Comparison of bacterial eradication between standard and double-painted antiseptic application method in minor hand surgery.

Background: Bacteria need to be eliminated for skin preparation in minor hand surgery. The standard method of skin preparation uses an antiseptic scrub and antiseptic solution, which is expensive and time-consuming. Objective: Design a “double-painted antiseptic application method”, and compare the effectiveness of eliminating bacteria at the area around the hand and wrist between the standard method and the double-painted antiseptic application method. Methods: This cross-over designed experimental study was performed on seven volunteers. The standard and the double-painted antiseptic application method were alternately used for skin preparation around the hand, wrist, and half of the forearm. The bacterial colony counts were collected before, immediately after, and at 45 minutes after skin preparation by using the modified glove-juice technique. The primary outcomes were the eradication rate and the number of bacterial colonies. Results: There was no statistical difference in bacterial colonies between either method before skin preparation. The median of bacterial colony counts immediately after and at 45 minutes after skin preparation were zero colony forming units per milliliter in both methods. The eradication rate was 61.5% and 76.9% in the standard and doublepainted antiseptic application method, respectively, for a risk difference of -15.4. There was no statistically significant difference (p=0.67). Conclusion: The number of bacterial colonies and eradication rate were not significantly different between either method. The double-painted antiseptic application method can be used instead of the standard method for the skin preparation in minor hand surgery, which has an expected duration of about 45 minutes or less.

Flexor tendon rupture after distal radius fracture. Report of 2 cases.

Flexor tendon rupture after distal radius fracture is very rare. The authors reported two cases. The first case had flexor pollicis longus tendon rupture. The other had flexor pollicis longus and multiple finger flexor tendons rupture. The authors propose two modes of mechanism of tendon rupture after distal radius fracture.

Floor activity score.

OBJECTIVE: To propose an instrument to measure the amount of floor activities performed by an individual. MATERIAL AND METHOD: A list of 12 questionnaires relating to floor activities is proposed. A cross-sectional survey of the response to the questionnaires was tried on 3 communities representing rural, urban and metropolitan areas. The total number of enrolled people was 733. The scores of the questionnaires were tested for statistical difference (p< 0.05) among the communities by Chi-square and ANOVA nonparametric tests. RESULTS: The total scores among the three communities were significantly different. The rural civilians achieved the highest score, whereas the metropolitan area had the lowest score. CONCLUSION: The proposed instrument measuring floor activities is able to discriminate the activities of civilians in rural, urban and metropolitan areas.

Cost analysis of osteoporotic hip fractures.

OBJECTIVE: To assess the total costs of hip fracture treatment subsequently incurred in 1 year MATERIAL AND METHOD: A cohort study was conducted from January 1, 2002 to December 31, 2004. All new osteoporotic hip fracture patients were enrolled with informed consent. A total cost was estimated, and multivariate analysis was performed to determine factors related to costs. RESULTS: A total of 37 patients were included. Average age was 75 +/- 11.8 years. Four of them (11%) died. Median total cost of hip fracture treatment in 1 year was 116,458.6 Baht (range 21,428.5-5,070,665.0). Median direct cost was 59,881.6 Baht (range 21,428.5-595,520.4). Direct cost per live-year saved was 118,168. 3 Baht. Preoperative status was the only factor related to direct cost. CONCLUSION: Cost incurred from hip fracture in 1 year was high. The appropriate solution to prevent hip fracture might bring about good health in the Thai elderly and reduce its cost in the future.

Meniscal lesions in the anterior cruciate insufficient knee: the accuracy of clinical evaluation.

OBJECTIVE: The purpose of this study was to find out the accuracy of certain symptoms and examination findings that are used to diagnose meniscal injury associated with a torn anterior cruciate ligament. STUDY DESIGN: Cross-sectional study. MATERIAL AND METHOD: The authors studied one hundred consecutive patients with anterior cruciate ligament insufficiency who were scheduled for surgery. During preoperative admission, one of the authors (KT) examined the patients and recorded the demographic data, duration of symptoms, and the clinical findings including Ballottement sign, joint line tenderness, Childress' sign, Merke's sign, Steinmann I sign, McMurray test, and Apley test. All patients underwent arthroscopically assisted anterior cruciate reconstruction by the senior author (PC). Specific meniscal procedures were performed according to the surgeon's preference at the time of surgery. Predictive results of preoperative examination tests for meniscal tears were compared with the findings at surgery and analyzed using arthroscopic findings as the gold standard. RESULTS: There were one hundred patients included in the present study. Out of 100 patients, 75% had meniscal tears and 6% had both meniscal and cartilage lesions. The most sensitive test was Childress' sign (68%), which also had the highest accuracy (66%). The most specific tests were Steinmann I sign and Apley test (100%). CONCLUSION: Childress' sign was more accurate than other tests for detecting meniscal lesions in anterior cruciate insufficient knees. Steinmann I sign and Apley test had the highest specificity.

Incidence of hip fracture in Chiang Mai.

The reported incidence of hip fracture varies to a large extent across regions. Most studies relied on hospital data under the assumption that nearly all cases of hip fracture get access to hospital care. As in many developing countries, a number of hip fracture cases in Thailand might not seek care in hospitals due to geographical, socio-cultural and financial barriers. Therefore, using hospital data alone, could lead to under estimation of the magnitude of hip fracture. This study was undertaken to obtain such information using a combined method of hospital discharge survey and a cross sectional community survey. It resulted in an estimated incidence of 151.2 per 100,000 (95% CI 136.7-167.2) from the hospital survey and 185.2 per 100,000 (95% CI 138.1-247.6) from the community survey. In comparison to developed countries, age-adjusted incidence of hip fracture in this study was markedly lower than that reported from developed countries. It was argued that different degree of urbanization might explain the discrepancy. This implicated promotion of physical activity as a public health measure to prevent hip fracture.