Tract Wound Research Articles

Novel Nanozyme-Based Multicomponent in situ Hydrogels with Antibacterial, Hypoxia-Relieving and Proliferative Properties for Promoting Gastrostomy Tube Tract Maturation.

Gastrostomy is the commonly used enteral feeding technology. The clinical risks caused by tube dislodgement and peristomal site infection are the common complications before complete tract maturation after gastrostomy. However, there is currently no relevant research to promote gastrostomy wound treatment and tract maturation. Herein, a nanozyme loaded bioactive hydrogels (MO-HPA) was developed to accelerate tract maturation and inhibit bacteria. Nano-manganese dioxide (n-MO) and polylysine modified hyaluronic acid (HP) were synthesized and characterized. In situ hydrogels were prepared by mixing the HP/ alginate solution, and the n-MO solution containing Ca2+. The structure, physicochemical and mechanical properties of MO-HPA were evaluated. Furthermore, the antibacterial activity, and the In vitro and intracellular oxygen production efficacy were determined. The cell migration, wound healing and tube tract maturation promotion effect were assessed in cell experiments and in skin defect mouse model, as well as rabbit gastrostomy model. The n-MO has a uniform particle size with oxygen producing activities. The MO-HPA demonstrated a homogeneous and porous microstructure. Additionally, the gelation time, swelling ratio, rheological behavior, and mechanical properties of hydrogels could be tuned by adjusting the HP content. The antibacterial efficiency of the MO-HPA1.0 group on E. coli and S. aureus increased by about 40.1% and 55.6% respectively, compared to the MO-HPA0.5 group. Additionally, MO-HPA1.0 hydrogel demonstrated effective oxygen-producing and cell migration-promoting functions in both in vitro and cellular experiments. The MO-HPA1.0 group significantly accelerated wound healing in both of mouse skin defect model and rabbit gastrostomy model. The hydrogel group exhibited a significant promotion in collagen content and reduction in HIF-1α, which effectively hastened tract maturation. Therefore, our study provides new and critical insights into a strategy to design bioactive hydrogels with multiple functions, which can open up a new avenue for accelerated wound healing after gastrostomy.

Prevalence of Exfoliative Toxin Genes (eta and etb) in Staphylococcus aureus Isolates from Tonsillitis, Wound, and Urinary Tract Infections in Iraq

Prevalence of Exfoliative Toxin Genes (eta and etb) in Staphylococcus aureus Isolates from Tonsillitis, Wound, and Urinary Tract Infections in Iraq

Prevalence of Extensively and Pan-drug-resistant Acinetobacter spp. in Nosocomial Infections in Western Saudi Arabia

Multidrug resistance patterns of Acinetobacter spp. have led to their emergence as an important source of nosocomial infections. This study investigated the prevalence and clinical characteristics of Acinetobacter spp. in hospital-acquired wound and urinary tract infections. A total of 432 samples [wound swabs (210) and urine samples (222)] were analyzed for the presence of Acinetobacter spp. through selective culturing on MacConkey and Leeds Acinetobacter medium followed by identification with API 20E strips and Vitek 2 compact system. Antimicrobial susceptibility was assessed by adopting the disk diffusion method on Muller-Hinton agar, whereas the minimum inhibitory concentration procedure was carried out by using a ComASP™ Colistin test kit. Biofilm formation was examined using microtiter plates and following the crystal violet staining method. PCR was performed to amplify virulence (lasB, bap, and plcN) and antimicrobial resistance (blaOXA-51like) genes. The results revealed a low prevalence of Acinetobacter spp. (1.85 %) where Acinetobacter baumannii was the predominant species. Acinetobacter baumannii isolates harbored blaOXA-51-like gene to exert extensive or pan-drug resistance. Most Acinetobacter baumannii isolates demonstrated weaker to moderate biofilm-forming capabilities and carried the bap gene. Acinetobacter baumannii isolates lacked the combination of virulence factors encoding lasB and plcN genes. Acinetobacter baumannii infections are rising in Saudi Arabia. The results of this study highlight the epidemiology of virulent and antibiotic-resistant Acinetobacter spp., particularly A. baumannii, in Saudi Arabia. The detailed elaboration on the diversity, virulence, and antimicrobial susceptibility patterns of Acinetobacter spp. in Saudi Arabia requires further in-depth molecular investigations.

