Premature epiphyseal fusions in beta thalassaemia.

Thalassemia patients are now living longer due to better transfusion methods and diagnostic awareness. To see whether this longevity is associated with orthopaedic disability, especially physeal growth defects, we examined 105 patients aged between 5-25 years for evidence of clinically detectable premature epiphyseal fusions (PEF). Ours is a center focussed on transfusion dependent beta thalassemia (TDBT) patient management, and so detailed transfusion records related to age at first transfusion, regularity of transfusions and pre-transfusional haemoglobin (Hb) levels were available. Five (4.7%) patients had deformities or limb length discrepancies, which lead to the detection of PEF. All patients with PEF had pre transfusion haemoglobin levels of less than 8 gm/dL. On comparing with the literature, we found that the prevalence of clinically detectable PEF in TDBT patients has decreased with better blood transfusion regimes. Though the pathogenesis of PEF is yet to be conclusively established, it is apparent that better control of the disease to maintain pre-transfusional haemoglobin levels consistently above 8 gm/dL in the first decade, can decrease the occurrence of PEF.

Efficacy of indigenously developed single vial kit preparation of 99mTc-ciprofloxacin in the detection of bacterial infection: an Indian experience.

OBJECTIVE: To investigate the diagnostic efficacy of indigenously developed single vial kit preparation of Tc-ciprofloxacin (Diagnobact) for the detection of orthopedic infections. METHODS: Seventy-seven patients [25 with clinical suspicion of diabetic foot osteomyelitis (DFOM), 25 with orthopedic device-related infection (ODRI) and 27 with tubercular bone infection] underwent three-phase Tc-methylenediphosphonate bone scintigraphy followed by static Tc-ciprofloxacin imaging at 1, 4 and 24 h. Imaging (anterior and posterior views) was performed under a dual-head gamma-camera using a low-energy, high-resolution, parallel-hole collimator. The lesion-to-background ratio (LBR) of the radiotracer was calculated on the static isotime Tc-ciprofloxacin images using semiquantitative analysis. Scintigraphic (Diagnobact) results were compared with the histopathological and/or culture/PCR analysis as a gold standard. RESULTS: The mean LBR of the radiotracer (Tc-ciprofloxacin) in the positive scans (n=29; 16 ODRI, 13 DFOM) was > or =2.0 at 1 h postinjection and remained consistent till 24 h. In contrast, the mean LBR in the negative scans (n=21; 12 DFOM, nine ODRI) was < or =1.5 at 1 h and declined significantly (P<0.05) at 24 h. The observed trend in the mean LBR in positive (n=18) and negative (n=9) scans for tubercular osteomyelitis was identical to that seen in the nontubercular bacterial infections. CONCLUSION: The management protocol for patients with suspected bony infection may include a three-phase bone scan followed by Tc-ciprofloxacin scan. An LBR of > or =2.0 at 1 h that remained consistent till 24 h on Tc-ciprofloxacin scan is indicative of active bacterial infection. However, resistance to ciprofloxacin at the bacterial cell membrane may be a limitation of this technique.

En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature.

INTRODUCTION: Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius. MATERIALS AND METHODS: Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients. RESULTS: Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence. CONCLUSION: Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.

Bacterial load in tissues and its predictive value for infection in open fractures.

The role of quantitative bacteriology is considered controversial for the prediction of infection in open fractures. A study was done in 20 patients with open fractures. Post debridement pieces of skin, muscle and periosteal tissue were obtained for quantitative bacterial counts. Among a total of 50 samples from all of the tissues, 29 showed positive bacterial counts (16 of 20 skin, 11 of 20 muscle and 2 of 10 periosteum samples). By quantitative estimation, the bacterial load was >10(5) per gram in 10 skin and 3 muscle tissue samples. Infection developed in 9 of the 20 cases within one month, and eight of these patients had contamination of >10(5) per gram in 8 of the skin but only 3 muscle samples. It was concluded that with tissue specific bacterial load estimation, prediction of subsequent infection can be made if skin tissue contains >10(5) per gram, or if muscle tissue carries any level of bacterial presence.