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Faustine Vallon Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland

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Axel Gamulin Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland

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dynamic hip screw (DHS), are nowadays accepted options for surgical fixation of simple trochanteric fractures (AO-OTA 31-A1), multi-fragmentary trochanteric fractures (AO-OTA 31-A2), and some subtypes of femoral neck fractures with a rather vertical

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Martin C Jordan Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany

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Konrad F Fuchs Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany

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Steven C Herath Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Tübingen, Germany

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Joachim Windolf TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany
Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

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Rainer H Meffert Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany

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Anne Neubert TraumaEvidence @ German Society for Trauma Surgery, Berlin, Germany
Department of Orthopaedic and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

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-book injuries with affection of one or both SI joints and that were classified as APC II or AO: 61-B2.3d in adults. In cases with bilateral instability, both sides needed to be stabilized. Pediatric injuries in patients <18 years (skeletally immature

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Karl Stoffel Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland

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Christoph Sommer Department of Surgery, Kantonsspital Graubuenden, Chur, Switzerland

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Mark Lee Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California, USA

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Tracy Y Zhu AO Innovation Translation Center, AO Foundation, Davos, Switzerland

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Karsten Schwieger AO Innovation Translation Center, AO Foundation, Davos, Switzerland

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Christopher Finkemeier Sutter Roseville Medical Center, Roseville, California, USA

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osteoporotic bone, and in high-energy or open fractures ( 13 ). Biomechanical evidence supporting the use of double plating comes from studies using models of comminuted extraarticular fractures (AO Foundation/Orthopaedic Trauma Association type 33A3) ( 14

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Juan Ignacio Cirillo Hospital del Trabajador, Santiago, Chile
Clínica Universidad de los Andes, Santiago, Chile
Universidad Andrés Bello, Hospital del Trabajador, Facultad de Medicina, Santiago, Chile

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Guillermo A Ricciardi Centro Médico Integral Fitz Roy, Buenos Aires, Argentina
Sanatorio Güemes, Buenos Aires, Argentina
Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina

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Facundo Lisandro Alvarez Lemos Hospital Roberto del Río, Santiago, Chile

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Alfredo Guiroy Elite Spine Health and Wellness Center, Florida, USA

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Ratko Yurac Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile
Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile

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Klaus Schnake Center for Spinal and Scoliosis Surgery, Malteser Waldrankenhaus St. Marien, Erlangen, Germany
Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany

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AO Spine Latin America Trauma Study Group
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AO Spine Latin America Trauma Study Group

its intrinsic severity. During the last decade, Vaccaro et al. published the most currently disseminated system, the ‘AO Spine Subaxial Cervical Spine Injury Classification System (SCICS)’. This system, just like its predecessor used for

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Patrick Ziegler BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland

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Christian Bahrs Schön Klinik Neustadt, Neustadt in Holstein, Germany

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Christian Konrads Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany

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Philipp Hemmann BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany

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Marc-Daniel Ahrend BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
AO Research Institute Davos, Davos Switzerland

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useful for the indication for surgery and the choice of incision. The AO classification of ankle fractures is a further development of the Weber classification and enables the most precise description of the injury pattern. It should therefore be mainly

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Francesco Pirato Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Federica Rosso Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Federico Dettoni Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Davide Edoardo Bonasia Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Matteo Bruzzone Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Roberto Rossi Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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  • Knee stiffness is a widely known and worrying condition in several postoperative knees. Less is known about native stiff knee. The aim of this manuscript is to summarize the available literature on native stiff knee epidemiology, classification and treatment.

  • In 1989 stiff knee was defined as a knee with less than 50° of total range of motion. If range of motion is <30°, it is defined as an ankylosed knee. Knee stiffness can be divided into three main types: flexion contractures, extension contractures, and combined contractures. Different risk factors have been associated to native stiff knee and grouped into modifiable or not modifiable. Furthermore, risk factors can be divided into patients’ related no patients’-related.

  • Different treatment modalities can be indicated to treat knee stiffness, including manipulation under anesthesia (MUA), arthroscopic and open surgical release. When stiffness is associated with articular disruption TKA represent an option. TKA in native stiff knee can be challenging for the surgeon. Implant’s choice and knee exposure are the first steps. In some cases, additional release and extensive can be considered. A stepwise approach and careful preoperative planning are mandatory to obtain long-term satisfactory outcomes.

