ABSTRACT
External fixation is widely used in orthopaedic and trauma surgery. Infections around pin or wire sites, which are usually localised, non-invasive, and are easily managed, are common. Occasionally, more serious invasive complications such as necrotising fasciitis (NF) and toxic shock syndrome (TSS) may occur. We retrospectively reviewed all patients who underwent external fixation between 1997 and 2012 in our limb lengthening and reconstruction programme. A total of eight patients (seven female and one male) with a mean age of 20 years (5 to 45) in which pin/wire track infections became limb- or life-threatening were identified. Of these, four were due to TSS and four to NF. Their management is described. A satisfactory outcome was obtained with early diagnosis and aggressive medical and surgical treatment. Clinicians caring for patients who have external fixation and in whom infection has developed should be aware of the possibility of these more serious complications. Early diagnosis and aggressive treatment are required in order to obtain a satisfactory outcome.
Subject(s)
Bone Lengthening/instrumentation , External Fixators/adverse effects , Surgical Wound Infection/etiology , Adolescent , Adult , Bone Lengthening/adverse effects , Bone Nails/adverse effects , Bone Wires/adverse effects , Child , Child, Preschool , Early Diagnosis , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/etiology , Fasciitis, Necrotizing/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Shock, Septic/diagnosis , Shock, Septic/etiology , Shock, Septic/therapy , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapyABSTRACT
INTRODUCTION: Aspirin is one of the pharmacological agents used for thromboprophylaxis. MATERIALS AND METHODS: National thromboprophylaxis guidelines, peer-reviewed studies and data from national joint register of England and Wales were analysed for evidence regarding the efficacy of aspirin versus other agents in thromboprophylaxis and the recommendations of guidelines. RESULTS: Two of five guidelines reviewed recommend the use of aspirin for thromboprophylaxis. Aspirin is used as thromboprophylactic agent in approximately 25% of patients undergoing total hip and total knee arthroplasty in year 2006 in England and Wales. There is no difference in mortality in these patients compared to patients on other pharmacological agents. CONCLUSION: There is conflicting evidence and differences in interpretation of the data from the literature. If specific outcome measures and complications such as symptomatic DVT, PE and bleeding were logged in arthroplasty registers, the resulting data would be useful in individualised decision-making.
Subject(s)
Anticoagulants/therapeutic use , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Aspirin/therapeutic use , Pulmonary Embolism/prevention & control , Venous Thrombosis/prevention & control , Fondaparinux , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Lower Extremity/surgery , Polysaccharides/therapeutic use , Practice Guidelines as TopicABSTRACT
Thigh infection associated with local emphysematous signs on presentation to the emergency room should alert the medical staff at once of potential complication associated with it. The infection may be associated with underlying bowel pathology and has a high mortality rate. Hence, emergency treatment should be instituted. We discuss a case with this uncommon presentation, treatment administered and relevant literature.
Subject(s)
Bacteroides Infections/complications , Bacteroides fragilis , Soft Tissue Infections/complications , Staphylococcal Infections/complications , Subcutaneous Emphysema/etiology , Thigh/microbiology , Aged , Diverticulitis, Colonic/complications , Diverticulosis, Colonic/complications , Hip/microbiology , Hip/surgery , Humans , Male , Thigh/surgeryABSTRACT
We describe a case of volar dislocation of the index carpometacarpal (CMC) joint in association with a Bennett's fracture of the thumb following a motorcycle accident. Volar dislocation of the index carpometacarpal joint is an exceedingly rare but easily missed injury, with only a few reported cases in the literature. This report highlights the importance of a true lateral radiograph and close scrutiny of the film to detect this injury. Closed reduction supplemented with Kirschner wire fixation restored normal anatomical relations and achieved an excellent clinical result.
