CONCLUSIONS The regulation and sanitary actions directed to patient safety in Brazil have increased after the creation of ANVISA. In the face of this activities, the social role played by the Brazilian Health Regulatory System toward the advancement in the field of risk minimization in health services can be highlighted as a protagonist in the process of promoting patient safety.OBJECTIVES The aim of the study was to evaluate clinical outcomes and adverse events (AEs) experienced by patients treated within the Hospital in the Home (HITH) service of a major metropolitan hospital in South Australia. METHODS A retrospective case note audit of 100 HITH episodes among adults who received continuous intravenous antimicrobial therapy via an elastomeric or electronic infusion device was undertaken. Age- and sex-adjusted binomial logistic regression analyses were undertaken to identify factors associated with major and minor AEs. RESULTS Of the 100 patients included, 71 were male and the mean (SD) patient age was 62.8 (17.19) years. Elastomeric infusion devices were used for 98 patients. The mean (SD) HITH treatment duration was 20.1 (11.9) days. Overall, 130 AEs were documented for 72 patients (72%), of whom 12 patients experienced a major AE and 68 patients experienced a minor AE. There were 45 occasions among 23 patients where an infusion administered through an elastomeric device did not run to completion. Fifteen patients were readmitted to hospital. Minor AEs were more likely among people with more vascular line days (adjusted odds ratio [aOR] = 1.05; 95% confidence interval (CI) = 1.01-1.10 per day increase) and females (aOR = 4.43; 95% CI = 1.14-17.17). An increased number of vascular line days was associated with an increased likelihood of an incomplete infusion (aOR = 1.05; 95% CI = 1.01-1.09). Hospital readmission was more likely with increasing age (aOR = 1.06; 95% CI = 1.01-1.11 per year increase). CONCLUSIONS Adverse events need to be monitored carefully when HITH treatment is provided for extended periods.OBJECTIVES The stiffness of locking plates provide increased stability for early fracture healing but may limit late interfragmentary motion (IFM) necessary for secondary bone healing. An ideal plating construct would provide early rigidity and late flexibility to optimize bone healing. A novel screw plate construct utilizing locking screws with a degradable polymer locking mechanism is a dynamic option. METHODS Conventional locked plating constructs (group A) were compared with locking screws with a threaded degradable polymer collar before (group B) and after polymer dissolution (group C). Monotonic axial compression, monotonic torsion, cyclic axial load to failure, and IFM at the near and far cortices were tested on synthetic bone models. RESULTS One-way analysis of variance and post hoc Tukey-Kramer testing demonstrated similar axial stiffness in group A (873 ± 146 N/mm) and B (694 ± 314 N/mm) but significantly less stiffness in group C (379 ± 59 N/mm; F(2,15) = 9.12, P = 0.003). Groups A and B also had similar IFM, but group C had significantly increased IFM at both the near (F(2, 15) = 48.66, P = 2.76E-07) and far (F(2, 15) = 11.78, P = 0.0008) cortices. In cyclic axial load to failure, group A (1593 ± 233 N) and B (1277 ± 141 N) were again similar, but group C was significantly less (912 ± 256 N; F(2, 15) = 15.00, P = 0.0003). All failures were above the 500-N threshold seen in typical weight-bearing restrictions for fracture care. Torsional stiffness demonstrated significant differences between all groups (F(2, 15) = 106.64, P = 1.4E-09). CONCLUSIONS Use of locking plates with a degradable polymer collar show potential for in vitro construct dynamization. Future in vivo studies are warranted to assess performance under combined loading and the effects of decreasing construct stiffness during the course of bony healing.OBJECTIVES To determine whether a particular surgical approach or combination of approaches is a risk factor for infection. DESIGN Retrospective review. SETTING Two Level-1 trauma centers. PATIENTS/PARTICIPANTS Five hundred ninety pilon fractures in 581 patients (66% male) with a median age of 45 years were identified. INTERVENTION Open reduction internal fixation of pilon fractures. MAIN OUTCOME MEASURES Postoperative deep surgical site infection and risk factors for postoperative deep infection. RESULTS The most common primary surgical approach was medial (54%), followed by anterolateral (25%), anteromedial (11%), posterolateral (8%), and posteromedial (2%). A dual approach to the distal tibia was used in 18% of the cases. The overall deep infection rate was 19%. There was no association between primary surgical approach and development of infection (P = 0.19-0.78). Independent risk factors for infection were smoking (hazard ratio, 2.1; P less then 0.001) and need for soft tissue coverage (hazard ratio, 6.9; P less then 0.001). CONCLUSIONS Surgical approach does not appear to be a significant risk factor for postoperative infection after open reduction internal fixation of distal tibial pilon fractures. https://www.selleckchem.com/products/BEZ235.html When treating tibial plafond fractures, surgeons should select the approach they feel best addresses the specific fracture pattern. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.OBJECTIVE To determine the association between prophylactic antibiotic duration after the definitive wound closure of an open fracture and deep surgical site infection (SSI). DESIGN Retrospective cohort study. SETTING 41 clinical sites in the United States, Canada, Australia, Norway, and India. PARTICIPANTS Patients (N = 2400) with open fractures of the extremities who participated in the Fluid Lavage of Open Wounds (FLOW) trial. INTERVENTION Extended antibiotic prophylaxis, defined as more than 72 hours of continuous antibiotic use after definitive wound closure. MAIN OUTCOME MEASUREMENT Deep SSI diagnosed within 1 year of enrollment. RESULTS Forty-two percent of participants received extended antibiotic prophylaxis. Deep SSI prevalence was 5%, 8%, and 23% for wounds with mild, moderate, and severe contamination, respectively. In open fractures with mild contamination, extended antibiotic use showed a trend toward increased odds [adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI), 0.92-2.11] of deep SSI compared with shorter use.