Treatment of Post - traumatic Bone Defects with infection in L ong B ones

Background: Open fractures are a challenging condition to treat because they are frequently compounded by infection and nonunion. Traditional bone defect care strategies are mostly focused on fracture union rather than infection prevention. The goal of this study is t o use the Masquelet approach to examine the outcome of a post - traumatic defect with infection in long bones. This method is a two - step process. Stage I surgery includes debridement and the placement of an antibacterial spacer in the bone defect. Stage II s urgery involved removing the spacer while preserving the induced membrane that had grown on the spacer's surface and filling the bone - gap with morselized iliac crest bone - graft within the membrane sleeve. Methods: There were 22 patients in this study (18 m ales and 4 females), all of them had infected long bone fractures with a bone defect. The average length of the bone defect was 3.5 centimetres. The duration of follow - up varied from 6 to 15 months. Results: After an average of 11.5 weeks following the fir st step of surgery, radiological union was achieved. After stage 1, no patient had any remaining infection. After radiological union, all of the patients were able to mobilise with full weight bearing and a satisfactory range of motion in the adjoining joi nts. Conclusion: With favourable outcomes, this treatment can be used on infected fractures with bone loss on a regular basis. Antibiotic cement spacers, used in conjunction with complete debridement, minimise the risk of infection. The graft is revascular ized through induced biomembrane. In most circumstances, union may be predicted; nonetheless, the length of time it takes to reach an agreement is a constraint. The technique is low - cost and does not necessitate any additional training or equipment. Despit e the fact that it is a two - stage procedure, it does not necessitate several surgeries as in traditional approaches.

Results Of Compound Diaphyseal Tibial Fractures Treated By Unreamed Nail

Compound fractures of tibia are one of the commonest fractures seen in clinical practice. Traditionally their treatment involved the application of external fixator and then definitive surgery once the wound has healed. This prospective study of 47 patients was undertaken to evaluate the results of unreamed interlocking nailing in such fractures. They were followed up for an average of 14 months. All the fractures united at an average of 24 weeks and there were no major complications. In our study17 cases (36.7%) had excellent results, 19cases (40.4%) had good results, 11 cases (23.4%) had fair results and none of the cases had poor results as per criteria laid down by Johner and Wruhs (1982) [15]. Our study does suggest that unreamed interlocking nailing is a good method of primary internal fixation of compound (grade I to IIIB) fractures of tibia.

Incidence of Post-Operative Wound Infections and Bacterial Antibiotic Sensitivity Patterns in Compound Fractures.

Objectives: To know the incidence of post-operative wound infections in compound fractures & to evaluate the bacterial isolate and to identify the antibiotic sensitivity patterns in compound fractures to facilitate the use of effective prophylactic antibiotics to prevent infections. Methodology: This was a prospective study conducted at Jawahar Lal Nehru Medical College and Hospital between 1st may 2014 to 31st July 2014.This study included all the patients with Compound fractures of extremities, presenting to Orthopaedic emergency. All the open fractures were classified according to the Gustilo and Anderson’s classification. Two pus culture swabs were taken in all patients under all aseptic precautions. First sample was taken at time of arrival of patient at emergency department, and immediately sent for culture and sensitivity. Prophylactic antibiotic (i.v. cefoperazone) was started immediately after taking the first culture. Second pus culture swab was taken after three days, at the time of wound inspection. All the fractures were managed with thorough wound debridement and fracture stabilization. Data was collected according to set proforma, regarding the results of initial and post-operative swab cultures and were analysed. Observation & Results: This study involved fourty patients with compound fractures of extremities presenting to the emergency department. The incidence of wound infection before any operative procedure i.e, first pus culture in the study was fifty five percentage.. Out of twenty two infected cases thirteen patients had staphylococcus aureus as the growing organism. All Staph.aureus were found to be sensitive to amikacin, vancomycin. The incidence of wound infection in second pus culture report was found to be thirty percentages. In the second swab culture sample which was taken on third day, eight (twenty percentage) cultures showed Staph. aureus. Six were sensitive to amikacin, six were sensitive to cefazoline. Conclusion: Compound fractures are associated with high incidence of infection. Antibiotics should be such that it covers all the commonly infecting organisms. In this study the commonest infecting organism was found to be Staph. aureus followed by E. fecalis, Citrobacter, E. coli and Klebsiella. It indicates that antibotics should be given initially empirically to cover the Gram positive and negative bacteria followed by giving specific antibiotics following pus culture report to combat and eradicate wound infection. Most of these organisms were found to be sensitive to Cephalosporins, Vancomycin and Aminoglycosides. Thus it is highly recommended that Prophylactic antibiotics in the management of compound fractures should always include one Cephalosporin or Vancomycin and one Aminoglycoside to cover the commonly infecting organisms. The results of this study may hold true for elective Orthopaedic procedures also.