Track Infection Research Articles

Management of infected total knee arthroplasty by Ilizarov fixator

Introduction Persistent infection after total knee arthroplasty (TKA) is a very serious complication. Arthrodesis is considered if the prosthesis cannot be retained or revision surgery is obviated. The purpose of this study was to evaluate the radiological and functional results of knee arthrodesis with Ilizarov external fixator to treat infected TKA. Patients and methods This was a retrospective study of 13 patients with infected TKA treated by implant removal, debridement, and fusion by Ilizarov fixator operated from October 2010 to March 2015. The study included nine females and four males with a mean age of patients of 64.08 years. Seven patients were diabetics and two had a past history of deep venous thrombosis. Time, from the primary TKA till knee fusion, ranged from 18 to 37 months. All patients had previous surgical interventions with a mean of 4.62 procedures. Eleven patients had draining sinuses. In addition to clinical and radiographic evaluation, the functional assessment was done by Western Ontario and McMaster Universities Osteoarthritis index questionnaire. Results Patients were followed up for a mean of 28.62 months. The mean external fixator period was 7.77 months. Postoperative hematoma occurred in one patient. Pin track infection occurred in 10 cases. All cases had successful fusion except two patients and infection was controlled in all cases. The mean leg length discrepancy was 3.96 cm. The mean postoperative Western Ontario and McMaster Universities Osteoarthritis index score was 30.08. Conclusion Knee arthrodesis by Ilizarov external fixator for treating persistently infected TKA achieved high fusion and infection control rates and provided a stable limb with pain relief and functional improvement.

Clinical Practice Guidelines for Management of Dementia.

Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of dementia, in the year 2007. (http://www.indianjpsychiatry.org/cpg2007.asp). The current version of the CPG is an update of the earlier version of CPGs for management of dementia There were three separate CPGs for management of dementia, one each for Reversible Dementias, Alzheimer's Disease and Vascular Dementia, Please note that the present CPG on dementia deals all types of dementia together. The current version of the CPGs for dementia in elderly must be read in conjunction with the previous version of CPGs for dementia. The focus of the present CPG is to provide suggestions and clinical tips to differentiate dementia syndrome from other clinical conditions, identify the subtypes of dementia and then offer suggestions for management. These guidelines only provide a broad framework for assessment, management and follow-up of older people with dementia. While most of the recommendations are evidence based, these guidelines should not be considered as a substitute of professional knowledge and clinical judgment. The recommendations made as part of these guidelines should be tailored to address the clinical needs of the individual patient and the treatment setting.

Triple management of cubitus valgus deformity complicating neglected nonunion of fractures of lateral humeral condyle in children: a case series.

Long standing nonunion of the lateral humeral condyle (LHC) usually results in elbow pain and instability with progressive cubitus valgus and tardy ulnar neuritis. Surgical treatment of long standing nonunion is still a controversial issue due to the reported complications, such as stiffness, loss of elbow motion, and avascular necrosis of the LHC fragment. In this study, we reported the outcomes of treatment of cubitus valgus deformity in long standing nonunion of the LHC in children treated with combined triple management (fixation of the nonunion site, dome corrective osteotomy, and anterior transposition of ulnar nerve) through a modified para-triceptal approach. We evaluated tenpatients with cubitus valgus deformity more than 20 degrees after neglected nonunion of the lateral humeral condyle more than 24months. Only childern with post-operative follow up more than 24months were included in this study. All patients were evaluated clinically, radio logically, and by pre- and post-operative functional evaluation using Mayo elbow performance score. For evaluation of ulnar nerve affection, the Akahori's system was used. There were six females and four males with the average age of 7.7years at operation. The left elbow was affected in six patients and the right elbow was affected in four patients. The average time between fracture of the LHC and operation was 40.3months with average post-operative follow up of 44.3months. The average carrying angle of the healthy side was 5.5 degrees and pre-operative carrying angle of the affected side was 33.5 degrees. The average post-operative carrying angle of the affected side was 6.1 degrees. The improvement of the carrying angle at the last follow up was found statistically significant (p < 0.05). All six patients that had pre-operative various degrees of ulnar nerve affection had completely improved at last follow up. The osteotomy site united in an average time of 43days, whereas the LHC nonunion site united in an average time of 77.2days. The osteotomy site united in significantly less time than the LHC non-union site (p < 0.05). The correlation between time since injury and time of union of LHC non-union site was significant (p < 0.05). Post-operative elbow range of motion was not changed in five patients, slightly decreased in four patients, and increased in one patient. Three patients had an average 6.7 degrees (range; 5-10) loss of the last degrees of flexion. One patient developed extension lag of 10 degrees. The mean elbow range of motion (ROM) pre-operatively was 139 ± 4.6 degrees while the mean post-operative ROM was 138 ± 5.3 degrees. The difference was found to be statistically insignificant (p > 0.05). The mean pre-operative Mayo elbow performance score was poor 55 ± 9.7, four patients had fair score, and six had poor score. The mean post-operative Mayo elbow performance score was excellent 92.5 ± 10, six patients had excellent score, and four had good score. The improvement of the Mayo score at the last follow up was found to be statistically significant (p < 0.05). No intra-operative complications were recorded during any of the procedures and no patient developed a wound or pin track infection post-operatively. At the last follow up, none of the patients had developed avascular necrosis of the LHC. Preservation of the blood supply of the nonunited fragment is the key to successful management. This combined technique successfully addresses different aspects of the problem simultaneously and provides a durable solution without deterioration of the results over time. The para-triceptal approach provided excellent exposure of both sides of the elbow with minimal disruption of the triceps muscle.

