ABSTRACT
@#Introduction: The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. Materials and methods: Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest. Results: All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united. Conclusions: The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
ABSTRACT
Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.