Risk factors for infection in fixation of distal tibia fractures.

BACKGROUND: The aim of this study is to evaluate risk factors for infection as well as infection rates after open reduction and internal fixation for distal tibia fractures with a distal tibia locking plate and/or isolated screws. METHODS: This is a retrospective and descriptive study based on 55 patients treated in our Major Trauma Centre from January 2009 to December 2016. All patients were classified by age, sex, open or closed fracture, injury mechanism, comorbidities, fixation and time from injury to surgery. 22 extraarticular fractures AO/OTA 43-A and 33 intraarticular (14 cases 43-B and 19 43-C) were recorded. High energy trauma was related in 27 patients, while open fractures were observed in 10 patients. Splint until surgery was applied routinely while temporary external fixation (EF) was performed in 21 patients (7 extraarticular and 14 intraarticular). Patients were treated by 5 different consultant surgeons performing isolated screws (SC) in 20% of the surgeries, antero-medial locking distal tibia plate (AM) and anterolateral (AL) were used in 47% and 33% of the patients respectively. After assessing normality and homogeneity of the subgroups, statistical contrast tests were performed. RESULTS: Infection rate was 31.5%, mainly caused by S. aureus. We obtained a statistically significant correlation between greater age and infection rate. In the same way, a positive statistical trend between infection and AL plating was found. The use of EF followed by ORIF was not observed as a risk factor for infection compared with splint followed by internal fixation, however, the group of patients in which a splint was used, a positive relationship was found between the infection rate and shorter time until the definitive fixation. No statistically significant associations were found between extra/intraarticular fracture pattern, use of corticosteroids or open fractures and infection rate. CONCLUSION: Greater age was a predisposing factor for infection. The use of external fixation before definitive ORIF seems to be a safe procedure regarding risk infection, and if an external fixation is not used, we recommend longer waiting time until definitive ORIF. Screw fixation or antero-medial plates, if allowed by fracture pattern, can be an option to avoid infection.

Detección de coccidios en niños asintomáticos mediante esporulación de muestras fecales / Coccidiae detection in asymptomatic children by esporulation of fecal samples

Objetivo: Estimar la prevalencia de la infección por coccidios intestinales en niños asintomáticos de una comunidad urbano marginal de Lima. Material y Métodos: Se recolectó muestras fecales de 79 niños asintomáticos de 7 meses a 7 años de edad del Asentamiento Humano "Las Casuarinas de Villa". Se revisó por el método directo y se preparó frotis para la coloración con la técnica de Kinyoun. Una parte de la muestra se colocó en frascos con bicromato de potasio al 2,5 por ciento para la esporulación. Después de 10 días, se preparó frotis para colorearlos con Kinyoun. Resultados: El examen directo detectó una muestra con Cryptosporidium (1,3 por ciento ); en los frotis coloreados previa esporulación se encontró 3 muestras con Cryptosporidium (3,8 por ciento ) y una con Isospora belli (1,3 por ciento ) y en los frotis coloreados postesporulación se detectó 6 muestras con Cryptosporidium (7,6 por ciento ) y una con Isospora belli. Conclusión: La esporulación permitió aumentar la posibilidad de detectar casos con Cryptosporidium.