Prospective study of unstable distal radius fractures treated with external fixation in Indian rural set-up

Aim: Distal radius fracture is common fracture in daily orthopaedic practice accounting for 1/6th of all the fractures. Conventionally the fractures were treated with closed reduction and immobilization with casts. Even though union of these fractures occurs, they have a very high incidence of going in for malunion and wrist joint instability especially with comminution & intra articular extension cases. Moreover a change in trend to younger age groups as a result of RTA’s (road traffic accidents) & trauma is leading to more complicated fractures with intraarticular extension and comminution. Also the importance of anatomical alignment and reconstruction of radiocarpal and radioulnar ulnar joints has been emphasized in recent trends. Hence the management of distal radius fractures changed from universal use of cast immobilisation to operative interventions. Aim of this study is to observe the effect of external fixation for unstable distal radius fractures in rural set up. Materials and methods: Prospective analysis of 30 patients with unstable distal radius fractures, who were operated at MIMS hospital, nellimarla village, vizianagaram district between may 2016 to feb 2017 treated with external fixator. Patient position- supine with arm table support. For external fixation of the wrist we used the 4 mm (small) external fixator system. For pin insertion into the second metacarpal, the distal pin is inserted proximal to the transition of the metacarpal head into the shaft and the more proximal pin is inserted distal to transition of the shaft into the metacarpal base.The proximal two pins are inserted proximal to the muscle bellies of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). Proximal to these muscles, the radial shaft is palpated through the skin between the bellies of the extensor digitorum communis (EDC) and extensor carpi radialis longus/brevis (ECRL/ ECRB) over a distance of 3-4 cm at which the proximal pins inserted into the radial shaft with 4-5cms apart. Longitudinal traction is applied on the thumb and index finger or the distal partial frame to reduce the fracture. T clamps are fixed to bridging rods, first proximally followed by tightening of distal fragment T clamps to maintain the traction and reduction, there by healing of fracture by the principle of ligamentotaxis. Results: Average Mean hospital stay is 4days, there are 13males and 17 females between age group 28-60yrs, 27 cases out of 30 had functional and radiological union by 12weeks (range 6-18 weeks), 2 had pin track infection which were treated successfully with iv antibiotics. 1 patient had deep bone infection and pin loosening which was managed with external fixator removal, long course antibiotics and casing. We followed standard Sarmiento radiological scoring system, Gartland and Werley Score (demerit system) demerit point scoring system, DASH scores, Green & O Brien grade scoring systems to evaluate the end results. Conclusion: External fixation of unstable distal radius fractures can be considered as effective treatment in elderly populations of Indian rural set up as it is simple, cost effective, short duration procedure with good results.

Effectiveness of an Educational Program on Orthopedic Nurses' Knowledge Concerning Pin Track Infection of External Fixation in Al-Emamin AL- Khadamin Medical City.

Effectiveness of an Educational Program on Orthopedic Nurses' Knowledge Concerning Pin Track Infection of External Fixation in Al-Emamin AL- Khadamin Medical City.

