Does pin tract infection after external fixator limits its advantage as a cost-effective solution for open fractures in low-middle income countries, a prospective cohort study

OBJECTIVE: To determine the frequency of pin tract infection in external fixator tibia and its effects on the definite fracture fixation and bone healing. METHODS: The prospective study was conducted at Lady Reading Hospital, Peshawar, Pakistan, from August 2017 to July 2018, and comprised patients regardless of age and gender with open fracture tibia Gustillo-Anderson type II and type IIIA. Pin tract infection was assessed following the application of locally made external fixation of tibia open fractures. Follow-up was done fortnightly till soft tissue healing, removal of external fixator and definite fracture healing. Pin tract infection was classifiedand treated according to the Checketts-Otterburn classification system. SPSS 20 was used for data analysis. RESULTS: Of the 117 patients, 95(81%) were males and 22(19%) were females with an overall mean age of 24.7±9.35 years. Pin tract infection was documented in 28(23.9%) patients. Minor and major pin tract infections were reported in 27(96.4%) and 1(3.5%) patient respectively. Soft tissues healed in 27(96.4%) cases. CONCLUSION: External fixator for initial stabilisation of open tibial fractures in all patients is recommende

A Rare Variant of Acute Open Fracture Dislocation of Knee Joint

Acute knee dislocation usually results from high-energy trauma like motor vehicle accidents, fall from significant height and sports related injuries. Early intervention to reduce joint and recognize any limb threatening vascular injury and repair is mandatory. Knee dislocations are usually closed and very rarely associated with proximal tibia or patella fractures. We presented a very unique case of open posterior dislocation of knee joint with medial Hoffa fracture and avulsion of ligamentum patellae without any neurovascular injury. We reduced the knee joint, fixed the fracture and stabilized the patellar tendon. The fracture achieved union and patient had full range of knee motion and full weight bearing without any support or pain. To our knowledge this is the first case in the literature which does not fit into any classification system and not yet reported.&nbsp

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A comparison of distal femoral locking plates for distal femur fractures: long working length versus short working length

Objective: To compare long working length distal femoral locking plates with short working length for treating extra-articular distal femur fractures in terms of union and implant failure. Method: The randomised controlled trial was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from April 28, 2018, to March 10, 2021, and comprised all adult patients of either gender with extra-articular distal femur fractures who were randomised into two groups. Group A was exposed to long working length, while group B had short working length. Patients in both the groups were followed up regularly for one year for the assessment of fracture union and implant failure. Data was analysed using SPSS 22. Results: Group Of the 61 patients, 30(49.2%) were in group A; 24(80%) males and 6(20%) females with overall mean age 37.9±9.6 years. The remaining 31(50.8%) were in group B; 26(83.8%) males and 5(16.1%) females with overall mean age 37.2±1 years. The mean working length in group A was 75±5mm and in group B it was 35±9mm. In group A 28(93.3%) fractures healed, while in group B 19(61.2%) fractures achieved union (p=0.01). Non-union was noted in 2(6.6%) patients in group A and 7(22.5%) in group B (p=0.08). Plate breakage was noted in 3(9.6%) patients and screw breakage in 2(6.4%) patients in group B and none in group A (p=0.0001). Conclusion: Long working length titanium locking plates were found to be better than short working length in achieving fracture union and avoiding implant failure. Clinical Trial Number: ACTRN12619001023145 http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377657&isReview=true Key Words: Bone plate, Bony callus, Femoral fractures, Fracture healings, Internal fixation device, Titanium

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous