Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures

Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (p-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). Results: The overall incidence of infection was 6.4% (n = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56–3.38)), the presence of an open fracture (OR 4.23 (3.18–5.61)), the need for massive transfusion (OR 1.42 (2.39–8.39)), post-operative transfusion (OR 1.40 (1.10–1.79)) and prolonged length of stay (OR 1.04 (1.02–1.06)). The Commonest causes of superficial infection were Staphylococcus aureus (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and Staphylococcus aureus (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Conclusion: Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture.

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Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01834-6 ◽

2021 ◽

Author(s):

Michalis Panteli ◽

James Shen Hwa Vun ◽

Robert Michael West ◽

Anthony John Howard ◽

Ippokratis Pountos ◽

...

Keyword(s):

Open Reduction ◽

Femoral Fractures ◽

Deep Infection ◽

Surgical Time ◽

Level Of Evidence ◽

Superficial Infection ◽

Non Union ◽

Cerclage Wire ◽

Femur Fractures ◽

Increased Risk

Abstract Purpose The aim of this study was to identify factors associated with the need for open reduction in subtrochanteric femoral fractures and investigate the effect of cerclage wiring compared to open reduction alone, on the development of complications, especially infection and non-union. Methods All consecutive patients with a fracture involving the subtrochanteric region were retrospectively identified, over an 8-year period. Data documented and analysed included patient demographics, fracture characteristics, patient comorbidities, time to fracture union and development of complications. Results A total of 512 patients met the inclusion criteria (523 fractures). Open reduction was performed in 48% (247) of the fractures. Following matching and regression analysis, we identified diaphyseal extension of the fracture to be associated with an open reduction (OR: 2.30; 95% CI 1.45–3.65; p < 0.001). Open reduction was also associated with an increased risk of superficial infection (OR: 7.88; 95% CI 1.63–38.16; p = 0.010), transfusion within 48 h following surgery (OR: 2.44; 95% CI 1.96–4.87; p < 0.001) and a prolonged surgical time (OR: 3.09; 95% CI 1.96–4.87; p < 0.001). The risk of non-union, deep infection and overall mortality was not increased with open reduction. The use of cerclage wires [50 out of 201 fractures (24.9%) treated with an open reduction] to achieve anatomical reduction as compared to open reduction alone significantly reduced the risk of non-union (OR: 0.20; 95% CI 0.06–0.74; p = 0.015). Conclusion Open reduction of subtrochanteric fractures is not associated with an increased risk of deep infection and non-union, even though it is associated with an increased risk of superficial infection, prolonged surgical time and transfusion. The use of cerclage wire is associated with reduced risk of non-union with little evidence of an increase in complications. Level of evidence III.

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FRACTURE OF SHAFT OF FEMUR

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.04.361 ◽

2018 ◽

Vol 25 (04) ◽

pp. 627-632

Author(s):

Sajjad Rasool ◽

Basharat Manzoor ◽

Muhammad Omer Aslam

Keyword(s):

Deep Infection ◽

Delayed Union ◽

Implant Failure ◽

P Value ◽

Superficial Infection ◽

Non Union ◽

Interlocking Nail ◽

Screw Breakage ◽

Group A ◽

Group B

Introduction: Fracture of the shaft of the femur is among the most commonfractures encountered in orthopedics practice.1 Objectives: The aim of the study was alsocompare the outcome of solid versus canmulated inter locking nails as a method of internalfixation in closed fractures of the shaft of femur in adults. Design: Quasi Experiment design.Setting: Orthopedic Department Allied Hospital P.M.C Faisalabad. Results: We had total of60 cases, 30 in groups of solid I/M nailing and 30 in group B of Cannulated in I/M nailing wehave reported the follow up study up to 9 months. (1) There were 27 (90%) males and 3 (10%)females in group A. (2) If in group B 26 (86.666%) were males 4 (13.333%). (3) The mean agewas 37.4 + 1.61 years. Union: Group A, In 26 (86.666%) patients the fracture uniting within 3months. 3 (10%) patients went into phase of delayed union which ultimately united. 1 (3333%)patient into non-union for which bone grafts has to be done after nine months. Group B: In 26(86.666%) patients the fracture united within 3 months. Patient in group B went into nonuniondue to deep infection, second due to nail breakage an in third no apparent causes was found.Total no of cases of non-union in group B were 3. Infection: In group A one patient in groupB 2 patient had superficial infection which were treated with appropriate antibiotics. In groupB one patient had deep infection and went into non-union due to infection. Implant Failure:In group B one case with nail breakage.. 2 Cases with distal Inter Locking screws breakage& 1 case with proximal interlocking screw breakage were noted. Conclusion: (1) There isno statistical difference in union and infection in both groups (P-Value > 0.05). (2) There issignificant difference in implant failure in both groups no patients in group A went with implantfailure but four patients in group B developed implant failure (P-value < 0..05) so Solid interlocking nail is stronger than cannulated interlocking nail.

