In-hospital low-cost custom made VAC: Effective method for reducing infection in late presenting Open lower limb fractures in overburdened Indian hospitals.

BACKGROUND: Open fractures are still associated with troublesome rates of infection. Thorough debridement irrigation and antibiotic cover are of paramount importance irrespective of the fixation method. VAC therapy is a well known method of accelerating the wound healing and decreasing the infection in non healing ulcers. The main drawback of VAC therapy is requirement of a special equipment and high cost. We in our hospital are using low cost custom made VAC therapy for non healing ulcers in lower socio-economic people and have seen extremely good results in wound healing and infection control. OBJECTIVE: To evaluate the role of pre operative low cost custom made VAC therapy as an adjunctive method of decreasing the rates of infection in late presenting lower limb open fractures. METHODS: A retrospective study of 26 open femur and tibia fractures for which low cost VAC therapy was used between January 2014 to January 2017. RESULTS: 2 out of 26 cases (7.4%) ended up with deep infection. CONCLUSION: Pre operative in-hospital low cost custom made VAC therapy is a useful adjunctive method of reducing infection rates in late presenting open fractures.

A review of upper limb injuries in bear maul victims: Consistent pattern and inverse relation in severity with facial and scalp injuries.

PURPOSE: Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. METHODS: Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. RESULTS: All the patients had facial/scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and 1 had clavicle fracture. Only 1 had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. CONCLUSION: Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such complex limb injuries.

Impending gangrene of fingers by constriction bands of mother's hair mistaken as pernio by parents: A case series of 10 infants.

BACKGROUND: Long harsh winter in Kashmir Valley increase the incidence of pernio in children so much that common people consider every hand swelling as pernio. METHODS: 10 Infants over two years were brought to our hospital as cases of pernio involving fingers. RESULTS: All the infants came out to be cases of impending gangrene due to mother's hair as constriction bands around fingers. CONCLUSION: Impending gangrene of fingers in infants due to mother hair as constriction band is very rare. However its symptoms overlap with symptoms of peripheral cold injuries and can be easily mistaken for each other by people.