Pin Site Infection Research Articles

Anterior approach versus posterior approach for the open reduction of displaced pediatric supracondylar humerus fracture

BackgroundThis study's objective was to compare the results and adverse outcomes of the anterior approach and posterior approach in patients with a type 3 Gartland pediatric supracondylar fracture who failed close treatment and indicated open reduction. Methodsin this retrospective study patients with Gartland type 3 fracture who failed close reduction and required open reduction were enrolled in the study. Eligible patients underwent open reduction via anterior and posterior triceps sparing approaches. Patients were followed up 3, 6, and 12 months after the surgery. Study variables included age, sex, Bauman's angle, pin site infection, nerve injury, osteonecrosis, and elbow arc of motion. ResultsThe study included a total of 83 patients. Surgery was performed on 49 patients using the posterior technique and 34 patients using the anterior approach. The mean age of patients was 6.78 ± 1.40 years. The mean age and the relative frequency of sex didn't differ significantly between study groups (P > 0.05). Two-way repeated measures ANOVA test showed that there was a statistically significant difference in elbow arc of motion in the anterior approach in comparison with the posterior approach, however, this increase was not clinically significant. In terms of adverse events including pin site infection, nerve injury, osteonecrosis, and cubitus varus, there was no statistically significant difference between the two approaches. ConclusionThere was no clinically significant difference in elbow arc of motion and adverse events between the anterior approach and the posterior approach. Therefore, surgeons should choose the approach with which they are more familiar and comfortable.

Persistent Infection in a Patient with Tibial Non-union

This report presents a case of persistent pin site infection that resulted in the removal of hardware in a patient who underwent Ilizarov stabilization for compound tibial fractures. Despite antibiotics, the infection worsened, necessitating removal of the entire Ilizarov frame to prevent permanent damage or non-union. Bone marrow stimulators were subsequently placed for healing support. The report emphasizes the importance of rigorous pin site care, meticulous monitoring, low threshold for diagnosis of complications and swift escalation of treatment when needed. However, vigilance alone may not be enough, especially in those with co-morbidities, open injuries or hardware applications simplifying opportunities for nosocomial infection. The patient's recovery process involved early, optimized rehabilitation, medical and social supports, leading to a return to partial mobility and function despite a prolonged recovery process. Diligent follow-up was necessary at each stage to recognize complications before permanent damage and revise treatment plans as needed. The report aims to share lessons learned and strengthen preparedness for future cases facing similar challenges. Success emerged from determination, vigilance and partnership. Close monitoring makes the difference between catastrophic loss and maximal benefit from an ordeal already threatened by overcoming disability.

Penggunaan Antiseptik untuk Mencegah Pin Site Infection pada Pasien Terpasang Eksternal Fiksator

This study aims to review antiseptics used in pin-site care to prevent pin-site infection in patients with external fixators attached. The research method is a systematic review, which begins with the process of selecting articles through PRISMA, which is followed by the process of reviewing reports to determine then which papers can be reviewed. The results of a systematic review of six articles showed the benefits of using antiseptics for pin site care in preventing pin site infection. The combination of chlorhexidine with other antiseptics such as alcohol and 1% silver sulphadiazine, the use of single chlorhexidine, povidone iodine, emollient, and microbicidal liquid polymer is effective in preventing pin site infection. Chlorhexidine is considered to be used in low concentrations to minimize the risk of skin irritation. Povidone iodine has the advantage of being an antiseptic that can be found easily in hospitals and has a low price. In conclusion, antiseptics can be used to prevent pin site infection, but the use of emollient skincare, a combination of 5% chlorhexidine - 1% silver sulphadiazine, and microbicidal liquid polymer still requires further research due to the lack of literature and the use of unfamiliar materials.
 