Management of 30 infected nonunited tibial fractures by Ilizarov external fixator with acute shortening distraction technique with consideration of the causative organism

Background: Long-standing infected nonunion and gap nonunion tibial fractures are difficult to treat and pose a challenging problem to orthopaedic surgeons. They may lead to residual deformity, persistent infection, knee or ankle contracture, and, at worst, can result in a painful and useless limb requiring amputation. Methods: This prospective study involved 30 patients (27 males and three females) with infected tibial nonunions treated by Ilizarov external fixation with acute shortening and distraction. The mean age was 40 yr with an average bone defect of 3.85 cm (range 2.5 cm to 6 cm). The duration of nonunion before treatment ranged from 6 to 48 mo with an average of 14 mo. The average number of prior surgeries was 1.5 (range 1 to 4). Eleven (36.66%) of the 30 patients had overlying soft-tissue compromise. The causative bacteria were identified and treated with the appropriate antibiotic for at least 6 wk (range 6 to 12 wk). Results: Most infected nonunited fractures in this series (86.66%) occurred in the productive age (four in the 3rd, eight in the 4th, nine in the 5th, and 5 in the 6th decades of life) indicating the socioeconomic impact of this severe injury. The time to consolidation ranged from 3.5 mo to 9 mo, with an average of 6 mo. All fractures united except one (3.33%), with 19 (63.27%) and eight (26.64%) patients having an excellent and good result and two (6.66%) patients having a fair result when applying the Association for the Study and Application of the Method of Ilizarov (ASAMI) classification. Functional results per ASAMI were 12 (39.96%), and 14 (46.62%) patients had excellent and good results. Twenty-seven (89.91%) had bony consolidation with complete remission of infection. The most common isolated bacteria were Staphylococcus aureus (10 patients) and Staphylococcus epidermis (four patients). The most common complication was pin track infection which occurred in all patients. All were uneventfully treated with proper wire/pin care and the appropriate antibiotics. Conclusions: Ilizarov fixation with acute shortening distraction technique is a safe and reliable method for treatment of infected tibial nonunion, however, with the potentially devastating complication of vascular injury during acute compression. The amount of acute shortening is done on an individualized basis as we could not identify safe limits for acute shortening. This technique deals with soft-tissue defects that may require treatment and precludes the need for complex microvascular procedures and secondary bone grafting at the fracture site.

Monitoring the Path to the Elimination of Infectious Diseases.

During the endgame of elimination programs, parasite populations may exhibit dynamical phenomena not typical of endemic disease. Particularly, monitoring programs for tracking infection prevalence may be hampered by overall rarity, the sporadic and unpredictable timing and location of outbreaks, and under-reporting. A particularly important problem for monitoring is determining the distance that must be covered to achieve the elimination threshold at an effective reproduction number less than one. In this perspective, we suggest that this problem may be overcome by measuring critical slowing down. Critical slowing down is a phenomenon exhibited by nonlinear dynamical systems in the vicinity of a critical threshold. In infectious disease dynamics, critical slowing down is expressed as an increase in the coefficient of variation and other properties of the fluctuations in the number of cases. In simulations, we show the coefficient of variation to be insensitive to under-reporting error and therefore a robust measurement of the approach to elimination. Additionally, we show that there is an inevitable delay between the time at which the effective reproduction number is reduced to below one and complete elimination is achieved. We urge that monitoring programs include dynamical properties such as critical slowing down in their metrics for measuring achievement and avoid withdrawing control activities prematurely.

Tracking Infection Diffusion in Social Networks: Filtering Algorithms and Threshold Bounds

This paper deals with the statistical signal processing over graphs for tracking infection diffusion in social networks. Infection (or Information) diffusion is modeled using the susceptible-infected-susceptible (SIS) model. Mean field approximation is employed to approximate the discrete valued infection dynamics by a deterministic difference equation, thereby yielding a generative model for the infection diffusion. The infection is shown to follow polynomial dynamics and is estimated using an exact nonlinear Bayesian filter. We compute posterior Cramer-Rao bounds to obtain the fundamental limits of the filter that depend on the structure of the network. The SIS model is extended to include homophily, and filtering on these networks is illustrated. Considering the randomly evolving nature of real world networks, a filtering algorithm for estimating the underlying degree distribution is also investigated using generative models for the time evolution of the network. We validate the efficacy of the proposed models and algorithms with synthetic data and Twitter datasets. We find that the SIS model is a satisfactory fit for the information diffusion, and the nonlinear filter effectively tracks the information diffusion.

