RESUMO
A prospective cohort study was undertaken to assess the incidence of late-implant sepsis after internal fixation in HIV-positive patients. A total of 91 HIV-positive patients (67 males and 24 females) who underwent 103 procedures (111 implants) were followed up for a mean period of 27 months (range 12-66 months). No occurrences of late implant sepsis were found in 100 implants (94 procedures) in 82 patients at 27 months' follow-up (range 12-66 months). Nine patients (9 procedures, 9 implants) developed early infections within 6 weeks and were treated with antibiotics (6 patients), amputation (1 patient) or removal of metal work (2 patients). There was no evidence of subsequent late implant sepsis in any of these patients, at a mean follow-up of 25 months (range 12-52 months). This study demonstrates that it is safe to perform internal fixation in HIV-positive patients, with no observed increase risk of late implant sepsis. There is no indication to remove implants after fracture union, other than for the general clinical indications that may lead to removal of metal work in any patient.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Soropositividade para HIV/imunologia , Complicações Pós-Operatórias/imunologia , Sepse/imunologia , Contraindicações , Remoção de Dispositivo , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/complicações , Fraturas Ósseas/imunologia , Humanos , Hospedeiro Imunocomprometido , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Próteses e Implantes , Sepse/etiologia , Sepse/prevenção & controle , Fatores de TempoRESUMO
We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation.
Assuntos
Jacarés e Crocodilos , Mordeduras e Picadas/microbiologia , Mordeduras e Picadas/cirurgia , Bactérias Anaeróbias Gram-Negativas , Infecções por Bactérias Gram-Negativas/terapia , Infecção dos Ferimentos/terapia , Adolescente , Jacarés e Crocodilos/microbiologia , Amputação Cirúrgica , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/tratamento farmacológico , Criança , Desbridamento , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/etiologia , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Boca/microbiologia , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/patologiaRESUMO
Acute compartment syndrome of the thigh is rare but has been described as a result of femur fracture and also thigh contusion in sports injury. Emergency fasciotomy has routinely been the recommended treatment. We describe a patient with a closed femur fracture, initially without any syndrome whilst on traction, and required surgical intervention. He was found to have a large haematoma associated with significant muscle damage in the posterior compartment. This case is unusual in that symptoms started 12 days after injury possibly after manipulation of the leg whilst on traction. Diagnosis is mainly clinical with an earliest alarming sign being disproportional increasing pain on passive stretch of the group of muscles. A high index of suspicion and prompt intervention are required to diagnose and treat compartment syndrome and prevent irreversible damage.