Role of external fixator combined with t-plate internal fixation in the treatment of comminuted distal radial fractures

Background: A technique of external fixator combined with T-plate internal fixation for intra-articular fractures of the distal radius is based on the finding that the separate t-plate fixation do not give complete stability to the fracture. However, if it is combined externally by external fixator, you get a solid synthesis of the fractured radius. This enables early mobilization of the wrist without the use of plaster cast. Objective: The aim of the study was to evaluate the results of external fixator combined with palmar T-plate internal fixation for the treatment of comminuted distal radial fractures. Patients and methods: This was a prospective study that was conducted on 20 patients. Patients were treated by the external fixator combined with T-plate internal fixation. All patients were attending to the Emergency Department and Outpatient Clinic of Orthopedic Surgery Department in Tanta University Hospitals. Results: Patients had excellent range of motion, normal ROM of the arm, shoulder and hand. No significant differences in the radiographic parameters were detected between fracture fixation and fracture healing. Complications were few. At final follow-up evaluations, patients had well to excellent results with respect to range of motion scores. Stable fixation allowed starting active and passive motion of the wrist without compromising postoperative alignment. The poor results in this case were due to late intervention, osteoporosis due to old age and poor general condition of the patient, which resulted in incomplete union. Conclusion: External fixator combined with T-plate internal fixation is an efficacious treatment option for intra-articular distal radius fractures with excellent long-term results

Evaluation of simple screening tests in the diagnosis of non fermentative gram negative bacilli, a prospective study

Carbapenemases are B-lactamases which include serine B-lactamases andmetallo B-lactamases [MBLs]

Their production is the most important mechanisms of microbial resistance to [beta]-lactam antibiotics

Modified Hodge test is a phenotypic method for detection ofcarbapenemases. EDTA disk synergy [EDS] test is used for detection of MBLs. AmpC disk test is the commonly used tests for detection of AmpC [betaj-lactamases. Detection of genes coding for carbapenem resistance by PCR, usually give reliable and satisfactory results, but this method is of limited practical use for daily application in clinical laboratories because of the cost. This study was conducted over a period of ten months [July 2012 to April 2013] at the Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University. A total of 110 Acinetobacter species and 120 Pseudomonas species were included in this study

These organisms were isolated from specimens like aspirated synovial fluid from knee infective arthritis, sputum, tracheal aspirate, pus, urine, blood, pleural fluid and ascitic fluid of patients admitted to Internal Medicine, Chest, ENT, Orthopaedic and Urology Departments, Faculty of Medicine, Tanta University

The Acinetobacter species and Pseudomonas species were identified and screened for meropenem resistance by Kirby-Bauer method. The meropenem resistant strains were subjected to modified Hodge test for detection of carbapenemases. EDTA disk synergy [EDS] test was done with simultaneous testing of two different [beta]-lactams [meropenem and ceftazidime], for detection of metallo-[beta]-lactamases in the meropenem resistant isolates. AmpC disk test was also done for the meropenem resistant strains for detection of AmpC [betaj-lactamases. Of the 110 clinical isolates of Acinetobacter species, 82 were A. baumannii, while 28 were A. Iwoffli. Among the 120 Pseudomonas isolates screened, 91 were Ps. aeruginosa, while the remaining 29 were other Pseudomonas spp. Forty two [51.0%] A. baumannii, 8 [31.8%] A. Iwoffii, 29 [31.8%] Ps. aeruginosa and 8 [27.6%] Pseudomonas spp. were found resistant to meropenem. Among the 29 meropenem resistant Ps. aeruginosa, 13 [44.8%] were AmpC [beta]-lactamase producers, 15 [51.7%] were MBL producers by EDTA disk synergy test, but only 10 [34.4%] were positive for carbapenemases by modified Hodge test. Of the 8 meropenem resistant Pseudomonas spp., 5 [62.5%] were AmpC [beta]-lactamase producers, 2 [25.0%] were MBL producers by EDTA disk synergy test, but only 1 [12.5%] was positive for carbapenemases by modified Hodge test

Among the 42 meropenem resistant A. baumannii, 32 [76.2%] were AmpC [beta]-lactamase producers, 3 [7.1%] were MBL producers, but only 2 [4.8%] was positive for carbapenemases by modified Hodge test

Of the 8 meropenem resistant A. Iwoffii, 3 [37.5%] were AmpC [beta]-lactamase producers, and 2 [25.0 %] were positive for MBL that were detected only using EDTA-ceftazidime combination and no carbapenemases were detected by modified Hodge test. EDS is a more sensitive diagnostic method for detection of MBLs. The modified hodge test is not considered a useful screening test for carbapenemases as many MBL producing isolates were not detected by this test, while EDS is a more sensitive diagnostic method for detection of MBLs. AmpC B- lactamase is a major factor for carbapenemases resistance among the isolates in the hospital