Outcomes of post-traumatic tibial osteomyelitis treated with an Orthofix LRS versus an Ilizarov external fixator

ObjectiveTo compare the therapeutic effects of the Orthofix limb reconstruction system (LRS) versus the Ilizarov external fixator on osteomyelitis of a tibial bone defect. Materials and methodsAmong 153 patients hospitalized for bone lengthening therapy from January 1, 1996 to January 1, 2015, 129 patients were selected for a retrospective analysis. Forty-three of the candidate patients were treated using the Orthofix LRS and the other 86 were treated using an Ilizarov external fixator. The average follow-up was 96 months. We evaluated the patients at follow-up visits, and compared the length of time the patients wore the fixation devices. We also examined the scores of Activities of Daily Living (ADL) tests and a Self-rated Anxiety Scale (SAS), the range of motion, and the incidence of pin track infections. ResultsThe results indicated that both approaches were effective for treating the bone defect. Compared with the patients who wore an Ilizarov fixator for the treatment of post-traumatic osteomyelitis, those who wore an Orthofix LRS tended to be more satisfied with their quality of life and the outcome after the operation. ConclusionAlthough both approaches were effective for treating the bone defect, the overall patient outcomes were superior for the Orthofix LRS, suggesting that it should be considered as the first option in the treatment of traumatic osteomyelitis of the tibial diaphysis.

ESIN and K-wire fixation has similar results in both bone pediatric forearm fractures

The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. The cohort comprised 5 girls and 35 boys whose mean age was 11.60 ± 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures.

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis.

The incidence of fragility fractures of the pelvis is increasing quickly. The characteristics of these fractures are different from pelvic ring disruptions in adults. Fragility fractures of the pelvis are the consequence of a low-energy trauma which occurs in a patient with an important decrease of bone mineral density. Due to a consistent pattern of alteration of bone mass distribution in the sacrum, other fracture morphologies occur than in younger adults. The leading symptom is immobilizing pain in the lower back, in the buttocks, in the inguinal region and/or at the pubic symphysis. Conventional radiographs and CT will show the presence and localization of the fractures in the anterior and posterior pelvic ring. A new, comprehensive classification system distinguishes four categories of instability. This first criterion is most important, because it also gives hints for the preferred type of treatment. The second criterion, leading to the subtypes in the four categories, is the localization of the instability in the posterior pelvic ring. This criterion points the way towards the type of the surgical procedure to be used. When a surgical treatment is chosen, the procedure should be as minimal invasive as possible. Different techniques for percutaneous or less invasive fixation of the posterior pelvic ring have been developed. Their advantages and limitations are presented: sacroplasty, iliosacral screw osteosynthesis, cement augmentation, transiliac internal fixation, trans-sacral osteosynthesis, lumbopelvic fixation. Fractures of the anterior pelvic ring also need special attention. Retrograde transpubic screw fixation is recommended for pubic rami fractures. Fractures of the pubic body and instabilities of the pubic symphysis need bridging plate osteosynthesis. We do not recommend anterior pelvic external fixation in elderly because of the risk of pin track infection and pin loosening.

Pin-track infections: Past, present, and future

Pin-track infections are a common problem with external fixation and any other implant that breaks the skin barrier. The literature is rich with reports and techniques for treating these infections, but lacks a universally accepted definition of a pin track infection, a single commonly accepted classification, or a standard method of reporting. However, the surgeon can follow a commonly accepted series of practical steps to reduce the occurrence of infection. Continuing development of improved surfaces, substances, and techniques may make pin track infections rarer in the future. Careful preoperative planning, meticulous surgical technique, patient education, and close patient monitoring are all critical to minimize pin-track infections.

A prospective study of management of closed diaphyseal fractures of radius and/or ulna in children with intramedullary titanium elastic nail system

Background & Aim: Intra-medullary elastic nailing system is an ideal device for the treatment of pediatric forearm fractures. It is simple, safe, minimally invasive technique and has a fewer complications. The aim of the study was to evaluate and report our experiences regarding union rates, clinical and functional outcome and complications associated with this treatment modality in BBF between age group of 5 to 15 years. Material & Methods: 40 cases of pediatric diaphyseal both bone forearm in children of age group 5 to 15 years operated at National Institute of Medical Science and hospital, Jaipur meeting the inclusion and the exclusion criteria ( as given below) managed between January 2015 to December 2015 with TENS were prospectively reviewed. The final functional and clinical outcome & complications were assessed at 6 month of follow up by Andersons et al criteria. Results: Of all 40 patients had undergone close reduction in which 2 required open reductions. All fractures united at a mean of 7.95 weeks (range 6-10 weeks) with achievement of full R.O.M at elbow and wrist in majority with reported restriction in 3 cases. There were no major complications but encountered minor complications in 18 patients such as pain (22.5%), hardware skin irritation (12.5%), and pin track infection (10%). The final functional outcome evaluated by Andersons et al criteria showed 90% excellent results and remaining showed good outcome. Conclusion: TENS is an ideal device for the treatment of pediatric forearm fractures as it is a simple, safe, minimally invasive technique and has fewer complications. It also does not interfere with growth of the forearm and provides early union due to non interference of fracture hematoma and minimal periosteal stripping. It provides shorter hospital stay, rapid return to daily activity & school, avoids long & uncomfortable immobilization & cosmetically acceptable