Spectrum of Candida auris infections in a tertiary care hospital, South India

<i>Candida auris</i> is a globally emerging multi-drug resistant yeast, causing bloodstream, wound, urinary and respiratory tract infections. Understanding the epidemiology and risk factors associated with <i>C. auris</i> infection, would help in early diagnosis and instituting appropriate antifungal therapy. In this retrospective observational study, we analyzed the clinical and epidemiological data of twelve cases of <i>C. auris</i> from our institute for a period of 3 years from 2018 to 2020. The demographic, clinical and microbiological data were collected and analyzed. Identification was done by Vitek 2C and antifungal susceptibility testing by broth microdilution for all the isolates. Of the total 217 patients diagnosed with invasive candidiasis,<i> C. auris</i> was the causative species in 12 (5.5%) patients. <i>C.auris</i> was isolated from blood in 10/12 (83.3%) of these patients and from pus and tissue in one patient each with surgical site infection (SSI). Risk factors identified were the presence of invasive devices, surgical procedures, neutropenia, prolonged ICU stay, previous hospitalization, previous bacterial and fungal infections, prior use of broad-spectrum antimicrobials and antifungals. High MIC to amphotericin B (MIC range 8-16µg/ml) and fluconazole (MIC range 32-64µg/ml) were noted in 11 of 12 isolates. Seven patients with sepsis expired before <i>C.auris</i> infection was reported. In the present study, the isolates of <i>C.auris</i> were multidrug resistant which is a matter of concern. Presence of risk factors that might have led to the nosocomial acquisition of <i>C.auris</i> infection.

Purine and carbohydrate availability drive Enterococcus faecalis fitness during wound and urinary tract infections.

Although E. faecalis is a common wound pathogen, its pathogenic mechanisms during wound infection are unexplored. Here, combining a mouse wound infection model with in vivo transposon and RNA sequencing approaches, we identified the E. faecalis purine biosynthetic pathway and galactose/mannose MptABCD phosphotransferase system as essential for E. faecalis acute replication and persistence during wound infection, respectively. The essentiality of purine biosynthesis and the MptABCD PTS is driven by the consumption of purine metabolites by E. faecalis during acute replication and changing carbohydrate availability during the course of wound infection. Overall, our findings reveal the importance of the wound microenvironment in E. faecalis wound pathogenesis and how these metabolic pathways can be targeted to better control wound infections.

Bursting of the upper jaw prosthesis and fractures of the lower jaw as indirect injury pattern caused by a headshot: a case report

Gunshots to the human body can cause direct and indirect injuries. Direct injuries are a consequence of the projectile guiding its way through the body, creating a permanent wound channel and thereby damaging the penetrated as well as the adjacent tissue. In addition, the temporary wound cavity is responsible for indirect injuries occurring distant to the actual wound tract. This can potentially affect different types of tissue, like blood vessels, organs, or bones, that are not directly passed through by the projectile. For this case report, we describe a suicidal headshot to the temporal area where the extension of the temporary wound cavity and its subsequent collapse led to massive energy transfer to the surrounding tissue leading to breakage of the upper dental prosthesis and fractures of the lower jaw. Thereby outlining the ballistic mechanisms causing indirect injury pattern that have to be considered when examining gunshot wounds.

