A Comparative Study of Bacteriological Culture Results Using Swab and Tissue in Open Fractures: A Pilot Study.

INTRODUCTION: The role of perioperative cultures to identify infection in open fractures has been doubtful. The method of sampling for cultures in open fractures includes swab or tissue collection. However, the efficacy of either of these two techniques has not been compared in the setting of an acute open fracture. We conducted a study to compare the bacteriological culture results between the two techniques. METHODOLOGY: A pilot study was done at our institution, where all type 2, 3A, and 3B open fractures admitted in the emergency and operated for debridement and stabilization were included in the study. Intraoperatively, after debridement of the wound, swab and tissue specimens were collected and sent to the same laboratory. The results of the cultures were then collected for comparison after the necessary incubation period. Follow-up of outpatient records was also done to see its clinical significance. RESULTS: A total of 30 samples of swab and tissue cultures collected post-debridement of acute open fractures in the operation theater were studied. Only 13 samples grew an organism either in swab/tissue culture or both. Nine tissue samples and eight swab samples showed growth. In four cases, both swab and tissue showed growth, but the same organism grew in only one instance. The other three cases showing growth in both tissue and swab had different organisms. Statistically, the kappa coefficient was found to be 0.26 and the agreement between swab and tissue culture was found fair. However, the kappa did not account for the species of the organisms. Tissue samples showed more number of specific organism growing in them, compared to swab culture samples. CONCLUSION: The ideal technique of taking samples for culture in acute open fractures is uncertain. Tissue culture may be better in isolating specific organisms in an acute open fracture wound. However, it is uncertain if the same organism may cause infection.

Evidence of higher intramyocellular fat among normal and overweight Indians with prediabetes.

BACKGROUND: The rise in prevalence rates of Type 2 Diabetes among Indians is well recognized. The research focus has been primarily to understand the changes in insulin sensitivity and beta cell dysfunction among Indians with Type 2 Diabetes. However, no data are available on the role of peripheral tissue, in particular intramyocellular lipid (IMCL) content and its impact on glucose homeostasis among Indians with prediabetes. METHODS: 28 male subjects (20-40 year) were studied. 13 with prediabetes (BMI ranging from 25.4 ± 2.9 kg/m2) and 15 controls (BMI ranging from 24.6 ± 2.8 kg/m2) were recruited. Body composition by dual energy X-ray absorptiometry (DXA), insulin sensitivity, insulin secretion rates were derived using the minimal model of C-peptide secretion and kinetics rates and skeletal muscle strength of the lower limb (quadriceps) was assessed using Isokinetic dynamometry. From muscle biopsy samples of the vastus lateralis, IMCL fat content (Oil red O staining) was determined. RESULTS: The prediabetes group were older compared to controls (P < 0.01), but had similar BMI. The muscle to fat ratio, plasma Insulin, C peptide, HOMA-IR and HOMA % B were also comparable between the groups. IMCL fat content (%) was significantly higher in the prediabetes group compared to controls (7.0 ± 0.7% vs. 2.0 ± 0.3%, P < 0.01). This difference persisted even after controlling for age. Overall the IMCL fat content (%) was positively and significantly associated with HbA1c (r = 0.76, P < 0.01). HOMA-IR was significantly correlated with central (android, trunk) adiposity (kg) (r = 0.71, P < 0.01) but not with IMCL (%). CONCLUSIONS: This is the first direct evidence of existence of significantly higher lipid levels within skeletal muscle cells among normal and overweight young Indians with prediabetes. However, there was no association between IMCL and HOMA-IR among the prediabetes group.

Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects.

PURPOSE: To assess the Ilizarov technique in treating large infected tibial defects by resection of the infected focus, its acute compression, and gradual distant site lengthening. METHODS: 27 men (mean age, 39 years) with infected nonunion and large bone defects of the tibia underwent complete resection of the nonunion site, debridement, sequestrectomy, lavage, and Ilizarov ring fixator application. Patients underwent acute compression of the defect site, followed by distant site metaphyseal corticotomy for simultaneous lengthening. The mean length of resection was 10 (range, 6-17) cm. The mean follow-up was 27 (range, 25-39) months. RESULTS: The mean lengthening achieved was 10 cm, mean union time 6.3 months, and mean duration of consolidation 10.2 months. Functional results were excellent in 19 patients and good in 5. The union time was longer in older patients. CONCLUSION: Acute compression and simultaneous lengthening can be used safely for treatment of large bone defects in the tibia. This avoids secondary operations at the docking site and reduces the duration of treatment.

Ilizarov ring fixation and fibular strut grafting for C3 distal femoral fractures.

PURPOSE: To evaluate treatment outcome following surgical repair of C3 distal femoral fractures using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation. METHODS: A total of 15 patients with type C3 fractures (supracondylar and intercondylar fractures, with multiplane articular injury) underwent surgical repair at St. John's Medical College Hospital between 1994 and 2001, using autogenous fibular strut, cortico-cancellous bone grafting, and Ilizarov ring fixation. 13 were seen for ongoing follow-up and assessment. Definitive surgery was undertaken at a mean of 3 weeks after admission. Postoperatively, weight-bearing and mobilisation exercise were begun in 2 to 4 weeks. RESULTS: The mean follow-up period was 47 months. Union was achieved in all 13 cases by an average time of 19 weeks. At the last follow-up, the mean range of knee motion was 77 degrees. Assessment of functional outcome (using Neer's scoring criteria) revealed 10 cases with good or satisfactory outcomes, and 3 cases with poor or unsatisfactory results. CONCLUSION: Surgical repair with a fibular strut, cortico-cancellous bone graft and Ilizarov ring fixation appears a suitable treatment option for C3 distal femoral fractures.