Wound infection; frequency in clean surgical operations

The aim of the study was to evaluate the frequency of infection in clean surgical cases [General and Orthopaedic]. A descriptive study. This descriptive study was conducted at department of surgery and orthopaedic DHQ Teaching Hospital Sargodha from July 2007 to Dec, 2008. In this study 1500 clean surgical cases were included. Wounds were examined on third post operative day and then regularly after removal of stitches. Surgical wounds were examined finally on fifteenth post operative days. Description of wound condition and detailed data of patients were collected on preformed performas. Patients with wound infection developed pain at operation site and fever on third post operative day. Wounds were examined for swelling, redness, discharge; stitch abscess. Routine investigations were done as per protocol ie complete blood examination, complete urine examination, blood sugar, C-reactive proteins etc. Wounds swab was taken for microscopy and culture sensitivity. This study was carried out on fifteen hundred clean surgical cases [General and Orthopaedic]. There were 1064 males and 436 females. Male to Female ratio was 2.4:1. Infection was detected in 110 patients [7.3%] while no infection was found in 1390. Infection was maximum in patients more than 60 yrs of age [10.9%]. Wound infection was minimum in young patients [3.5%].commonest micro organism isolated from the infected wound was staphylococcus areus. Other organism isolated was streptococcus pyogenes, proteus and pseudomonas. No MRSA was detected. In our case study clean cases were found generally free of infection especially young patients. Whereas increased incidence of infection was noted in old patients. Wound infection is associated with significant morbidity in the form of delayed wound heeling, prolonged hospital stay and increased economical pressure on the patient

Evaluation of the role of MRI in spinal tuberculosis: a study of 60 cases

To evaluate the role of MRI in assessing the extent of disease in spinal tuberculosis. This was a descriptive study conducted at department of Surgery and Orthopaedics District Headquarter Teaching Hospital Sargodha from July, 2007 to December, 2008. This study was carried out on 60 cases of tuberculosis spine seen through out patients and admitted through accident and emergency department of DHQ- Hospital. There were 33 Males [55%], 27 Female [45%] Age range was 14-36 years. Mean age was 33 years. Clinical features of the patients were noted and detailed data of patients was collected on Pre-designed performa. Diagnosed cases of TB-spine were included in this study. Patients having non-tuberculous spondilitis were excluded. Most common symptom was backache in 38 cases [63%]. Spinal cord compression was found in 16 cases [26.6%]. Most commonly affected level was thoracolumber spine [45%]. Diffuse involvement was rare and only 3 cases [05%] were having more than one level involvement. Plain radiography was the primary imaging modality. MRI was the most valuable investigation. MRI findings of tuberculosis spine were reduced intervertabral disc space [95%] cases. wedge collapse of body 18 [30%], complete destruction of body 12 [20%], paraspinal abscess 24 [40%]. Calcification in 18 [30%] and card compression 16 cases [26.6%]. MRI is the most valuable investigation in patients with spinal tuberculosis. It gives information about the extent of disease and hence is used as guide to surgical treatment. MRI is also used during follow up to monitor the response to treatment

Early complications in the operative treatment of ankle fractures

We reviewed early complications of 35 surgically treated closed ankle fractures at Services Hospital, Lahore between January 1993 to January 1994. There were 28 males and 7 females with age ranging from 16-80 years. Webers AO Method of classification of fractures was used. There were 23 Weber type B and 12 Weber type C cases. Fracture dislocations were three times more common than simple fractures. The complication rate was 28.5%, with two major and eight minor complications. Fractures with blisters and skin abrasions had more than double the overall complication rate. Patients not fixed within 24 hours had 44% major complication rate compared to 5-3% in those operated upon as emergencies. We conclude that operative treatment of ankle fracture must be carried out in a timely fashion, especially in severe fractures. Fracture dislocations and delay in surgery are the major factors responsible for higher complication rate