 Keywords: Antiseptic, Patient Attached External Fixator, Pin Site Infection

Morphological Features and Clinical Results of C2 Vertebral Body Fractures

Type of study: Retrospective study. Objectives: To classify and analyze the morphological patterns of vertebral body fractures and report the clinical results. Summary of literature review: There have not been many reports on the classification of vertebral body fractures and treatment results, and it remains a matter of debate. Materials and methods: Among 107 patients diagnosed with an axis fracture from 2005 to 2019, 53 patients with fracture involving the vertebral body were selected. After the exclusion of 9 patients with a history of cervical spine surgery or who were lost to follow-up, 44 consecutive patients were enrolled in this retrospective study. Patients were classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the main fracture line. The demographic data, injury mechanism, discoligamentous injury, combined injury, neurological symptoms, and clinical treatment results were analyzed. Results: Patients’ average age was 61.7 years (range, 25–81 years). 24 patients were male and 20 were female. The average follow-up period was 14.2 months (range, 7–33 months). The coronal, sagittal, transverse, avulsion, and complex groups contained 5, 5,8, 7, and 19 patients, respectively. Six patients were injured by slip-down accidents, 12 patients by falling height, and 26 patients by traffic accidents. Eighteen patients were presented with a discoligamentous injury. Twenty-five patients showed a combination of fractures of cervical vertebrae and bones. Thirteen patients presented neurological symptoms. 16 patients were treated with a neck collar and 28 patients were treated with a halo-vest. Two patients eventually required surgical fusion because union was not achieved with conservative management. In the final follow-up, all neurological symptoms were resolved; however, 4 patients still complained of a mild tingling sensation in the upper extremity. Pin site infection occurred in 3 patients who were treated with a halo-vest, but it was controlled after antibiotic administration. Conclusion: Vertebral body fractures accounted for almost 50% of axis fractures in this study. Vertebral body fractures can be classified into 5 groups (coronal, sagittal, transverse, avulsion, and complex) according to the morphological pattern. Non-operative management can be a reasonable treatment option with good clinical results and bone union.

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

SHOULD WOUND SWABS BE SENT ON ALL PIN SITE INFECTIONS?

IntroductionIntroduction: Pin site infection is a common complication during treatment with a circular frame external fixator and increases time and support patients require from the limb reconstruction team. Wound swabs were not routinely sent by the clinical nurse specialists prior to this study, with most pin site infections treated as Staphylococcus aureus with flucloxacillin (clindamycin in penicillin allergy). The aim of this study was to ascertain whether routine sending of wound swabs in pin site infection would change antibiotic treatment.Materials & MethodsMaterials and Method: Patients presenting at clinic or physiotherapy with clinical signs of pin site infection were assessed using the Maz Oxford Nuffield (MON) Pin Site Infection Grading System© (OUH, 2021). Antibiotics were commenced as per unit guidelines and swabs sent for microscopy, culture and sensitivity.ResultsResults: There were forty patients treated with pin site infections. Swab results showed S. aureus in 60% (N=24), other organisms in 15% (N=6) and no growth or mixed skin organisms in 10% (N=10). Flucloxacillin was prescribed to 77.5% (n=31) of patients with the remaining 22.5% (n=9) of patients receiving clindamycin (due to allergy) or rifampicin and ciprofloxacin (due to a previous MRSA diagnosis). Antibiotic management was subsequently changed in only 5% (n=2) of patients due to one patient with a new MRSA diagnosis and one patient growing Enterobacter in three pin sites tested.ConclusionsConclusion: This study has shown that routine swab testing of pin sites does not usually change antibiotic management but should still be used in multiple, severe or unresolving pin site infections.

