversion to shoulder arthroplasty for any reason after fracture fixation were retrospectively reviewed in a single center. A pre-operative aspiration was done in 17 patients; all patients had intra-operative tissue sampling. All procedures were single-stage removal of hardware and performance of the arthroplasty. In cases of pre-operative positive bacterial growth, a single-stage procedure was performed according to the septic ENDO-Klinik protocol.

Results

In 4 of 17 pre-operative joint aspirations, bacterial growth was detected; one pre-operative negative aspiration demonstrated bacterial growth in intra-operative sampling. In three of them, the infection has been validated through intra-operatively results. Pre-operative aspiration showed a sensitivity of 75% and specificity of 92% (p < 0.005) for infection. No post-operative PJIs were observed. Six revisions were performed, most commonly for aseptic loosening (two cases) and conversion of hemiarthroplasty to a reverse design (two cases).

Conclusions

In conclusion, the risk of low-grade shoulder infection after fracture osteosynthesis may be higher than in hip and knee joints, based on limited study data. Adequate pre-operative testing is recommended to rule out occult shoulder infection in this setting.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-015-9450-z) contains supplementary material, which is available to authorized users.     

A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance,inflammation, and oxidative stress in gestational diabetes

ObjectiveTo our knowledge, no reports are available indicating the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation, and oxidative stress among pregnant women with gestational diabetes mellitus (GDM).This study was designed to investigate the effects of the DASH diet on insulin resistance, serum high-sensitivity C-reactive protein (hs-CRP) and biomarkers of oxidative stress among pregnant women with GDM.MethodsThis randomized controlled clinical trial was performed with 32 pregnant women diagnosed with GDM at 24 to 28 wk gestation. Participants were randomly assigned to consume either the control (n = 16) or DASH diet (n = 16) for 4 wk. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and was low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d of sodium. The control diet contained 40% to 55% of its energy as carbohydrates, 10% to 20% as proteins, and 25% to 30% as total fats. Fasting blood samples were taken at baseline and after 4 wk of intervention to measure fasting plasma glucose (FPG), serum insulin, and hs-CRP, Homeostasis Model of Assessment—Insulin Resistance (HOMA-IR), plasma total antioxidant capacity (TAC), and total glutathione levels (GSH).ResultsConsumption of the DASH diet compared with the control diet resulted in decreased FPG (–7.62 versus 3.68 mg/dL; P = 0.02), serum insulin levels (–2.62 versus 4.32 μIU/mL, P = 0.03), and HOMA-IR score (–0.8 versus 1.1; P = 0.03). Increased concentrations of plasma TAC (45.2 versus –159.2 mmol/L; P < 0.0001) and GSH (108.1 versus –150.9 μmol/L; P < 0.0001) also were seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed significant reductions in plasma TAC and GSH levels in the control diet, while a significant increase in these biomarkers in the DASH diet.ConclusionConsumption of the DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC, and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.