A DESCRIPTIVE STUDY OF BACTERIOLOGICAL SPECTRUM OF ORTHOPEDIC IMPLANT INFECTION IN CLOSED FRACTURES

Background: Surgical Site Infection (SSI) is defined as pain associated with erythema, induration, local tenderness, pus discharge or any culturepositive or negative discharge from a surgically created wound. Methods: Hospital based Descriptive type of Observational study conducted on Patients in the department of Orthopaedics. Results: Total 5.00% patients have wound infection. Gram positive 80.00% patients have found with Staph. Aureus and Gram negative 20.00%patients have found with Pseudomonas. Conclusion: Infection in closed fractures with implants was quite high. The adverse outcome of SSIs related to a clean orthopedic surgical procedure can be associated with significant morbidity, cost, and even mortality. Keywords: Infection, SSI, Fracture

Surgical antimicrobial prophylaxis in open reduction internal fixation procedures at a metropolitan hospital in Australia: a retrospective audit

Background Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update. Methods A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant. Results Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines. Conclusion Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.

Comparative study of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus treated by open reduction and internal fixation

Background To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. Methods We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. Results A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). Conclusion OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Accuracy of the WSES classification system for pelvic ring disruptions: an international validation study

Background In 2017, a novel classification for pelvic injuries was established by the World Society of Emergency Surgery (WSES). We validated its effectiveness using nationwide real-world data. The roles of associated vascular injury and open fracture in this system were also evaluated. Methods Patients with pelvic fractures in the National Trauma Data Bank 2015 dataset were retrospectively studied. First, the mortality rates were compared by WSES classification. Second, independent predictors of mortality were evaluated using a multivariate logistic regression model. Patients with and without associated vascular injuries and the same hemodynamic and pelvic ring stability statuses were compared. Patients with associated vascular injuries were compared to the proportion of nonsurvivors and survivors with unstable pelvic ring injuries. Third, the outcomes were compared between patients with open pelvic fracture and closed pelvic fracture in the mild, moderate and severe WSES classes. Results During the 12-month study period, 44,163 blunt pelvic fracture patients were included. The mortality rates were 1.8%, 3.8% and 10.6% for the mild, moderate and severe WSES classes, respectively (p < 0.001). MLR analysis showed that unstable pelvic ring injury did not significantly affect mortality (p = 0.549), whereas open pelvic fracture and associated vascular injury were independent predictors of mortality (odds of mortality: open pelvic fracture 1.630, p < 0.001; associated vascular injury 1.602, p < 0.001). Patients with associated vascular injuries showed that there was no significant difference in the proportion of patients with unstable pelvic ring injuries between survivors and nonsurvivors (37.2% vs. 32.7%, p = 0.323). In all three classes, patients with open pelvic fractures had significantly higher mortality rates and infection rates than patients with closed fractures (mortality rates: minor 3.5% vs. 1.8%, p = 0.009, moderate 11.2% vs. 3.3%, p < 0.001, severe 23.8% vs. 9.8%, p < 0.001; infection rates: minor 3.3% vs. 0.7%, p < 0.001, moderate 6.7% vs. 2.1%, p < 0.001, severe 7.9% vs. 2.8%, p < 0.001). Conclusions Based on this nationwide study, the WSES guideline provides an accurate and reproducible classification of pelvic fractures. It is recommended that open/closed fractures and associated vascular injuries be evaluated as supplements of the WSES classification.