ANKLE PRESERVATION: TWO CASES OF CABLE TRANSPORT FOR BONY DEFECTS FOLLOWING ANEURYSMAL BONE CYST RESECTION

IntroductionAneurysmal bone cysts commonly found in lower limbs are locally aggressive masses that can lead to bony erosion, instability and fractures. This has major implications in the lower limbs especially in paediatric patients, with potential growth disturbance and deformity. In this case series we describe radical aneurysmal bone cyst resection and lower limb reconstruction using cable transport and syndesmosis preservation.Materials & MethodsCase 1 - A 12-year-old boy presented with a two-week history of atraumatic right ankle pain. An X-ray demonstrated a distal tibia metaphyseal cyst confirmed on biopsy as an aneurysmal bone cyst. The cyst expanded on interval X-rays from 5.5cm to 8.5cm in 9 weeks. A wide-margin en-bloc resection was performed leaving a 13.8cm tibial defect. A cable transport hexapod frame and a proximal tibial osteotomy was performed, with syndesmosis screw fixation. The transport phase lasted 11 months. While in frame, the boy sustained a distal femur fracture from a fall. The femur and the docking site were plated at the same sitting and frame removed. At one-year post-frame removal he is pain-free, with full ankle dorsiflexion but plantarflexion limited to 25 degrees. He has begun graduated return to sport.ResultsCase 2 - A 12-year-old girl was referred with a three-month history of lateral left ankle swelling. X-ray demonstrated an aneurysmal bone cyst in the distal fibula metaphysis. The cyst grew from 4.2 × 2.3cm to 5.2 × 3.32cm in 2 months. A distal fibula resection (6.2cm) with syndesmosis fixation and hexapod cable transport frame were undertaken. The frame was in situ for 13 weeks and during this time she required an additional osteotomy for premature consolidation and had one pin site infection. After 13 weeks a second syndesmosis screw was placed, frame removed, and a cast applied. 3 months later she had fibular plating, BMAC and autologous iliac crest bone graft for slow union. At 3 years post-operative she has no evidence of recurrence, is pain-free and has no functional limitation.ConclusionsWe describe two cases of ankle syndesmosis preservation using cable transport for juxta-articular aneurysmal bone cysts. This allows wide resection to prevent recurrence while also preserving primary ankle stability and leg length in children. Both children had a minor complication, but both had an excellent final outcome. Cable bone transport and prophylactic syndesmosis stabilization allows treatment of challenging juxta-articular aneurysmal bone cysts about the ankle. These techniques are especially useful in large bone defects.

MID- TO LONG-TERM OUTCOME OF OPEN TIBIAL FRACTURES DEFINITIVELY MANAGED WITH A CIRCULAR FRAME

IntroductionOpen tibial fractures typically occur as a consequence of high energy trauma in patients of working age resulting in high rates of deep infection and poor functional outcome. Whilst improved rates of limb salvage, avoidance of infection and better ultimate function have been attributed to improved centralisation of care in orthoplastic units, there remains no universally accepted method of definitive management of these injuries. The aim of this study is to the report the experience of a major trauma centre utilising circular frames as definitive fixation in patients sustaining Gustilo-Anderson (GA) 3B open fracturesMaterials & MethodsA prospectively maintained database was interrogated to identify all patients. Case notes and radiographs were reviewed to collate patient demographics and injury factors . The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventionsResults247 open tibial fractures with a soft tissue manipulation in order to achieve skin cover, of which 203 had a minimum follow up of 2 years. Mean age was 43.2 years old, with 72% males, 34% smokers and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Nine (4.4%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-five (37%) of patients had a secondary intervention of which; 8 comprised debridement of deep infection, 1 amputation for deep infection and the remainder adjustments of frames.ConclusionsOrthoplastic care including circular frame fixation for GA 3B fractures of the tibia results in a low rate of deep infection, around a quarter of contemporary literature for internal fixation.

Inter- and Intra-rater Reliability of the Checketts' Grading System for Pin-site Infections across All Skin Colours.

Groenewoud R, Chhina H, Bone J, et al. Inter- and Intra-rater Reliability of the Checketts' Grading System for Pin Site Infections across All Skin Colours. Strategies Trauma Limb Reconstr 2023;18(1):2-6.

