ABSTRACT
INTRODUCTION: In the staged management of tibial pilon fractures, overlap between definitive internal fixation and external fixation pin sites has been investigated as a risk factor for infection with equivocal conclusions. Our aim was to determine if overlap or proximity of definitive internal fixation to external fixation pin sites influences the risk of deep infection. PATIENTS AND METHODS: We reviewed 280 AO/OTA 43B or 43C type distal tibia fractures in 277 patients at two level-one trauma centers. Patients underwent staged management using early temporizing external fixation followed by definitive open reduction and plate fixation. Primary outcome was the association between pin site overlap and the development of deep infection. Secondary outcome was the relationship between development of deep infection and the distance from pin site to definitive fixation. RESULTS: The average duration between external fixation and definitive internal fixation was 14 days. 24% of fractures developed deep infection requiring surgical intervention. There was no association between pin site overlap and the development of deep infection (pâ¯=â¯0.18). There was no relationship between infection and the distance between proximal plate extent and pin site (pâ¯=â¯0.13). DISCUSSION: We identified no association between pin site overlap and the development of deep infection. We suggest that temporizing external fixation pins should be placed so as to obtain optimal stability of the construct with lesser emphasis on aiming to be absolutely outside the zone of future fixation. LEVEL OF EVIDENCE: Level III Therapeutic Retrospective Comparative study.
Subject(s)
Ankle Injuries/surgery , External Fixators/microbiology , Fracture Fixation/methods , Fractures, Open/surgery , Surgical Wound Infection/microbiology , Tibial Fractures/surgery , Wound Healing/physiology , Adult , Ankle Injuries/microbiology , Ankle Injuries/pathology , Bone Nails/microbiology , Debridement/methods , Female , Fracture Fixation/adverse effects , Fracture Fixation/instrumentation , Fractures, Open/microbiology , Fractures, Open/pathology , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Surgical Wound Infection/prevention & control , Tibial Fractures/microbiology , Tibial Fractures/pathology , Treatment OutcomeSubject(s)
Ankle Injuries/complications , Shock, Septic/etiology , Streptococcal Infections/etiology , Streptococcus pyogenes , Ankle Injuries/microbiology , Child , Contusions/complications , Contusions/microbiology , Emergency Service, Hospital , Fatal Outcome , Humans , Male , Shock, Septic/microbiology , Streptococcal Infections/microbiologySubject(s)
Arthritis, Infectious/complications , Exotoxins/physiology , Hip Joint/microbiology , Leukocidins/physiology , Osteomyelitis/complications , Pulmonary Embolism/etiology , Staphylococcal Infections/complications , Staphylococcus aureus/metabolism , Thrombophlebitis/etiology , Acute Disease , Ankle Injuries/complications , Ankle Injuries/microbiology , Anticoagulants/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Bacteremia/complications , Bacteremia/microbiology , Bacterial Toxins/genetics , Cefadroxil/therapeutic use , Child , Clindamycin/administration & dosage , Clindamycin/therapeutic use , Cloxacillin/administration & dosage , Cloxacillin/therapeutic use , Drug Resistance, Microbial , Drug Therapy, Combination , Exotoxins/genetics , Female , Humans , Leukocidins/genetics , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Osteomyelitis/surgery , Pulmonary Embolism/drug therapy , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , Staphylococcus aureus/genetics , Staphylococcus aureus/isolation & purification , Thrombophlebitis/drug therapy , Wound Infection/complications , Wound Infection/microbiologyABSTRACT
Total talar dislocation is a rare injury, which is usually open and with associated fractures. We report two cases of open anterolateral talar extrusions following high-energy traffic accidents. Both were treated with wound debridement, joint irrigation, closed reduction and external fixation. At 12 months follow-up, both patients had pain-free motion of the ankle without any signs of avascular necrosis or arthritis.
