Seropositivity Load in Orthopedic Surgery at Tertiary Care Hospitals in North India - An Observational Study.

BACKGROUND: Exposure to blood and blood-borne viruses is major concern for orthopedic surgeons and operation theater staff because of constant exposure to sharp instruments and bodily fluids. The objective of this study was to assess the burden of seropositive patients in the orthopedic department of tertiary care hospitals in North India. MATERIALS AND METHODS: This retrospective study was carried out in author's institute on indoor patients admitted from January 2015 to December 2017. A total of 8914 patients were included in the study and relevant clinical data were collected for seropositivity of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in patients admitted in the orthopedic emergency department. These patients were routinely tested for seropositivity before undergoing various surgical procedures. RESULTS: A total of 8914 patients included in the study, out of which 7193 (80.7%) were male and 1721 (19.3%) were female. Out of total patients, 262 (2.9%) were found to be seropositive. Out of these patients, 31 (11.8%) were found to be positive for HIV, 190 (72.5%) for HCV, and 41(15.7%) for HBV. About 35.90% of patients with highest prevalence of seropositivity were truck drivers. CONCLUSION: HIV, HBsAg, and HCV are common in this region with HCV infection being the major concern in Punjab. Screening for viral markers will help in adequate pre-operative planning, timely precautions, and immediate post-exposure prophylaxis in case of contact with blood or body fluids of seropositive patients.

Clinical outcome in Giant cell tumor of cervico-thoracic spine: Our experience with three cases.

BACKGROUND: Giant cell tumor (GCT) of the spine is uncommon but most aggressive benign tumor of the spine with unpredictable outcome. The purpose of this study was to report on a surgical treatment for the cases of GCT (C2, T4 and C7-T1). The spine is not a common site for a Benign GCT, with a 2.5% incidence in the sacrum and 2.9% in the vertebrae above the sacrum. In the cervico-thoracic spine, the incidence is extremely low and has been reported very less in the literature. MATERIAL AND METHODS: This study was conducted on 3 cases of GCT of the spine and evaluated the outcome of different treatment modalities retrospectively. All the cases were treated with intralesional surgical resection but only one developed recurrence. RESULTS: Cord compression and neurological deficits of varying grades was observed in all the cases. All patients also presented with clinical as well as radiological instability. Overall results were satisfactory, as all patients were symptom-free postoperatively. One out of the three cases had tumour recurrence and needed repeat intervention. CONCLUSION: Giant cell tumour of cervico-thoracic spine is a rare entity and should be managed Surgically with en bloc/extralesional resection but due to risk of surrounding neurovascular structures damage they are managed by marginal resection therefore since total resection is not possible there are high chances of recurrences, Hence require close monitoring and follow up for early diagnosis and appropriate management.

Wound healing of open fractures: comparison of vaccum assisted dressing versus traditonal dressing.

PURPOSE: For permanent wound coverage of compound fractures, the wound surface should have 100% granulation tissue without any discharge or necrotic slough. Negative pressure wound therapy (NPWT) is a well known modality in the management of open fractures, and post-operative wound problems. This study was conducted to compare the outcome of NPWT and traditional dressing in wound healing of open fractures. MATERIAL AND METHODS: A prospective study of 100 cases was conducted to compare the wound healing outcomes of open fracture following vacuum assisted closure (VAC) dressing (50 cases) and traditional wound dressing (50 cases). Patients included in the study underwent initial debridement to remove necrotic slough and tissue when indicated. Foam dressings were used to cover the wounds using aseptic conditions in the VAC group. Dressings were changed daily for patients in traditional dressing group using hydrogen peroxide, normal saline and povidone iodine in a sequential manner and every 3-4 days in the VAC dressing group. Patients were evaluated clinically for appearance of granulation tissue, duration of hospital stay and reduction in wound surface area using appropriate statistical methods. RESULT: There was a significant difference between the rate of wound healing in the group NPWT/VAC group compared to the traditional wound dressings group in terms of appearance of granulation tissue, reduction in wound surface area and duration of hospital stay. CONCLUSION: Vacuum assisted dressing is more effective than traditional wound dressing in wound healing of open fractures.

Nutritional Osteomalacia-induced Bilateral Neck Femur Fracture in an Elderly Patient: A Case Report.

INTRODUCTION: Simultaneous bilateral neck of femur fracture is rare. Majority of them are due to low energy incidents with underlying conditions such as malnutrition, chronic renal failure, cystic fibrosis, celiac disease, seizures, steroid abuse, or osteomalacia. CASE REPORT: A 68-year-old woman was referred with a 1-year history of bilateral hip pain and a 9-month history of inability to bear weight. She was diagnosed as a displaced bilateral femoral neck fracture secondary to osteomalacia. Due to the long duration of this condition and associated comorbidities, staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow-up. CONCLUSION: Osteomalacia should be suspected in any patient with long-standing bone pain and muscle weakness regardless of age. Numerous options in the form of percutaneous screws, bipolar hemiarthroplasty, and total hip arthroplasty have been mentioned in the literature regarding the management of simultaneous bilateral femoral neck fractures. Staged bipolar hemiarthroplasty was done due to the associated comorbidities.

Proximal Femoral Non-unions with Implant In Situ Treated by Revision Osteosynthesis: A Real Challenge.

INTRODUCTION: Proximal femur fractures non-union with implant failure creates a nightmare for both the surgeon and the patient. Meticulous surgical planning and the correct choice of the implant are essential to achieve success in the revision surgery. MATERIALS AND METHODS: Eleven patients with ununited proximal femur fractures including both intertrochanteric and subtrochanteric fractures who had a failed previous implant were included in the study. Femoral neck nonunions and infected nonunions were excluded from the study. One patient was lost to follow-up. RESULTS: One patient was lost to follow-up and out of the remaining ten patients, six were males and four were females. Mean age was 62.2 years (35-74). Union was achieved with mean union time of 10.1 months (9-14). Mean surgical time was 105 min (90-125) and mean blood loss during surgery was 600 ml (350-850). Mean time of revision surgery after the primary index surgery was 20 months (15-30). Mean duration of follow-up was 12.9 months (12-16). CONCLUSION: Revision osteosynthesis in proximal femoral nonunions with implant failure is a real test of surgeons expertise because of the many factors going against like osteoporosis, distorted proximal femur anatomy due to the already present implant resulting in poor bone stock availability. Judicious and appropriate selection of implants is an impeccable factor for fracture union and positive outcome.

Traumatic Anterior Hip Dislocation in Elderly Male: An Atypical Case Report.

INTRODUCTION: Anterior dislocation of the hip joint is a rare presentation accounting for around 15% of all hip dislocations. Obturator (inferior) type traumatic anterior hip dislocation in adult is rare of all types of hip dislocation. Here, we described a case with same description. It can occur as a result of a high-energy trauma in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. CASE REPORT: We reported the case of a 70-year-old man who suffered an anterior dislocation of his hip joint who was brought to the emergency room with a history of fall from the bicycle hit by a motorcyclist from his back. After examined clinically and radiologically, the patient was diagnosed with obturator type of anterior right hip dislocation. Closed reduction under short general anesthesia was planned. CONCLUSION: Inferior hip dislocations are very rarely seen injuries with severe high-energy trauma. The reduction must be done as soon as possible because it involves the functional prognosis of the hip by the risk of necrosis of the femoral head and subsequent osteoarthritis requiring long-term monitoring.