Comparison of Pin Site Infection Rate between Schanz Screws And K-Wires in Ilizarov Fixator for Tibial Fracture

Comparison of Pin Site Infection Rate between Schanz Screws And K-Wires in Ilizarov Fixator for Tibial Fracture

Clinical trial of a low-cost external fixator for global surgery use

PurposeA low-cost modular external fixator for the lower limb has been developed for global surgery use. The purpose of this study is to assess outcome measures in the first clinical use of the device.MethodsA prospective cohort study was conducted with patients recruited in two trauma hospitals. Initial clinical procedure data were collected, and patients were followed up every two weeks until 12 weeks or definitive fixation. Follow-up assessed infection, stability, and radiographic outcomes. In addition, patient-reported outcomes and surgeons’ feedback on device usability were collected by questionnaires.ResultsThe external fixator was used on 17 patients. Ten were mono-lateral, five were joint spanning, and two were delta configuration. One patient had a pin site infection at 12-week follow-up. All were stable when tested mechanically and using radiographic assessment, and 53% were converted to definitive fixation.ConclusionThe low-cost external fixator developed is appropriate for use in global surgery trauma centres with good clinical outcomes.Prospective trial registration number and dateSLCTR/2021/025 (06 Sep 2021).

External fixator as a safe method in the treatment of distal tibial fractures in children.

The objective of this study is to evaluate the functional and radiological results of external fixator application in the treatment of distal tibial metaphyseal diaphyseal junction (MDJ) fractures in children and to analyze differences between stable and unstable fractures. Medical records of children with distal tibial MDJ fracture confirmed by imaging from January 2015 to November 2021 were retrospectively analyzed. Patients were divided into stable and unstable groups and parameters, including clinical and imaging data and Tornetta ankle score were compared. Twenty-five children, comprising 13 with stable and 12 with unstable fractures, were included in our study. The mean age was 7 years (range, 2-13.1 years), and there were 17 males and 8 females. All children had closed reduction, and the basic clinical data of the two groups were comparable. Stable fractures showed shorter intraoperative fluoroscopy, operation, and fracture healing times than unstable fractures. No significant difference in Tornetta ankle score was observed. Twenty-two patients had excellent ankle score, and three had a good ankle score, for a combined incidence of 100%. Two patients in the stable fracture group and one in the unstable fracture group developed a pin site infection, and one patient with unstable fracture showed a length discrepancy (discrepancy<1 cm). External fixator is safe and effective for the treatment of distal tibial MDJ fractures, whether the fracture is stable or not. It has the advantages of minimally invasive, excellent ankle function score, few major complications, needless auxiliary cast fixation, and early functional exercise and weight bearing. Level IV.

HOST FACTORS AND RISK OF PIN SITE INFECTION IN EXTERNAL FIXATION: A LITERATURE REVIEW EXAMINING AGE, BODY MASS INDEX, SMOKING, AND COMORBIDITIES INCLUDING DIABETES

An international Consensus Group has by a Delphi approach identified the topic of host factors affecting pin site infection to be one of the top 10 priorities in external fixator management. The aim of this study was to report the frequency of studies reporting on specific host factors as a significant association with pin site infection. Host factors to be assessed was: age, smoking, BMI and any comorbidity, diabetes, in particular. The intention was an ethological review, data was extracted if feasible, however no meta-analysis was performed.A systematic literature search was performed according to the PRISMA-guidelines. The protocol was registered before data extraction in PROSPERO. The search string was based on the PICO criterias. A logic grid with key concept and index terms was made. A search string was built assisted by a librarian. The literature search was executed in three electronic bibliographic databases, including Embase MEDLINE (1111 hits) and CINAHL (2066 hits) via Ovid and Cochrane Library CENTRAL (387 hits). Inclusion criteria: external fixation, &gt;1 pin site infection, host factor of interest, peer-reviewed journal. Exclusion criteria: Not written in English, German, Danish, Swedish, or Norwegian, animal or cadaveric studies, location on head, neck, spine, cranium or thorax, editorials or conference abstract. The screening process was done using Covidence.A total of 3564 titles found. 3162 excluded by title and abstract screening. 140 assessed for full text eligibility. 11 studies included for data extraction. The included studies all had a retrospective design. Three identified as case-control studies. Generally the included studies was assessed to have a high risk of bias. A significant associations between pin site infection for following host factors: a) increased HbA1C level in diabetic patients; b) congestive heart failure in diabetic patients; c) less co-morbidity; d) preoperative osteomyelitis was found individually.This systematic literature search identified a surprisingly low number of studies examining for risk of pin site infection and host factors. Thus, this review most of all serves to demonstrate a gap of evidence about correlation between host factors and risk of pin site infection, and further studies are warranted.