Current approaches to treatment of patients with closed fractures of the patella

Introduction Treatment of patients with acute fractures of the patella is the task of the trauma and orthopedic service and should provide restoration of the integrity of the bone tissue and the extensor apparatus of the knee joint for its early mobilization. There is an opinion that conservative treatment cannot meet requirements of patients’ quality of life, and therefore, most traumatologists are inclined to surgically treat patellar fractures. Purpose Based on the available literature data, to determine the most rational way to treat patients with patellar fractures Materials and methods Available studies published in the last 10 years were analyzed. The databases NCBI Pubmed, Healio Orthopedics, Medline were searched. Results Such osteosynthesis methods as patella suture, osteosynthesis with plates, special internal devices, external fixation devices, Kirschner wires and wire cerclage, various screws were covered. The question of clinical application of patellectomy was touched upon; the contribution of the Department of Traumatology, Orthopedics and Urgent Surgery of the Krasnov Samara State Medical University to the development of operative techniques of osteosynthesis of the patella, the basic concepts of scientific research, and also the most optimal ways of treating patients with patellar fractures were described. Conclusion The conservative method of treating patients with patellar fractures is most relevant if there are contraindications to surgery. It inevitably leads to persistent arthrogenic contracture. The best functional results of treatment have been achieved with surgical treatment due to the possibility of early mobilization of the knee joint. According to the data of available studies, plates and screws as well as osteosynthesis with Kirschner wires and wiring cerclage show maximum stability. There is evidence of a direct correlation between the risk of developing infectious complications and pain in the postoperative period and the number of elements of subcutaneous metal implants. Thus, the most optimal way to treat closed fractures of the patella is osteosynthesis with the use of wires and wire cerclage according to the tension band principle.

1334 Improving Patient Flow Through the Hand Trauma Pathway

Aim A full-cycle audit was conducted at our plastic surgery unit, assessing adherence to hand trauma standards by the British Society for Surgery of the Hand. These stipulate that time from referral to clinic for open injuries and closed fractures should be within 24 hours and 72 hours respectively and time to theatre from date of injury (DOI) within 4 and 7 days, respectively. Method Data for the initial audit was collected from Nov 2019-Feb 2020 and for the re-audit from Aug-Dec 2020. Lists were generated of 50 patients with open injuries including flexor tendon, extensor tendon and nerve injuries and 50 hand fractures in both cycles. Data was collected on DOI, date of referral, clinic review and surgery. Results The initial audit results showed poor DOI documentation (open injuries 30%, fractures 54%). For open injuries, 44% met standards for clinical review within 24 hours and 94% for time to theatre. For fractures, 94% met the standard for time to clinic and 90% for time to theatre. The interventions included adding the standards to the clinic booking form and creating a mandatory DOI field on the referral system. The re-audit showed improvement of DOI documentation (open injuries 95%, fractures 100%) and the proportion of open injuries seen within 24 hours to 60%. Conclusions The interventions had a positive impact on our hand trauma pathway. Areas for improvement include reducing the number of patient visits to the service and encouraging early decision-making, particularly for patients reviewed in the emergency department.

Epidemiological study of ankle fractures

Objective: To evaluate the epidemiological characteristics of patients with fractures in the ankle region. Methods: This prospective, observational, descriptive, and epidemiological study included ankle fractures treated at our service from March 1, 2017 to March 1, 2018. Data were obtained from 150 patients through a detailed questionnaire. Results: The sample, which included 61.33% men, aged mainly between 20 to 30 years; 46.68% were of mixed race, and 41.33% had only completed elementary school. A total of 33.66% of the ankle fractures occurred in the afternoon. According to the Weber classification system, 46.66% were type B fractures.Conclusion: Ankle fractures were more common in men of working age, and were mostly closed fractures in the right lower limb. Level of Evidence IV; Prognostic Studies; Case Series.

A DESCRIPTIVE STUDY OF BACTERIOLOGICAL SPECTRUM OF ORTHOPEDIC IMPLANT INFECTION IN CLOSED FRACTURES

Background- Surgical Site Infection (SSI) is defined as pain associated with erythema, induration, local tenderness, pus discharge or any culture positive or negative discharge from a surgically created wound. Methods- Descriptive type of Observational study conducted on Patients in the department of Orthopaedics. Results- 6.00% patients have wound infection. Gram positive 83.33% patients have found with Staph. Aureus and Gram- negative 16.67% patients have found with Pseudomonas. Conclusion- Infection in closed fractures with implants was quite high. The adverse outcome of SSIs related to a clean orthopedic surgical procedure can be associated with significant morbidity, cost, and even mortality. Keywords- SSI, Closed, Implants

Comparative Study of Functional Outcomes between OTA/AO type C, Gustilo type I/II Open Fractures and Closed Fractures of the Distal Humerus Treated by Open Reduction and Internal Fixation.

Background: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation.Methods: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and comparedResults: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1±13.6 months. There were no significant differences in the hospitalization time, operation time, intraoperative blood loss, medical costs, range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, or complications between the two groups (P>0.05).Conclusion: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation.Level of Evidence: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.