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Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study

Journal of Bone and Joint Infection ◽

10.7150/jbji.30636 ◽

2019 ◽

Vol 4 (2) ◽

pp. 99-105 ◽

Cited By ~ 8

Author(s):

Ashish Taneja ◽

Ahmed El-Bakoury ◽

Hoa Khong ◽

Pam Railton ◽

Rajrishi Sharma ◽

...

Keyword(s):

Blood Transfusion ◽

Knee Arthroplasty ◽

Case Control Study ◽

Deep Infection ◽

P Value ◽

Receive Blood Transfusion ◽

Retrospective Case ◽

Superficial Infection ◽

Total Hip ◽

Control Study

Abstract. Background: To assess using a retrospective case control study, whether patients undergoing primary, elective total hip or knee arthroplasty who receive blood transfusion have a higher rate of post-operative infection compared to those who do not.Materials and Methods: Data on elective primary total hip or knee arthroplasty patients, including patient characteristics, co-morbidities, type and duration of surgery, blood transfusion, deep and superficial infection was extracted from the Alberta Bone and Joint Health Institute (ABJHI). Logistic regression analysis was used to compare deep infection and superficial infection in blood-transfused and non-transfused cohorts.Results: Of the 27892 patients identified, 3098 (11.1%) received blood transfusion (TKA 9.7%; THA 13.1%). Overall, the rate of superficial infection (SI) was 0.5% and deep infection (DI) was 1.1%. The infection rates in the transfused cohort were SI 1.0% and DI 1.6%, and in the non-transfused cohort were SI 0.5% and DI 1.0%. The transfused cohort had an increased risk of superficial infection (adjusted odds ratio (OR) 1.9 [95% CI 1.2-2.9, p-value 0.005]) as well as deep infection (adjusted OR 1.6 [95% CI 1.1-2.2, p-value 0.008]).Conclusion: The odds of superficial and deep wound infection are significantly increased in primary, elective total hip and knee arthroplasty patients who receive blood transfusion compared to those who did not. This study can potentially help in reducing periprosthetic hip or knee infections.

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CASE STUDY OF TITANIUM ELASTIC NAIL FOR FRACTURES

International Medical Science Research Journal ◽

10.51594/imsrj.v1i3.64 ◽

2020 ◽

Vol 1 (3) ◽

pp. 50-60

Author(s):

Mohammad Sadiq ◽

Mohammad Alam

Keyword(s):

Plate Fixation ◽

Clavicle Fracture ◽

Operating Time ◽

Operative Management ◽

Clinical Results ◽

Deep Infection ◽

Implant Removal ◽

Superficial Infection ◽

Non Union ◽

Plate Group

Mostly, clavicle fracture is treated conservatively but because of higher rates of delayed union, non-union, symptomatic, malunion cosmetic deformity and other complications, there is increased used of operative management for clavicle fracture. In this regard, plating and intramedullary nailing are common surgical options. The operative technique is also found to be producing favorable results compare to the traditional method based on recent prospective randomized studies. In this study, the objective is to make a comparison between clinical results, operative method, and resulting complications proportion. The study was conducted on 66 patients who had OTA type B DMCFs and underwent surgical fixation with antegrade TENs and 1/3rd tubular plate. The study participants were divided in to two groups based on TENS and other with plate fixation with 1/3rd tubular plate. We conducted evaluation using constant-murley shoulder outcome and dash scores at 6, 12, weeks, 3, 6, and 12 months for determining outcomes. It was observed that among TENS group, there was easier implant removal and minimal complications, less blood loss, lesser operating time, with only complication of shortening of about 0.5 cm in fewer cases. In the other group which is plate group, no major complications were observed except minor one such as deep infection, superficial infection, hypertrophied scarring without pain, and decreased shoulder motion with no case of shortening. In terms of union and stability, no significant differences were found in both groups. Based on the result, it is suggested that TENS is more preferable since it involves fewer morbidity, better cosmetic results, and easier implant removal. Fixation with plate seems to be little more stable and its implant of choice is comminuted fracture.