TIBIAL OSTEOMYELITIS TREATED WITH THE TAYLOR SPATIAL FRAME

Treatment of tibial osteomyelitis can be challenging and lengthy, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) for a large cohort of patients, and analyse factors that affect outcomesBetween 2015-2020, 51 patients were treated with TSF for osteomyelitis at a major trauma centre.Demographic, infection and treatment factors of: age, smoking status, diabetes, and BMI, acute (&lt;6 weeks post injury) or chronic (&gt;6 weeks) osteomyelitis, bacteria isolated, time to debridement, therapy/surgery number of TSF, time TSF was in, antibiotic treatment period, time to partial weight bear (PWB) and full weight bear (FWB) prescriptions, were collected. Outcomes of complications and time to union were obtained.Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six and three patients were further treated with fusion and amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin site infection, malunion, and non-union being most prevalent.Univariate factor analysis, multicollinearity diagnostics, then multivariate model construction were performed.Staphylococcus Epidermidis in bone debridement microbiology was significantly negatively associated with pin site infection (OR 0.093, 95% CI 0.011-0.828) and malunion (OR 0.698, 95% CI 0.573-0.849), and enterococcus with non-union (OR 0.775, 95% CI 0.656-0.916), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p=0.035), time TSF was in (p=0.021), presence of complications (p=0.045), bone loss complication(p=0.037), time to FWB prescription(p=0.001).We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union.

EVALUATING INTER-RATER RELIABILITY OF THE MODIFIED GORDON SCORE FOR PIN SITE INFECTION

There is no consensus on how to evaluate and grade pin site infection. A precise, objective and reliable pin site infectious score is warranted. The literature was reviewed for pin site infection classification systems, The Modified Gordon Score (MGS) grade 0-6 was used. The aim was to test the reliability of The Modified Gordon Infection Score. The observed agreement and inter-rater reliability were investigated between nurse and doctors.MGS was performed in the outpatient clinic at Aalborg University Hospital, Denmark on 1472 pin sites in 119 patients by one nurse and one of three orthopaedic surgeons blinded to each other's judgement. The data was stored in a Red Cap Database for further statistical analysis. The observed agreement between the nurse and the 3 orthopaedic surgeons was evaluated with a one-way random-effect model with interclass correlation with absolute agreement. Furthermore the observed agreement for each of the 3 surgeons with the nurse was calculated.The distribution of MGS infection grade in the 1472 pin sites was: Grade 0; n=1372, Grade 1; n=32, Grade 2; n=39, Grade 3; n=24, Grade 4; n=5, Grade 5; n=0, Grade 6; n=0.The observed agreement between the nurse and the surgeons was calculated as 98%. The ICC estimated between nurse and the surgeons was 0,8943 (ICC &gt;0,85 = reliable). The grading was done by three different doctors with an agreement with the nurse as follows. Rater1 (n=416) =99,5 %, Rater2 (n=1440) =97,4%, Rater3 (n=1440) =96,6%.A limitation to this study is that the dataset represents mostly clean pin sites with MGS 0. Only 100 pin sites had signs of superficial infection MGS 1-4 none above 4. We found that the MGS infection score is highly reliable for low grade infections but we cannot conclude on reliability in severe infections.