A deep surgical site infection risk score for patients with open tibial shaft fractures treated with intramedullary nail

ObjectivesTo identify deep infection risk factors in patients with open tibial shaft fractures and to develop a scoring algorithm to predict the baseline deep infection risk in this patient population. MethodsA retrospective cohort study conducted at a single academic trauma center identified patients with open tibial shaft fractures treated with intramedullary nail fixation from December 2006 to October 2020. The primary outcome was a deep surgical site infection requiring surgical debridement. The outcome was identified by Current Procedural Terminology codes and confirmed with a medical chart review documenting evidence of a tibial draining wound or sinus tract. ResultsDeep surgical site infection occurred in 13% of patients (97/769). Factors that predicted deep surgical site infection were identified. Gustilo-Anderson type IIIB or IIIC was the strongest predictor with a 12-fold increase in the odds of deep infection (OR 11.8, p < 0.001). Additional factors included age >40 years (OR 1.7, p = 0.03), American Society of Anesthesiologists score ≥3 (OR 1.9, p < 0.01), Gustilo-Anderson type IIIA vs. type I or II (OR 2.8, p = 0.004), and gunshot wounds (OR 2.9, p = 0.02). The risk scoring model predicted patients who would develop an infection with an acceptable level of accuracy (AUC 0.79). The risk score categorized patients from a low probability of deep infection 2%–6% with <10 points to high risk (58%–69%) with >40 points. ConclusionsThis risk score model predicts deep postoperative infection in patients with open tibial shaft fractures treated with intramedullary nails. The ability to accurately estimate deep infection risk at the time of presentation might aid patient expectation management and allow clinicians to focus infection prevention strategies on the high-risk subset of this population.

Advances in Hydrogel Adhesives for Gastrointestinal Wound Closure and Repair.

Millions of individuals undergo gastrointestinal (GI) tract surgeries each year with common postoperative complications including bleeding, perforation, anastomotic leakage, and infection. Today, techniques such as suturing and stapling seal internal wounds, and electrocoagulation stops bleeding. These methods induce secondary damage to the tissue and can be technically difficult to perform depending on the wound site location. To overcome these challenges and to further advance wound closure, hydrogel adhesives are being investigated to specifically target GI tract wounds because of their atraumatic nature, fluid-tight sealing capability, favorable wound healing properties, and facile application. However, challenges remain that limit their use, such as weak underwater adhesive strength, slow gelation, and/or acidic degradation. In this review, we summarize recent advances in hydrogel adhesives to treat various GI tract wounds, with a focus on novel material designs and compositions to combat the environment-specific challenges of GI injury. We conclude with a discussion of potential opportunities from both research and clinical perspectives.

Ballistic Wound Evaluation Based on Dye Diffusion Method

Ballistic gelatin is widely used as a kind of tissue simulants in wound ballistics. Evaluations of the wound tract of gelatin by projectiles are mainly based on fissures in the gelatin slices. For there are difficulties in building relationships between the areas and the fissures, a new method based on dye diffusion is proposed in this paper. Colored regions in the slices are obtained after penetration of a Chinese 7.62mm rifle bullet into the gelatin block. The colored regions can be divided into ‘X’, ‘I’ and branching ‘I’ shapes. In the second half of the penetration, there is a strong correlation between the areas of the regions and the energy dissipation of the bullet. However, the correlation is poor in the first half of the penetration. Branches of the colored regions mainly distributed at the heads and tails of the permanent cavities. The permanent cavities’ shapes have a great dependence on the nutation angles of the bullets. Orientation angles of the permanent cavities are determined by the precession angles of the bullets.

Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study

IntroductionLittle is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period. MethodsA longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point. Results2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth.Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter.Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum. ConclusionReports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.

Long-term healthcare use after postoperative complications: a prospective analysis of linked primary and secondary care routine data

Postoperative complications are associated with reduced long-term survival. We characterised healthcare use changes after postoperative complications. We linked primary and secondary care records for patients having elective surgery at four East London hospitals from 2012 to 2017, with at least 90 days of postoperative follow-up. We captured pre-specified complications (wound or urinary tract infection, pneumonia, new stroke, new myocardial infarction) using codes recorded within 90 days in primary or secondary care records. Outcomes were change in days of healthcare contact in the 2 yr before and after surgery (‘contact days’), and death in 2 yr. We report change as rate ratios (RaR) with 95% confidence intervals, age as median (inter-quartile range), and adjusted for preoperative healthcare use and confounders with a negative binomial model.