  • Native stiff knee is a rare but invalidating condition. Different treatment modalities have been proposed as treatment. However, considering that it is frequently associated to sever arthritis, TKA can be an option in painful stiff knees. Nature of knee stiffness necessitates a customized approach to ensure successful management and achieve satisfying outcomes.

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James W.A. Fletcher Department for Health, University of Bath, UK
AO Research Institute Davos, Switzerland

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Lisa Wenzel AO Research Institute Davos, Switzerland
Department of Trauma Surgery, Trauma Center Murnau, Germany

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Verena Neumann AO Research Institute Davos, Switzerland

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R. Geoff Richards AO Research Institute Davos, Switzerland

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Boyko Gueorguiev AO Research Institute Davos, Switzerland

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Harinderjit S. Gill Department of Mechanical Engineering, University of Bath, UK

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Ezio Preatoni Department for Health, University of Bath, UK

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Michael R. Whitehouse Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK

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outside the submitted work. RGR reports support for travel to meetings for the study or other purposes from AO Research Institute Davos for the submitted work. HSG reports a grant covering first author from the Royal College of Surgeons for the

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Nicola Ratto University of Torino, Italy

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Chiara Arrigoni University of Torino, Italy

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Federica Rosso AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Matteo Bruzzone AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Federico Dettoni AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Davide Edoardo Bonasia AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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Roberto Rossi AO Mauriziano Umberto I, Department of Orthopedics and Traumatology, Torino, Italy

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  • Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure.

  • Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care.

  • In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities. Other recognised pre-operative risk factors are urinary tract infections, intra-articular corticosteroid injections and nasal colonisation with Staphylococcus (S.) aureus, particularly the methicillin-resistant strain (MRSA).

  • In the intra-operative setting, protective measures for PJI include antibiotic prophylaxis, surgical-site antisepsis and use of pre-admission chlorhexidine washing and pulsed lavage during surgery. In this setting, the use of plastic adhesive drapes and sterile stockinette, as well as using personal protection systems, do not clearly reduce the risk of infection. On the contrary, using sterile theatre light handles and splash basins as well as an increased traffic in the operating room are all associated with an increased risk for PJI.

  • In the post-operative period, other infections causing transient bacteraemia, blood transfusion and poor wound care are considered as risk factors for PJI.

Cite this article: Ratto N, Arrigoni C, Rosso F, Bruzzone M, Dettoni F, Bonasia DE, Rossi R. Total knee arthroplasty and infection: how surgeons can reduce the risks. EFORT Open Rev 2016;1: 339-344 DOI: 10.1302/2058-5241.1.000032.

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Vanessa Morello Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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Axel Gamulin Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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multiple retrospective studies using multivariate analysis: higher AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification types (C vs B vs A) ( 32 , 34 , 49 , 51 ), higher Schatzker classification grades (IV–VI) ( 24 , 31 , 34 , 37 , 39

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Matías Sepúlveda Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, PAEG Expert Group, Davos, Switzerland

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Cecilia Téllez Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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Víctor Villablanca Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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Estefanía Birrer Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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  • The physis of the distal femur contributes to 70% of femoral growth and 37% of the total limb growth; therefore, physeal injury can lead to important alterations of axes and length.

  • Distal metaphyseal corner-type fracture prior to walking is classically associated with child abuse. In children aged >10 years, sports-related fractures and car accidents are significant contributors.

  • Imaging includes a two-plane radiographic study of the knee. It is recommended to obtain radiographs that include the entire femur to rule out concomitant injuries. In cases of high suspicion of distal metaphyseal fractures and no radiographic evidence, CT or MRI can show the existence of hidden fractures.

  • Fractures with physeal involvement are conventionally classified according to the Salter–Harris classification, but the Peterson classification is also recommended as it includes special subgroups.

  • Conservative and surgical management are valid alternatives for the treatment of these fractures. Choosing between both alternatives depends on factors related to the fracture type.

  • As there is a high risk of permanent physeal damage, long-term follow-up is essential until skeletal maturity is complete.

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