Results of open fractures of tibia treated by external fixator as primary and definitive procedure

Unilateral AO external fixator was used as primary and definitive procedure for treatment of open fractures of both bones of leg. There were 37 patients, and according to Gustilo and Anderson classification there were 20 patients in Type II and 9 in type III A and 8 in type III B. Type I and Type II C were excluded from the study. Males were 30 and females were 7. Maximum cases were in the age group 31-40 years (12 patients). The most common level of injury was at middle 1/3 of tibia. There were associated injuries in seven patients. In all the cases initial debridement and unilateral external fixation was applied. In 31 cases primary closure was done after ensuring the viability of the soft tissues and skin. Secondary closure was done in six cases. Flap cover was given in three cases and skin grafting in three cases. Release incision was done in two cases. The patients were followed for union of fracture; function of the limb and for complications. Fractures in 36 patients united by 10 to 24 weeks with an average of 16 weeks. The complications encountered were, non-union in one, loss of reduction in three, Pin track infection in 8, osteomyelitis in one patient.

Clinical observation of minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint

To explore the method and therapeutic effect of minor external fixation combined with Kirschner Treatment for open comminuted fracture of metacarpophalangeal joint. From January 2013 to December 2014, 13 patients with open comminuted fracture of metacarpophalangeal joint were treated by minor external fixation combined with Kirschner wire, including 9 males and 4 females, aged from 18 to 56 years old with an average of 35 years old.According to Gustilo classification, 8 cases were type II, 4 cases were type IIIA, and 1 case was type IIIB. The time from injury to operation ranged from 2 to 7 h with an average of 5 h. All fractures were involved with metacarpal phalangeal joint surface. Fracture healing time and postoperative complications were observed, TAM scoring system by Hand Surgery Association of Chinese Medical Association was used to evaluate functional recovery. All patients were followed up from 3 to 12 months with an average of 7 months. All fractures were obtained bone healing, and the time ranged from 4 to 6 weeks with an average of (4.6±1.0) weeks. No broken and loose needle, pin track infections, malunion, loose bracket, reflection sexual sense of neurological malnutrition occurred. According to TAM scoring system, 7 cases obtained excellent results, 4 cases good, 1 case moderate and 1 case poor. Minor external fixation combined with Kirschner wire for open comminuted fracture of metacarpophalangeal joint has advantages of simple operation, good stability and which could be adjusted at the later stage, less damage for soft tissue periosteum, low inflammatory, earlier functional exercise. It is worth to be popularized and applied.

The use of stable and unstable green fluorescent proteins for studies in two bacterial models: Agrobacterium tumefaciens and Xanthomonas campestris pv. campestris.

Fluorescent proteins have been used to track plant pathogens to understand their host interactions. To be useful, the transgenic pathogens must present similar behaviour than the wild-type isolates. Herein, a GFP marker was used to transform two plant pathogenic bacteria, Agrobacterium and Xanthomonas, to localize and track the bacteria during infection. The transgenic bacteria were evaluated to determine whether they showed the same fitness than the wild-type strains or whether the expression of the GFP protein interfered in the bacterial activity. In Agrobacterium, the plasmid used for transformation was stable in the bacteria and the strain kept the virulence, while Xanthomonas was not able to conserve the plasmid and transformed strains showed virulence variations compared to wild-type strains. Although marking bacteria with GFP to track infection in plants is a common issue, works to validate the transgenic strains and corroborate their fitness are not usual. Results, presented here, confirm the importance of proper fitness tests on the marked strains before performing localization assays, to avoid underestimation of the microbe population or possible artificial effects in its interaction with the plant.

Fracture management in HIV positive individuals: a systematic review.

