Surgical Site Infection In Orthopaedic Implants And Its Common Bacteria With Their Sensitivities To Antibiotics, In Open Reduction Internal Fixation.

BACKGROUND: Surgical site infection in orthopaedic implants is a major problem, causing long hospital stay, cost to the patient and is a burden on health care facilities. It increases rate of nonunion, osteomyelitis, implant failure, sepsis, multiorgan dysfunction and even death. Surgical site infection is defined as pain, erythema, swelling and discharge from wound site. Surgical site infection in orthopaedic implants is more challenging to the treating orthopaedic surgeon as the causative organism is protected by a biofilm over the implant's surface. Antibiotics cannot cross this film to reach the bacteria's, causing infection. METHODS: This descriptive case series study includes 132 patients of both genders with ages between 13-60 years conducted at Orthopaedic Unit, Ayub Medical College, Abbottabad from 1st October 2015 to 31st March 2016. Patients with close fractures of long bones were included in the study to determine the frequency of surgical site infection in orthopaedic implants and the type of bacteria involved and their sensitivity to various antibiotics. All implants were of stainless steel. The implants used were Dynamic hip screws, Dynamic compression screws, plates, k-wires, Interlocking nails, SIGN nails, Austin Moore prosthesis and tension band wires. Pre-op and post-op antibiotics used were combination of Sulbactum and Cefoperazone which was given 1 hour before surgery and continued for 72 hours after surgery. Patients were followed up to 4 weeks. Pus was taken on culture stick, from those who developed infection. Results were entered in the pro forma. RESULTS: A total of 132 patients of long bone fractures, who were treated with open reduction and internal fixation, were studied. Only 7 patients developed infection. Staphylococcus Aureus was isolated from all 7 patients. Staphylococcus aureus was sensitive to Linezolid, Fusidic Acid, and vancomycin. Cotrimoxazole, tetracycline, Gentamycin and Clindamycin were partially effective. CONCLUSIONS: Surgical Site Infection is common in orthopaedic implants, occurring in 5.30% cases. Staphylococcus aureus is the common bacteria, causing it.

RISK FACTORS LEADING TO DEVELOPMENTAL COMPLICATIONS AFTER OPEN REDUCTION IN DEVELOPMENTAL DYSPLASIA OF HIP.

BACKGROUND: The developmental dysplasia of the hip (DDH) is regarded as one of the commonest congenital deformities. Its incidence has been estimated to be one in 60 live births according to some estimates. Different forms of treatment modalities have been suggested and their success depends on the age of the patient. The study was done with the objectives to observe the post-operative complications of open reduction in patients with DDH and to determine the possible risk factors associated with these complications. METHODS: A total of 60 patients were enrolled with DDH in this descriptive cross-sectional study from August 2013 to November 2015. After obtaining an informed consent, the patients underwent open reduction and in some cases, subsequent osteotomy. The patients were followed-up at three months intervals for at least 9 months to look for development of complications, if any. RESULTS: The mean age of the patients was 31.32 ± 2.52 months. Majority 45 (75%) of the study population was female. The most common complication observed was osteonecrosis (5 patients; 8.33%) followed by residual dysplasia and re-dislocation in 3 (5%) patients each. Infection was identified as a complication in 2 (3.33%) patients. When stratified with complications of open reduction, female sex and bilateral hip involvement were found to have a significant association with the development of complications. CONCLUSION: Female sex and bilateral hip involvement confer a greater risk of developing a complication following open reduction for DDH.

Efficacy And Safety Of Interlocked Intramedullary Nailing For Open Fracture Shaft Of Tibia.

BACKGROUND: Due to increasing population and changing human habits the number of accidents and high energy trauma is rising. Management of open fracture tibia is a complex problem and is a challenge for both orthopaedic and plastic surgeons. The study was carried out to ascertain the efficacy and safety of interlocked intra-medullary nailing for open shaft tibial fractures in patients presenting at or after 24hr of injury. METHODS: In this descriptive case series, over a period of 6 moths, 163 consecutive cases of open fracture of tibial shaft were reviewed in terms of clinical profile, time of presentation, and gender distribution. RESULTS: In this study mean age was 30±0.02 years. Males comprised 85% of study population while 15% were females. Gustilo-I type fracture and Gustilo-II type fracture was diagnosed in 90% and 10% patients respectively. Thirty three percent patients had wound infection while fracture union was found in 15% cases. Moreover interlocked intramedullary nailing for open fracture shaft of tibia was safe in 80% patients while this procedure was effective in 85%. CONCLUSIONS: Un-reamed, interlocked intra-medullary nailing may be considered as a suitable option for treatment of open fractures of tibia.

OUTCOMES IN CLOSED REAMED INTERLOCKING NAIL IN FRACTURES OF SHAFT OF FEMUR.

