TY  - JOUR
A1  - Streck, Laura Elisa
A1  - Seefried, Lothar
A1  - Genest, Franca
A1  - Reichel, Thomas
A1  - Rudert, Maximilian
A1  - Rueckl, Kilian
T1  - Insuffizienzfraktur der Klavikula nach Implantation einer inversen Schulterendoprothese
JF  - Der Orthopäde
N2  - Wir stellen den seltenen Fall einer Insuffizienzfraktur der Klavikula nach Implantation einer inversen Schulterendoprothese (RSA) vor. Als Ursache solcher Frakturen wird eine vermehrte Zugbelastung durch den Musculus deltoideus nach RSA diskutiert. In den wenigen verfügbaren Fallberichten zeigten die betroffenen Patienten deutliche Funktionseinschränkungen. Die Versorgung erfolgte im vorliegenden Fall mit Plattenosteosynthese. Trotz intraoperativ gutem Korrekturergebnis kam es im Verlauf ohne Trauma zum Osteosyntheseversagen mit weiterer Dislokation der Fraktur.
KW  - Schulterendoprothetik
KW  - Glenohumeralgelenk
KW  - Osteoporose
KW  - Osteosynthese
KW  - Fraktur
KW  - postoperative Komplikationen
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265286
VL  - 51
IS  - 3
ER  - 
TY  - JOUR
A1  - Streck, Laura Elisa
A1  - Forster, Johannes
A1  - von Hertzberg-Boelch, Sebastian Philipp
A1  - Reichel, Thomas
A1  - Rudert, Maximilian
A1  - Rueckl, Kilian
T1  - The role of synovial fluid aspiration in shoulder joint infections
JF  - BMC Musculoskeletal Disorders
N2  - Background
Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re−/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place?

Methods
This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re−/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC.

Results
The sensitivity of microbiological cultures from PA was 58.3% and the specificity was 88.9%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7% and a specificity of 100.0%. The sensitivity and specificity of IA were 0.0% and 88.5%, respectively.

Conclusions
Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use.
KW  - revision arthroplasty
KW  - periprosthetic joint infection
KW  - white blood cell count
KW  - septic
KW  - microbiological culture
KW  - interstage aspiration
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300795
VL  - 23
ER  -