Characterisation and sequencing of the novel phage Abp95, which is effective against multi-genotypes of carbapenem-resistant Acinetobacter baumannii

Acinetobacter baumannii has become one of the most challenging conditional pathogens in health facilities. It causes various infectious diseases in humans, such as wound or urinary tract infections and pneumonia. Phage therapy has been used as an alternative strategy for antibiotic-resistant A. baumannii infections and has been approved by several governments. Previously, we have reported two potential phage therapy candidates, Abp1 and Abp9, both of which are narrow-host-range phages. In the present study, we screened and isolated 22 A. baumannii bacteriophages from hospital sewage water and determined that Abp95 has a wide host range (29%; 58/200). The biological and genomic characteristics and anti-infection potential of Abp95 were also investigated. Abp95 belongs to the Myoviridae family, with a G+C content of 37.85% and a genome size of 43,176 bp. Its genome encodes 77 putative genes, none of which are virulence, lysogeny, or antibiotic resistance genes. Abp95 was found to accelerate wound healing in a diabetic mouse wound infection model by clearing local infections of multidrug-resistant A. baumannii. In conclusion, the lytic phage Abp95, which has a wide host range, demonstrates potential as a candidate for phage therapy against multiple sequence types of carbapenem-resistant A. baumannii.

Epithelial ingrowth after anterior lamellar keratoplasty (clinical observation)

Epithelial ingrowth (EI) is a rarely occurring complication of surgeries on the anterior eye segment characterized by migration and proliferation of epithelial cells along the wound tract or into the anterior chamber. Several decades ago, EI often led to severe complications, including enucleation. Modern treatment methods allow not only removing the pathological focus of EI, but also minimizing the risk of its reoccurrence. This article presents a clinical case of EI after anterior lamellar keratoplasty involving formation of implant bed under the pathological focus without cutting open the interface zone. The technique helps minimize dissemination of epithelial cells in the area of the lesion. To prevent growth reoccurrence, the method was supplemented with application of a cytostatic agent. The treatment resulted in stable remission throughout the follow-up period (26 months).

Characterization of Genus Proteus Isolated from Various Clinical Specimens and Detection of Extended-Spectrum β-Lactamase Production

Background: Among Gram-negative bacteria, the presence of beta-lactamases is a defined modality of resistance to antibiotics of the beta-lactam group. Proteus species also has been showing various degrees of resistance to these groups of antibiotics and thereby appearing multidrug resistant. The aim of our study was to know the occurrence of Proteus species from different clinical samples their antibiotic susceptibility, extended-spectrum β-lactamase (ESBL) production, and the associated patient risk factors. Materials and Methods: This observational descriptive study was done from December 2020 to December 2021. All Proteus isolates obtained from various clinical samples, were biochemically identified, antibiogram, and screening for ESBL production was done using a combination of cefotaxime and cefotaxime clavulanic acid antibiotic discs. Results: Seventy-nine Proteus isolates were obtained from hospitalized patients. In that, Proteus mirabilis was the most common isolate followed by Proteus vulgaris. Proteus infections were common in the age groups of 41–60 years and males were affected more than females. Out of the 79 Proteus isolates 12 were ESBL producers. Among these, 25% of ESBL producers were P. mirabilis and 75% of them were P. vulgaris. Conclusion: The most common isolate was P. mirabilis among hospitalized patients and P. vulgaris was the main ESBL producers when compared to P. mirabilis. These pathogens mainly caused wound and urinary tract infections. The patient age groups ranged mainly from 49–60 years. Diabetes mellitus was the most significant risk factor in these Proteus infections.