PREPARING AN AUTOMATIC PIN SITE INFECTION DETECTION TOOL WITH MACHINE LEARNING FOR HOME-BASED SURVEILLANCE

To detect early signs of infection infrared thermography has been suggested to provide quantitative information. Our vision is to invent a pin site infection thermographic surveillance tool for patients at home. A preliminary step to this goal is the aim of this study, to automate the process of locating the pin and detecting the pin sites in thermal images efficiently, exactly, and reliably for extracting pin site temperatures.A total of 1708 pin sites was investigated with Thermography and augmented by 9 different methods in to totally 10.409 images. The dataset was divided into a training set (n=8325), a validation set (n=1040), and a test set (n=1044) of images. The Pin Detection Model (PDM) was developed as follows: A You Only Look Once (YOLOv5) based object detection model with a Complete Detection Intersection over Union (CDIoU), it was pre-trained and finetuned by the through transfer learning. The basic performance of the YOLOv5 with CDIoU model was compared with other conventional models (FCOS and YOLOv4) for deep and transition learning to improve performance and precision. Maximum Temperature Extraction (MTE) Based on Region of Interest (ROI) for all pin sites was generated by the model. Inference of MTE using PDM with infected and un-infected datasets was investigated.An automatic tool that can identify and annotate pin sites on conventional images using bounding boxes was established. The bounding box was transferred to the infrared image. The PMD algorithm was built on YOLOv5 with CDIoU and has a precision of 0.976. The model offers the pin site detection in 1.8 milliseconds. The thermal data from ROI at the pin site was automatically extracted.These results enable automatic pin site annotation on thermography. The model tracks the correlation between temperature and infection from the detected pin sites and demonstrates it is a promising tool for automatic pin site detection and maximum temperature extraction for further infection studies. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment using thermography.

Headless cannulated screw and external fixator in the treatment of type C distal femur fractures: Effect of early mobilization on clinical outcomes.

Distal femur fractures occur due to high-energy trauma in young patients and with low-energy traumas in osteoporotic elderly patients. Implants selected for use in the treatment of distal femur fracture should provide stable fixation and allow early mobilization especially at elder patients. We aimed to investigate the effects of the headless cannulated screw and external fixator combination on the early mobilization of the patients and postoperative complications. Twenty-one patients with Type C distal femur fracture were included in the study.The fracture lines were temporarily fixed with K wires. After the fracture reduction with headless cannulated screws a tubular external fixator with carbon fiber rods was applied to bridge the knee joint. The external fixators were removed at the 6th week follow-up, and the patients were forced to perform knee flexion as much as they could tolerate. The 6th month KSS scores of the patients were 44.3 (34-60) and the 18th month KSS scores were 77.5 (60-88).Preoperative VAS score was 8(7-10) and postoperative VAS score was 4(3-6).Knee flexion of the patients at 6th months was 95.9 (80-110 degrees) and at 6th months knee flexion was 114.5 (100-125 degrees). Superficial pin site infection was observed at 4 patients and regressed with antibiotic therapy. Combination of cannulated screws with an external fixator for joint restoration in type C distal femur fractures allows early mobilization and reduces postoperative morbidity.

Tibia Fractures in Children: A Single-Centre 11-Year Retrospective Study for Evaluating the Management and Outcomes in an Acute General Orthopaedic Hospital.