Subject(s)
Ankle Injuries/surgery , Joint Dislocations/surgery , Talus/injuries , Accidents, Traffic , Adult , Ankle Injuries/microbiology , Debridement , Fracture Fixation , Humans , Joint Dislocations/microbiology , Male , Middle Aged , Therapeutic IrrigationSubject(s)
Arthritis, Infectious/microbiology , Drug Resistance, Microbial , Osteoarthritis/microbiology , Staphylococcus aureus/isolation & purification , Abscess/drug therapy , Abscess/microbiology , Abscess/surgery , Acute Disease , Ankle Injuries/microbiology , Arthritis, Infectious/drug therapy , Arthritis, Infectious/surgery , Bacteremia/drug therapy , Bacteremia/microbiology , Bicycling/injuries , Cefadroxil/therapeutic use , Child , Combined Modality Therapy , Debridement , Femur/microbiology , Femur/surgery , Humans , Knee Injuries/microbiology , Male , Osteoarthritis/drug therapy , Osteoarthritis/surgery , Pubic Symphysis/microbiology , Staphylococcus aureus/drug effects , Tibia/microbiology , Tibia/surgery , Wound Infection/microbiologyABSTRACT
The authors report a case of a cutaneous infection due to Bacillus licheniformis. It occurred after a wound due to a wicker splinter. The bacteriological identification was easy thanks to the very typical aspects of culture. First intention antibiotherapy given for bacterial dermo-hypodermatitis may be ineffective because Bacillus licheniformis secretes a biofilm and is frequently resistant to Beta-lactams.
Subject(s)
Bacillaceae Infections/microbiology , Bacillus/isolation & purification , Wound Infection/microbiology , Abscess/etiology , Abscess/microbiology , Abscess/surgery , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Animals , Ankle Injuries/complications , Ankle Injuries/microbiology , Bacillaceae Infections/drug therapy , Bacillaceae Infections/etiology , Bacillaceae Infections/surgery , Bacillus/drug effects , Bacillus/growth & development , Cellulitis/etiology , Combined Modality Therapy , Dogs , Drainage , Drug Resistance , Drug Therapy, Combination/therapeutic use , Edema/etiology , Female , Foreign Bodies/complications , Foreign Bodies/surgery , Humans , Metronidazole/therapeutic use , Middle Aged , Wound Infection/drug therapy , Wound Infection/surgery , Wounds, Stab/complications , Wounds, Stab/microbiologyABSTRACT
Scedosporium prolificans infections of normal hosts usually require extensive debridement and sometimes amputation to effect cure, due to the intrinsic resistance of this species to available antifungal agents. Newer agents have not tested favourably. Variable results are obtained with voriconazole, and 100% resistance is described with echinocandins. Itraconazole and terbinafine has offered synergy against various moulds including S. prolificans. In vivo success is reported with the azole/terbinafine combination in S. apiospermum pulmonary infection and Pythium insidiosum periorbital cellulitis. We report a case of orthopaedic infection in a non-immunocompromised host with S. prolificans, in which the combinations of itraconazole/terbinafine and voriconazole/terbinafine showed synergy in vitro, and success was achieved without radical surgery, using voriconazole and terbinafine.
Subject(s)
Ankle Injuries/drug therapy , Antifungal Agents/therapeutic use , Mycetoma/drug therapy , Naphthalenes/therapeutic use , Pyrimidines/therapeutic use , Scedosporium , Triazoles/therapeutic use , Aged , Ankle Injuries/microbiology , Debridement , Drug Synergism , Drug Therapy, Combination , Humans , Male , Microbial Sensitivity Tests , Mycetoma/microbiology , Mycetoma/surgery , Scedosporium/drug effects , Terbinafine , VoriconazoleABSTRACT
Septic arthritis is usually of hematogenous origin and is increasingly being reported in elderly patients, who often have underlying medical conditions such as diabetes or alcoholism. We report a 62-year-old patient with alcoholic liver disease who presented with Escherichia coli bacteremia and septic arthritis in a previously fractured ankle. There are scarce reports of infectious arthritis in cirrhotic patients, but this is the first report of arthritis after a primary enteric bacteremia. We believe that the patient described here developed E. coli bacteremia as a result of bacterial overgrowth and translocation related to alcoholic liver disease and cirrhosis. The resulting bacteremia resulted in the development of infection in the left ankle, which had preexisting disease and was thus vulnerable. This case provides further evidence for the mode of infection being bacteremia in cirrhotic patients. In patients with cirrhosis and fever, a high index of suspicion is required for joint infection as a potential cause of fever or deterioration in the cirrhotic's patient general condition.