Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty.

Introduction: Previous literature has reported minimal incidences of positive fungal/AFB cultures, questioning the routine use of these tests. With growing concern for excessive use, predictive factors for patients at higher risk for intraoperative AFB/fungal infections would help surgeons limit unnecessary testing. This study evaluates the positivity rate and predictive factors of positive fungal and/or acid-fast bacillus (AFB) cultures after primary, conversion, or revision hip and knee arthroplasty.

Unstable Ankle Fractures in Neuropathic Diabetics.

Connolly recognized as early as 1998 that a displaced ankle fracture in a neuropathic diabetic puts that patient at risk for an amputation. It is well appreciated that the risk of a poor clinical outcome secondary to failure of the surgical construct, deep wound infection and osteomyelitis or a combination of both, is greatly increased in neuropathic diabetic patients, that is, those that are insensate to the Semmes-Weinstein 5.07 (10 g) monofilament, as compared with sensate diabetics or similar non-diabetic patients.

Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given.

The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula.

Outcomes-oriented amputation surgery.

Both patients and health care professionals generally view amputation as a failure of modern medicine. Recent technological advances allow preservation of many limbs that would have required amputation in the not-too-distant past. These technological advances can be overused, imparting substantial potential risks to the patients.