Knowledge
Medical Insight: Polodoc
Dr.med. Andreas KrĂźger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013 and affiliated with Polo Park Zurich
Complications After Surgery Infection diagnosis & treatment It started with a slight pain in the shoulder after a fall and ended with three operations and six weeks of antibiotics. Even a simple injury can dramatically change your sport, life and health. A possible scenario with every sport injury, but how can you lower the risk of such a negative outcome?
Injury pattern
The latest scientific work from Ludwig Neumayr in 2019 proves that the upper extremity is the most predominantly injured area (42% of all injuries in polo). Secondly
67% of all injuries in this study were classified as major. Two possible materials can be injured; most often the bone is the centre of breakage, but also the peripheral soft tissue can be damaged (ligaments or tendons). Most often a fracture is involved and must be fixed due to their dislocated position or comminution.
Problem
Surgery has a principal in-built risk of infection. Open reduction and stabilisation are the golden standard to repair the injury.
Despite advances in minimally invasive surgery and aseptic techniques, infection remains an all too common complication after medical device implantation. Systemically administered antibiotics are largely ineffective for peri-implant infections due to bacterial drug resistance, poor drug penetration, and suboptimal bioavailability at the site of infection. Signs of infection can be non-healing, ongoing pain, reddening or sinus track with pus drain.
Diagnosis
The diagnosis of infection has several steps. First a test is done by blood examination (CRP, white blood count). A precise radiological follow-up with X-ray and MRI/CT or even very elaborated Scintigraphy or even PET/CT (Positron Emission Tomography – Computed Tomography (PET/CT) examination can be performed to find the nest of bacteria. In most cases a mini invasive biopsy or punction is needed to name the pathogen correctly. Also, the possible antibiotic cure will be adjusted to these findings.
Treatment
If the infection takes hold, the implant will typically have to be removed, the infected
Reddening can be a sign of infection. Enlargement of the scare alone can happen without specific problems.
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Polo Times, November 2020
Shoulder MRI post-opertive after plate fixation. Fluid collection below the deltoid muscle and large bursitis. Healing of the initial bone injury.
www.polotimes.co.uk