Introduction Tibia fractures are children's most typical lower limb fractures affecting their general and mental well-being. This study aims to evaluate the management and outcomes of displaced tibia fractures. Methods A retrospective study was conducted to review children up to 16 years of age with displaced tibia shaft fractures who received treatment in our department from January 2011 to December 2021. Fractures managed in the operating theatre and patients who completed follow-up until fracture healing were included in the study. Treatment procedures were assessed, and outcome was measured by hospital stays, complications and revision procedure incidences. Results The study included 74 patients (75 fractures, including one re-fracture). The patient's ages ranged from 2 to 16 years (median age: 11 years). Seven patients sustained open fractures (Gustilo I, II). Tibia diaphysis was the most common site of involvement. A total of 43 patients were treated by manipulation under anaesthesia and cast. Surgical fixation was directly proportional to increasing age (p<0.05). Overall, 74% of patients were treated by fixation when age was >10 years. Three patients needed conversion of casting to surgical fixation. One patient had re-fracture following a secondary injury after six months of initial tibia shaft fracture treated by casting. Five patients had complications, including delayed union, pin site and surgical site infections. Antibiotics were adequate to manage infections except in one patient who needed debridement. The average hospital stay was three days. The median number of follow-up X-rays was 4. The planned removal of all flexible nails, and the circular frame was done between 2 and 15 months, except for one that had delayed union. All the patients underwent clinical and radiological union at the end of the follow-up. Conclusion The treatment plan was dependent on the individual need of the patient and the fracture pattern. Children older than 10 years were more likely to undergo surgical fixation. The majority of fractures were treated by manipulation and cast in operating theatres. Better logistic support in the emergency department could reduce the burden on the operating theatre.

Functional outcome analysis of ilizarov ring fixator as definitive fixation of open tibial fractures

: Ilizarov fixator for open tibia fractures permits axial micro mobility at fracture site to encourage bone regrowth. Literature search revealed dearth of studies from Indian centres which have evaluated its utility in open tibia fractures. : This was an observational prospective study conducted by Department of Orthopaedics at VVPF Medical College, Ahmednagar in Maharashtra, between July 2021 to June 2022. All patients who had open tibia fractures and managed by Ilizarov ring fixator were included. Duration of treatment with fixator was evaluated, along with range of motion at knee and ankle, union status and complications.: 30 patients were enrolled, majority being males (n=22, 73.33%). Most patients suffered from fractures of right side (n=21, 70%) confined to metaphyseal region (n=16, 53.33%). Commonest mode of injury was road traffic accidents (n=26, 86.67%). Based on Gustilo-Anderson classification, majority cases were grade IIIA (n=16, 53.33%). 23 cases (76.67%) were managed initially with external fixators, while 7 cases were directly managed with Ilizarov ring fixator. Most cases (n=15, 50%) received definitive fixation on day-3 of injury. Commonest complication noted was pin site infection (n=11, 36.67%) and delayed union (n=4, 13.33%). Knee stiffness at 30was noted in 3 cases, corrected by physiotherapy. All patients attained fracture union, with the earliest evidence of radiological union observed after 2 months of surgery. : As it allows for early full weight bearing mobilisation, has higher union rates and lesser incidences of malunion, use of Ilizarov external fixator maintains its importance in the management of open tibial fractures.

Validity of percutaneous external fixator for calcaneal fractures to allow early weight bearing

Calcaneum, the most common tarsal bone to fracture affecting manual labourers who were sole breadwinners of the family. Generally treated with below knee pop and ORIF, commonly associated with complications and delayed weight bearing. This study analyses functional outcome of early weight bearing with minimally invasive skeletal stabilisation of calcaneal fractures.This study was conducted at Institute of orthopaedics and traumatology, Coimbatore medical college and Meenakshi medical college hospital and research institute, Kanchipuram between July 2019 to October 2021. 15 patients in age group 20-65 years with 19 calcaneal fractures less than 4 weeks duration are included in study.Surgery averaged 1.6 days after injury. Full weight-bearing was achieved in 11.7 days for unilateral calcaneal fractures (range 9 to 15 days) and 43.5 days for bilateral fractures (40 to 49 days). Patients returned to work in 35.6 days on average (range 24 to 52 days). All 19 calcaneal fractures healed in 52.63 days. External fixator removal averaged 56.57 days. Two patients had postoperative pin site infections. No bones were infected. Six-month AOFAS scores averaged 86.15.In our study calcaneal fractures are fixed with mini external fixator percutaneously and it can be used in presence of compound fractures and with skin blisters. Though anatomical reduction cannot be attained completely weight bearing is possible from 2nd day after surgery and full weight bearing was possible in 2nd week. The limitations of our study include a smaller number of cases. A large multi-centric study may be necessary to confirm our results.