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DYNAMIC HIP SCREW (DHS)

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.01.800 ◽

2016 ◽

Vol 23 (01) ◽

pp. 076-080

Author(s):

Mehtab Pirwani ◽

Abbas Memon ◽

Shakeel Ahmed Memon

Keyword(s):

Deep Infection ◽

Lateral Approach ◽

Gender Ratio ◽

Superficial Infection ◽

Non Union ◽

Fracture Table ◽

Group A ◽

Hip Screw ◽

Comparative Results ◽

Group B

Objectives: To analyze the comparative results of dynamic DHS fixation in stableand the unstable intertrochanteric fractures at LUH. Study Design: Comparative study. Setting:Orthopedic unit I of LUH Jamshoro. Period: 26th May 2010 – 25th August 2011. Methodology:All 40 patients with femur intertrochanteric fracture were enlisted. All cases isolated in 2 groupsevery having 20 patients, group A stable fracture and group B unstable fractures. After completephysical examination, examinations and fracture arrangement evaluation, patients were readiedfor operation. Fracture table was used in each operation. Fracture reduction was initiallyattempted by close manipulation and was successful in 30 (75%) cases. Lateral approach forproximal femur was used in every case. All fractures, whether stable or unstable, were reducedanatomically without any type of osteotomy and then fixed with 135o dynamic hip screw.Results: Mean age was 62.8.2 years of the cases. Gender ratio was 3:1. According to modeof injury were found RTA in 21 (70%) patients. Postoperative complications were recorded as;superficial infection noted in 2 (5%) patients and there was no case of deep infection. Averagestay of hospital found 16.5 days in 17 (42.5%) patients belongs to stable group and 06 (15%)patients belong to unstable group. All (n=40) patients were pain free on their discharge fromhospital. In all (n=40) patients we achieved union and there was no case of delayed unionor non-union. We assessed functional outcome of our patients on the base of Stinchfield HipAssessment system. According to SHAS 28 (70%) patients were excellent, 05 (12.5%) patientswere good, 04 (10%) were fair and 03 (7.5) were poor. We had not found mortality in our patients.Conclusions: According to our conclusion DHS is the best implant for intertrochanteric fracturefixation. No matter; whether fracture is stable, unstable and fresh or old.

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Functional outcomes of reverse distal femoral locking plate in the extra capsular fractures of proximal femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191046 ◽

2019 ◽

Vol 5 (3) ◽

pp. 417

Author(s):

Jaspreet Singh ◽

Harpal Singh Selhi ◽

Rahul Gupta ◽

Gurleen Kaur

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Locking Plate ◽

Femoral Fractures ◽

Delayed Union ◽

Bony Union ◽

Proximal Femoral Fractures ◽

Superficial Infection ◽

Non Union ◽

Wound Breakdown

Background: The optimal management of unstable proximal femoral fractures is controversial. In this prospective study, the functional outcomes of reverse distal femoral locking plate for the treatment of comminuted unstable proximal femoral fractures were assessed. Objectives were to study the functional outcomes of reverse locking plate in extra-capsular fractures of the proximal femur, with respect to quality of reduction, time to bony union, mobility achieved, complications of the procedure, secondary procedures performed (if any) and delayed complications like implant breakage, delayed union, non-union.Methods: 17 patients with unstable proximal femoral fractures were assessed and managed with reverse distal femur plates, and evaluated with X-ray, physical examination, Palmer and Parker mobility score.Results: Union was achieved in all the patients, with average time to union 6.43±1.18 months (range 3-12 months). There was one loosening of implant and wound breakdown, which was managed conservatively. One case of loosening of proximal screws was there, but the fracture united in 9 months with some varus angulation. Superficial infection occurred in one patient, which healed after debridement and IV antibiotics.Conclusions: Taking into consideration the simple surgical technique, good healing rate and minimum complications, it is strongly recommended to use reverse locked distal femoral plates for the management of proximal femoral fractures and further in lean patients, sum-muscular MIPPO should be attempted.

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Prevalence and potential risk factors associated with methicillin resistant Staphylococcus aureus infection in Dairy farms

Mansoura Veterinary Medical Journal ◽

10.35943/mvmj.2020.21.2.0204 ◽

2020 ◽

Vol 21 (2) ◽

pp. 39-47

Author(s):

Mohamed El-Fateh ◽

Adel El-Gohary ◽

Mona Elsayed ◽

Fatma El-Gohary

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Environmental Samples ◽

Methicillin Resistant Staphylococcus Aureus ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Potential Risk Factors