Structural insight into substrate binding of Acinetobacter baumannii polyphosphate-AMP phosphotransferase (PPK2), a novel drug target

Acinetobacter baumannii is an opportunistic pathogen known for high morbidity and mortality. It causes life-threatening infections, such as ventilator-associated pneumonia (VAP), bacteremia, meningitis, wound and urinary tract infections (UTI). Increase in carbapenem resistance exhibited by A. baumannii has accentuated the need for novel targets for effective treatment. Despite the pronounced relevance of PPK2 as a pathogenicity determinant in several pathogens, it has not been explored as a drug target in A. baumannii. The present study was piloted to investigate the substrate binding by A. baumannii PPK2 (AbPPK2), a two-domain Class II polyphosphate kinase 2. A homology model of AbPPK2 was developed and validated for molecular docking of ATP and ADP in the predicted binding pocket. Further analysis of AbPPK2 revealed a set of common residues in the catalytic cleft interacting with ATP and ADP which would be useful for the screening of inhibitors against A. baumannii.

ISOLATION OF ENTEROCOCCUS SPP. IN VARIOUS CLINICAL SAMPLE AND THEIR ANTIMICROBIAL RESISTANT PATTERN WITH MIC OF VANCOMYCIN IN PATIENT ATTENDING TERTIARY CARE CENTRE, RIMS, RANCHI, JHARKHAND

Introduction- Enterococci are part of normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections.it is second most common cause of nosocomial infections in gastrointestinal tract, wound and genitourinary tract. To process all the clinicalAim- samples from various department in our hospital, for isolation of Enterococci spp. To speciate the isolates &amp; to have resistance pattern of the isolates of vancomycin total 926 sample were collected from both outMaterial &amp; Methods- patients and in patient in all clinical departments and transported to microbiology laboratory. specimens were processed by inoculating on to blood agar, MacConkey Agar, nutrient agar, potassium tellurite agar and incubated at 37°C for24-48 hr. Enterococci were identified by their typical arrangement in and salt tolerance test Gram stain, bile esculin test and biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum inhibitory concentration (MIC) values were identified by tube dilution methods. Result- a total of 926 sample, 645 (69.72%) were culture positive and 281 (30.28%) were culture negative. Among 645 culture positive cases, 81(12.55%) were Enterococcus faecalis. Antimicrobial susceptibility &amp; MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. the resistance to vancomycin was 1% &amp; further confirmed by MIC via tube dilution methods. In which MIC was ≥32 μg/ml in one isolate. About 8 of Enterococcal strains showed MIC of 0.0125μg/ml. species level identification of Enterococcus is important forConclusions- epidemiological study and also for analysis of drug resistant pattern. Effective detection of vancomycin resistance helps in reducing the morbidity and mortality of VRE in hospitalized patients.

Promising Photocytotoxicity of Water-Soluble Phtalocyanine against Planktonic and Biofilm Pseudomonas aeruginosa Isolates from Lower Respiratory Tract and Chronic Wounds

Alternative methods of killing microbes have been extensively researched in connection with the widespread appearance of antibiotic resistance among pathogenic bacteria. In this study, we report on in vitro antimicrobial phototoxicity research of cationic phthalocyanine with 2-(4-N-methylmorpholin-4-ium-4-yl)ethoxy substituents against selected clinical strains of Pseudomonas aeruginosa isolated from the lower respiratory tract and chronic wounds. The microorganisms tested in the research were analyzed in terms of drug resistance and biofilm formation. The photocytotoxic effect of phthalocyanine was determined by the reduction factor of bacteria. The studied cationic phthalocyanine at a concentration of 1.0 × 10−4 M, when activated by light, revealed a significant reduction factor, ranging from nearly 4 to 6 log, of P. aeruginosa cells when compared to the untreated control group. After single irradiation, a decrease in the number of bacteria in biofilm ranging from 1.3 to 4.2 log was observed, whereas the second treatment significantly improved the bacterial reduction factor from 3.4 to 5.5 log. It is worth mentioning that a boosted cell-death response was observed after the third irradiation, with a bacterial reduction factor ranging from 4.6 to 6.4 log. According to the obtained results, the tested photosensitizer can be considered as a potential antimicrobial photodynamic therapy against multidrug-resistant P. aeruginosa.