Human immunodeficiency virus (HIV) infection could potentially play an important role in the management of fractures as they have been shown to affect fracture healing and the post-operative risk of implant sepsis. A systematic review of the relevant literature was performed on PubMed and Scopus databases. Twenty-six studies were identified, critiqued and analysed accordingly. No randomised controlled trials were identified. HIV positivity was not shown to influence an individual's risk of early wound infection in operatively managed closed fractures. The rate of pin track infection in open injuries managed with external fixators was low. However, in open injuries managed with internal fixation, early wound infection rates were increased in the HIV-positive population compared to HIV-negative individuals. Regarding late implant infection, in closed fractures there appeared to be no increased risk of infection but there is limited evidence for open injuries. Additionally, further evidence is needed to establish if the rate of union in both open and closed fractures are influenced by HIV status. Overall, no evidence was found to suggest that surgical management of fractures in the HIV population should be avoided, and fixation of closed fractures in the HIV population appeared to be safe. The effect of anti-retroviral therapy is unclear and this should be further researched. However, based on the limited evidence, caution should be taken in the management of open fractures due to the potentially increased infection risk. The impact of anti-retroviral therapy on the outcomes of surgery needs further evaluation.

Masquelet TECHNIQUE COMBINED WITH TISSUE FLAP GRAFTING FOR TREATMENT OF BONE DEFECT AND SOFT TISSUE DEFECT

To explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect. Between August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation. Eighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case. The Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.

Ulnar Distraction Osteogenesis in the Treatment of Forearm Deformities in Children With Multiple Hereditary Exostoses

To report on the outcomes of using ulnar lengthening combined with acute angular correction for the treatment of forearm deformities in patients affected by multiple hereditary exostoses (MHE). Our hypothesis was that this procedure would improve both radiographic measurements and clinical outcomes with minimal complications. A retrospective chart review was performed on patients who had a diagnosis of MHE and had undergone ulnar lengthening via a uniplanar external fixator over a 12-year period. Clinical outcomes such as range of motion, pain, and surgical complications were assessed. Radiographic changes were measured using interval radiographs. The series included 17 patients. Median age at surgery was 7 years (range, 3-14 years). Median follow up was 55 months (range, 5-125 months). Improvements occurred in radial and ulnar radii of curvature, carpal slip, ulnar variance, and carrying angle at the elbow. There was 1 major pin track infection. There were 2 failures of the external fixator requiring exchange. Premature consolidation occurred in 1 case. Elbow, forearm, and wrist motion was not affected. Radiocapitellar joint congruency did not change. No patient reported pain at final follow-up. Our approach of using distraction osteogenesis of the ulna with angular correction in the radius and ulna as needed is able to correct carpal slip as well as to improve forearm bowing and elbow carrying angle. All of the patients maintained congruency of the radiocapitellar joint with no postoperative dislocations. Because of the low complication rate, the resolution of pain in patients who presented with pain, and the improvement of forearm bowing, this approach should be considered as a treatment option for children with MHE who are at risk for radiocapitellar dislocation. Therapeutic IV.

The Relationship Between Dust Quality and Home Ventilation with the Incidence of Upper Respiratory Tract Infection (URI) in The Ex-place of Final Processing (TPA) Keputih

Abstract: Upper Respiratory Track Infections (URI) is a kind of respiratory disease which is closely related to the quality of housing and the quality of ambient air. Ventilation is one component of a residential environmental health assessment. The dust may cause dryness of mucous in the respiratory tract so that a person may suffer or feel the symptoms of respiratory infection. This study aimed to analyze the relationship between ambient air dust and ventilation in the former place of fi nal processing (TPA) Keputih with URI (Upper Respiratory Tract Infection). This research is a cross sectional analytical and observational. The sample in this study is the ambient air concentration of dust particles and housewives from 77 families in RW VIII Keputih Area. To determine the relationship of ambient air dust and ventilation with respiratorydisease using Chi Square test. The results showed that respondents who had experienced respiratory infection as much as 89,6%. Levels of dust particles measured at the point I exceeded the quality standard that is equal to 0,3223 mg/Nm3. Home ventilation that do not appropiate the requirements of a healthy home is at 93.5%.There’s a relationship between the use of home ventilation with URI (p = 0.000) and the levels of ambient air dust particles with URI (p = 0.003). This study concludes that the two variables associated with the incidence of respiratory infection so the need for community empowerment and proactive attitude of the various instruments of government in the area of research on the prevention of URI and the presence of a good control of the quality of environmental health VIII RW Keputih Area.Keywords: dust quality, home ventilation, the ex-place of fi nal processing, URI