Objective: A cross sectional study was conducted between June 2017 and August 2018 in around Dakahlia governorate to identify Methicillin resistant Staphylococcus aureus (MRSA) and to determine risk factors associated with the occurrence of mastitis in dairy cows. Design: Cross sectional study Animals and samples: 130 dairy cattle (744 samples) and 181 environmental samples (36 bedding, 37 bulk tank milk BTM, 27 feed troughs, 27 water troughs, 27 milk linear and 27 worker’s nasal swabs), with a total of 925 samples were studied. Procedures: Three hundred and seventy-two quarters were examined to detect clinical and subclinical mastitis by physical examinations and California mastitis test. In addition, bacteriological isolation and identification of Staphylococcus aureus and MRSA were carried on the above milk samples of above mentioned quarters, teat swabs and environmental samples. Results: The overall prevalence of Staphylococcus aureus and MRSA was 59.4 and 22.4, respectively. The MRSA were more prevalent in mastitic quarter (X2 = 31.146, P-value = 0.000), Holstein Friesian breed (P-value = 0.021), Old aged dairy cattle (>8 years) (P-value = 0.000), Multiparous cows (P-value = 0.000), large herd size (>=2000) (P-value = 0.000). Conclusion and clinical relevance: The present result indicates that MRSA is a major cause of mastitis in dairy farms at northern Egypt, where one of the key elements for controlling its spreading depends mainly on determining its potential risk factors responsible for its existence.

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Nasal Carriage of Staphylococcus aureus among Healthy School Children in Kathmandu Valley

Nepal Journal of Science and Technology ◽

10.3126/njst.v9i0.3177 ◽

1970 ◽

Vol 9 ◽

pp. 139-142 ◽

Cited By ~ 1

Author(s):

Dev Raj Joshi ◽

Suraj Narayan Shrestha ◽

Rajdeep Bomjan ◽

Kamal Poudel

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

School Children ◽

Antibiotic Susceptibility ◽

Clinical Laboratory ◽

Nasal Carriage ◽

Diffusion Method ◽

P Value ◽

Kathmandu Valley ◽

Microbiological Methods

Staphylococcus aureus remains one of the most frequently isolated pathogens in both community and hospital practices. Methicillin resistant S. aureus (MRSA) continues to be a major cause of serious infections in the community worldwide. This study was undertaken to determine the prevalence of S. aureus and MRSA in school children in Kathmandu valley and, also to evaluate the antibiotic susceptibility pattern of the isolates. Identification of the S. aureus was confirmed by standard microbiological methods and the antibiotic susceptibility testing was performed by disk diffusion method according to the Clinical Laboratory Standards Institution (CLSI). Of the 324 school children who participated in the study, 38 (11.8%) had S. aureus isolated from nasal swabs. The potential risk factors for the S. aureus carriage showed the antibiotic usage within past 4 weeks to be associated with the rate of the nasal carriage (p value 0.000). Out of 38, two (5.2%) isolates were MRSA. One of the MRSA strains was also resistant to Cloxacillin. Erythromycin and Cloxacillin resistance was present in 3 (7.9%) isolates. Resistance to two or more antibiotics was noted in 2 (5.3%) isolates. However, no strains were resistant to Vancomycin. The results of this study indicated that the carriage of MRSA exists among young healthy school children who lack traditional risk factors for MRSA. Key words: community acquired MRSA; Staphylococcus aureus; nasal carriage; school children DOI: 10.3126/njst.v9i0.3177 Nepal Journal of Science and Technology 9 (2008) 139-142

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A prospective study of the management of open fractures of tibia

Journal of Nobel Medical College ◽

10.3126/jonmc.v1i2.7295 ◽

2012 ◽

Vol 1 (2) ◽

pp. 25-28

Author(s):

Abul Kalam Mohammad ◽

Mahesh Shrivastav ◽

Pradeep Gupta ◽

Awais Sayed

Keyword(s):

Prospective Study ◽

Skin Grafting ◽

Deep Infection ◽

Open Fractures ◽

Superficial Infection ◽

Non Union ◽

Wound Debridement ◽

Type Iii ◽

Medical College ◽

A Prospective Study

A Prospective study of 30 cases of type III open fractures of tibia is conducted at Nepal Medical College, Kathmandu and Nobel Medical College, Biratnagar from 2009 to 2011. All cases included in the study were initially managed by wound debridement and external fixation, and followed-up regularly for 10 months for outcome. Five cases developed deep infection and 10 had superficial infection, which subsided with prolonged use of antibiotics. Union was obtained in 7to 8 months for 28 cases. Two cases resulted in non- union which had been managed by bone grafting. Open Type III fractures of tibia are still a difficult and challenging problem for orthopedic surgeons. Almost all cases are required for twice surgery including secondary closure, skin grafting and readjustment.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7295 Journal of Nobel Medical College (2012), Vol.1 No.2 p.25-28

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