Peritonitis Caused by Morganella morganii After Elective Cesarean Section

Morganella morganii belongs to the tribe Proteeae of the Enterobacteriaceae family. This species is considered as an unusual opportunistic pathogen that mainly causes post-operative wound and urinary tract infections. In this case we report a 33 year old multigravid woman presented to the emergency with diffuse lower abdominal pain. She was on her postoperative sixth day after an elective cesarean. Physical examination showed signs of acute abdomen and laboratory findings were consistent with infection. An emergency laparatomy revealed intraabdominal purulent fluis collection and fibrin deposits on organs. Microbiologic culture resulted in M. morganii and appropriate antibiotherapy was applied. The patient was discharged with no further complications. In conclusion, M. morganii is a rare cause of cesarean section related peritonitis and our patient may be the first case of M. morganii peritonitis and the first of monobacterial infection with that organism.

ROLE OF PRE-CESAREAN SECTION CEFOTAXIME IN AMELIORATED POST-CESAREAN COMPLICATION.

The aim: The purpose of this study was to examine the efficacy of cefotaxime before and after skin incision in avoiding post-operative infection complications in caesarean section women, also evaluation the efficacy of cefotaxime in reducing post-caesarean section complications. Materials and methods: We conducted 150 women who undergoing caesarean section in the Obstetrics & Gynecological Department, Babylon government from January, 2021 to March, 2021. The caesarean operations were done by using standard protocols. Each patient was examined daily and post-operative infectious. Women were randomly divided into three groups; each group contains 50 women; Group 1: (control) given normal saline 12 hr. before and after skin incision. Group 2 (pre-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr. before skin incision, and Group 3 (post-operation antibiotic): given single dose of cefotaxime 1 g intravenously 12 hr after operation. Results: The outcome measures were post-operative febrile morbidity, healing period and urinary tract infections, in addition to socioeconomic state of each woman. Conclusions: cefotaxime pre-cesarean section could ameliorate post-operative problems such as infection of surgical wound, febrile, and urinary tract infections.

Study of a novel economical method of surgical management of complex distal tibia fractures with hybrid external fixator

Background and Objectives: Fractures of the distal tibia, especially complex open fractures have been historically difficult to manage due to the poor soft tissue envelope around the bone and the precarious blood supply. In this study, we aim at devising an economical model of a hybrid external fixator for complex distal tibia fractures by using reused Ilizarov rings and A O rods after adequate methods of sterilization and study the functional outcome, time to union and complications associated with it.Objectives: To devise an economical model of hybrid external fixator for the management of complex distal tibia fractures and to study the Functional outcome, Time to union and associated complications.Methods: Total 16 patients with complex distal tibia [AO type 43(A1-A3, B1-B3, C1-C3)] fractures were treated in our institution with an economical model of hybrid external fixator using reused Ilizarov rings and A O rods after adequate methods of sterilization between June 2019 to December 2021. Patients were followed up every 6 weeks till 6 months and then at the end of 1 year. Patients were evaluated for functional and radiological outcome using the Ovadia and Beals scoring criteria. Time to union and Immediate and late complications were analyzed.Results: Total 16 patients were evaluated postoperatively for functional and radiological outcome using Ovadia and Beals criteria which showed 3 patients (18.75%) had well to excellent and 13(81.25%) patients had fair outcome. The average duration for fracture union was 33.25 weeks. 6(37.5%) patients had pin tract infection which was treated with adequate antibiotics and pin tract care. No deep infections were noted. There were 7(43.75%) cases of joint stiffness, 5(31.25%) cases of mal union and 2(12.5%) cases of delayed union. Reusing the non invasive components of the fixator helped us in reducing the overall operating cost of the surgery by 35-40%.Interpretation and Conclusion: In our study, we found that reusing the non invasive components of a hybrid external fixator is an economical treatment option for complex distal tibia fractures when combined with minimal internal fixation of fibula fracture, adequate antibiotic coverage, wound and pin tract care and aggressive physiotherapy.