BACKGROUND: Femoral shaft fracture is one of the common fractures seen in accident and emergency department of our hospital. Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN), external fixators and inter locking nails. The study was done with an objective to evaluate the results of closed reamed interlocking nail in fractures of shaft of femur. METHODS: A prospective study of 114 cases of femoral shaft fractures was carried out at orthopaedic unit of Ayub Teaching Hospital Abbottabad during 1 year. All these cases were treated with statically locked nails under spinal or general anaesthesia. These cases were followed up for up to one year and Results of the interlocking nail were observed in terms of union and complications. RESULTS: Out of 114 patients, 95 underwent union in 90-150 days with a mean of 110.68 days. Ten patients had dynamization within six weeks because of obvious fracture gap in radiograph. There were 3 patients who had non-union, and 6 patients had delayed union which was treated with dynamization. CONCLUSION: Close reamed interlocking intramedullary nail in femoral shaft fractures is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and fracture healing response is good.

EARLY RESPONSE OF LOCAL STEROID INJECTION VERSUS MINI INCISION TECHNIQUE IN TREATMENT OF CARPAL TUNNEL SYNDROME.

BACKGROUND: Carpal tunnel syndrome (CTS) is one of the commonest peripheral neuropathies which effects mainly middle aged women. Different techniques are being tried to decrease the postoperative pain in patients operated for CTS. The objective of this study was to compare effectiveness of local injection of steroid and mini incision technique in the treatment of carpal tunnel syndrome. METHODS: This randomized control trial was conducted at department of Orthopedics and department of Neurosurgery, Ayub Teaching Hospital, Abbottabad from Aug 2011 to Feb 2013. A total of 116 patients of CTS were randomly allocated to either of the two groups.58 Patient in Group A were subjected to local steroid injection and the same number of patient in Group B underwent mini incision technique. All patients of were advised to report to the OPD after one month to determine intervention effectiveness in terms of improvement in at least one grade of pain. RESULTS: In this study mean age of the patients was 32.8 +/- 5.1 years. Female gender was in dominance with 99 (86.3%) cases. In this study we compared the effectiveness of local steroid injection and mini incision technique in the treatment of carpel tunnel syndrome. We found out that the steroid injection was effective in 69.0% cases while mini incision technique was effective in 56.9% cases. The difference being statistically insignificant with a p-value of 0.17. CONCLUSION: The difference in pain after 1 month of the intervention was not statistically significant.

Efficacy Of A Single-Injection Sodium Hyaluronate Treatment In Lateral Epicondylitis.

BACKGROUND: Lateral epicondylitis or tennis elbow is a disease of tendons arising from common extensor origin at the lateral epicondyle of elbow and is commonly characterized by pain on supination of forearms as well as extension of fingers and wrists. METHODS: This descriptive case series aims to determine the efficacy of a single-injection sodium hyaluronate treatment for lateral epicondylitis. The study was conducted at the Department of Orthopaedics. Ayub Teaching Hospital Abbottabad. From February 1 to August 31, 2014. Patients diagnosed with lateral epicondylitis were administered 1 cc of 1% Sodium hyaluronate 1 cm from the lateral epicondyle into the soft tissue. RESULTS: Hyaluronic acid is more effective in patients with moderate pain of lateral epicondylitis (VAS score ≤7 than in patients with severe pain (VAS score >7). Paired sample t-test was used to compared the means of the pre- and post-procedure VAS score and the difference was found to be statistically very significant (p=0.00) with a mean±SD change in VAS of 2.31±1.35 at 4 weeks. CONCLUSIONS: A single injection of sodium hyaluronate is effective in management of moderate, but not severe pain of lateral epicondylitis.

Mean Tip-Apex Distance In Lag Screw Cut-Out After Dynamic Hip Screw Fixation Of Hip Fracture.

BACKGROUND: To determine mean tip-apex distance after Dynamic Hip Screw fixation of intertrochanteric fracture. METHODS: This descriptive cross-sectional study was conducted in the Department of Orthopaedics, Hayatabad Medical Complex, Peshawar from October 2015 to September 2016 on a total 285 patients. RESULTS: A total of 285 patients were observed. Status of TAD among 285 patients was analysed as 171 (60%) patients had TAD ranged 15 mm to 20 mm, 91(32%) patients had TAD ranged 21 mm to 25 mm, 23 (8%) patients had TAD ranged >25mm. Mean TAD was 18 mm with SD±7.45. Eight percent patients had screw cut out while 92% patients didn't had screw cut out. CONCLUSIONS: To avoid lag screw cut out in dynamic hip screw for intertrochanteric fracture of hip the Tip apex distance must be accurate otherwise there will be cut out of lag screw.