A retrospective study of antibiotic prophylaxis value in surgical treatment of lower limb fracture.

BACKGROUND: Surgical site infections (SSI) are nosocomial infections that cause considerable problems in orthopaedic surgery. Antibiotic prophylaxis can be used to reduce the risk for SSI. There is no universal antibiotic that can be recommended for prophylaxis in terms of coverage of all possible pathogens because of antibiotic resistance, and there are no universal recommendations for different types of patients in terms of injury type, selected operation and risk factors for development of SSI. The aim of this study was to analyse the effectiveness of antibiotic prophylaxis in surgical treatment (ORIF) of closed lower limb fractures in young, healthy patients. PATIENTS AND METHODS: Patient details were collected from the patient histories. Inclusion criteria for participants were age 20-30 years, not suffering from any type of chronic disease or state that may affect postoperative infection and ISS≤9. Antibiotic prophylaxis use and outcome (SSI) were compared between two groups of patients. Data were analysed using descriptive statistics, Fisher's exact test and t-test for proportions. RESULTS: A total of 347 patients with closed lower limb fractures treated with ORIF met the inclusion criteria. There were 290 male and 57 female patients, with an average age of 24.47 years. Prophylactic antibiotics were given to 242 patients (69.74%); 2g ceftriaxone was administered to 88.02% of the patients who received antibiotic prophylaxis. Ten patients developed postoperative infection (eight out of 242 with antibiotic prophylaxis and two out of 105 without antibiotic prophylaxis). The difference between the two groups was not statistically significant (Fisher's exact test, P=0.749). CONCLUSION: Antibiotic prophylaxis was ineffective in preventing SSI in patients with no risk factors for SSI who were undergoing ORIF for closed lower limb fractures.

The Results of Internal Fixation of Proximal Humeral Osteoporotic Fractures with PHILOS Locking Plate.

BACKGROUND: In the last fifty years since plate and screw osteosynthesis has been implemented in fracture treatment, osteosporotic bone fractures were observed as a special problem. Due to special histologic, anatomic, physical and biomehanic properties of osteoporotic changed bone the laws of biomechanics suggest that stable osteosynthesis for osteoporotic bone is necessary to increase the contact surface of metallic implants and bone and the stability of the screw-plate-bone compound. There are numerous surgical techniques and methods for treatment of osteoporotic proximal humeral fractures. Every surgical procedure has to establish anatomical reduction and stable fixation that will enable early mobilisation. SUBJECTS AND METHODS: The aim of this study was to present results of internal fixation of proximal humeral osteoporotic fractures with PHILOS locking plate. Between 2007 and 2012, a total of 67 patients older than 65 years with closed proximal humerus fractures underwent surgical treatment with PHILOS plate system (Synthes, Switzerland). 42 patients were operated with deltopectoral approach and 25 with deltoid split approach. After a mean follow up period of 14.68 (6-28) months functional and radiologic results were assessed. RESULTS: We noted 9 postoperative complications related to surgical technique (1 intraarticular screw placement, 1 displacement in major tuberculum fragment, 1 displacement in major tuberculum fragment along with oblique placement of the plate, 2 cases of inadequate reduction, 1 case of humeral head avascular necrosis, varus humeral head fixation in 3 cases). None of the patients developed superficial or deep surgical infection. There was no nonunions. In the final evaluation, the Constant shoulder score was 91.75 (72-100). CONCLUSIONS: In this study PHILOS locking plate showed good applicability, respecting bone biologic properties because of negligible interference with blood supply of the humeral head. There was no requirement to shape the plate enabling stabilization at constant angles as clear benefit of this plate. All that enables early mobilisation, and no implant insufficiency resulting in satisfactory treatment results and high Constant shoulder scores.

Primary cutaneous cryptococcosis in a renal transplant recipient: case report.

We report a kidney transplant recipient with severe skin- and soft-tissue infection mimicking necrotising fasciitis. Patient failed to respond to empirical antibiotic therapy for presumed bacterial cellulitis. Culture of aspirate from the wound and tissue samples revealed Cryptococcus neoformans. No signs of systemic cryptococcal infection were found. After antifungal treatment and surgical intervention, complete healing was achieved. Clinical and microbiological characteristics of this patient are discussed. Our case indicates that primary cutaneous cryptococcosis must be included in the differential diagnosis of severe cellulitis in solid organ transplant recipients not responding to broad-spectrum antibiotic regimens. In our case, prompt diagnosis and treatment could dramatically modify the outcome.

Cutaneous myiasis caused by Cordylobia anthropophaga.

Cutaneous myiasis is a temporary parasitic infestation of the skin of human and other vertebrates by fly larvae, primarily species of the flies Dermatobia and Cordylobia. In Central and South America cutaneous myiasis is mainly caused by the larvae of Dermatobia hominis; in Africa it is mostly due to the larvae of Cordylobia spp. We describe a case of cutaneous myiasis in a family who returned to Slovenia from a three-week trip to Ghana. The parasites, in tumor-like swellings about 1-2 cm in diameter and 0.5-1 cm high, were removed from the back of the 48-year-old man, the nose, shoulder and wrist of his 47-year-old wife, and the back of their 14-year-old daughter. The parasites were identified as larvae of the fly C. anthropophaga. After removal of the larvae, which were oval-shaped and about 8 mm long, the lesions healed in two weeks without further treatment. Human cases of cutaneous myiasis are most probably underreported because many remain undiagnosed or unpublished. Because of increasing travel to tropical and subtropical areas, clinical and laboratory staff will need to be more alert to the possibility of Cordylobia myiasis in patients with furuncle-like lesions, particularly in individuals who have recently returned from tropical Africa.