Microbiology of post-operative wound infection in implant surgery

Background: Open reduction and internal fixation (ORIF) of fractures with implants and prosthesis has become the first line in the management of fractures in most trauma centres. Incidentally, this is associated with post-operative wound infection which is accompanied by significant morbidity, cost and mortality. The objective of this paper was to identify the pattern of the bacteriological isolates responsible and their antimicrobial sensitivityMethod: We prospectively studied two hundred and fifty-four patients who had ORIF with implants and prosthesis that fulfilled a set of inclusion criteria. Post-operative wound infection was diagnosed based on the criteria of the National Research Council and follow-up was for twelve weeks. Aerobic and anaerobic cultures were carried out on each specimen.Results: Two hundred and fifty-four patients were recruited and 19 had post-operative wound infection. The infection rate was 7.5%.Plates and screws were the commonest implant. Thirty-six bacterial isolates were recovered. Staphylococcus aureus was the commonest in 16 cases (44%), Bacteroides fragilis 4(11%), Escherichia coli 4(11%), Proteus spp.4 (11%).Others were Pseudomonas spp, Klebsiella spp. and Peptostreptococcus. Cephalosporins were found to be the most potent against Staphylococcus aureus while the anaerobes responded favourably to metronidazole.Conclusion: Staphylococcus aureus remains the most important microorganism responsible for POWI in implants and prosthesis. Resistant strains have emerged and previously reserved drugs have become first line. Anaerobic organisms remain important isolates were such are feasible. Metronidazole should be a component of the antibiotic regimen where such cultures are not feasible

Comparative Study of Oxidative Spoilage Effect on Margarine and Palm Oil Sold in Makurdi Benue State Nigeria

Palm oil and Margarine are consumed in substantive quantities in various communities of Benue State Nigeria and so require attention especially in the areas of their handling and preservation . Palm oil is one of the few highly saturated vegetable fats and is semi-solid at room temperature. Like most plant-based products, palm oil contains very little cholesterol. Margarine is a manufactured, vegetable-oil-based substitute for butter made through a multi-step process whereby vegetable oils are extracted from corn, cottonseed, soybeans or safflower seeds. Their exposure to atmospheric conditions makes their wholesomeness a thing of concern especially their taste and colour.According toR. MacRae, R.K. Robinson, and M.J. Sadler (1993) as soon as a food, feed, or ingredient is manufactured, it begins to undergo a variety of chemical and physical changes. Oxidation of lipids is one common and frequently undesirable chemical change that may impact flavor, aroma, nutritional quality .Margarine also become rancid when exposed to air , heat , light and in some cases even the oxidized fats which interact with proteins and carbohydrates causing changes in texture.The peroxide value PV test is a usual test that measures the stability of various foods and so in 45 days margarine and palm oil were kept in a laboratory exposed atmosphere at an average temperature of 30oC and the measured peroxide value PV of margarine was an average of 0.346 meq/kg , while that of palm oil 0.186 meq/kg showing slower tendency of oxidative reactivity of palm oil and its stability on exposure compared to margarine . Keywords: Oils, Volatiles, Peroxides, Saturation, Manufactured

Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs

Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs

Infection risk in Gustilo and Anderson type III tibia and fibular fractures treated with external fixation in a tertiary hospital of a developing country

Background: Open fractures of the tibia and fibula present with multiple management challenges of wound care, bone stabilization, potential risk of infection and its control. Attempt to resolve this problem, stabilization of the fracture with external fixators was introduced. However, this procedure predisposes infection too. This was an overview of the disposition of infection in the course of managing type III fractures in our center.Methods: This was a retrospective study of disposition of infection in Gustilo and Anderson type III open fractures of the tibia and fibula treated with external fixation device over ten years in Jos university teaching hospital. Data extracted from patients records and operation notes included age, sex, nature of open fracture with respect to Gustilo and Anderson classification in theater. Wound culture reports extracted early and weeks after commencement of treatment. The findings were analyzed using Epi info statistical software version 3.5.3.Results: A total of 74 patients, 63 (85.1%) males and 11 (14.9%) females (M:F=5.7:1) with mean age of 37.97±13.57 years. The mean duration of injury-presentation time was 13.48±38.73 days, 41 (55.4%). Patients that present with clinical infection were 40 (54.1%) among which staphylococcus aureus was isolated in 21 (28.3%). While treatment was on, the flora became altered. Motor cycles were responsible for 25 (33.7%), gunshots 20 (27%), motor vehicle injuries 19 (25.6%) while pedestrians accounted for 9 (12.2%).Conclusions: Type III fractures sustained from high energy risk of infections due to late presentation in our setting. Bacterial isolates tend to alter in course of hospitalization

Femoral Shaft Fractures: Management and Outcome in Nigerian Children.

Traditionally, majority of femoral shaft fractures in children are managed by conservative methods with good results. Recently, there is a trend towards operative treatment. This study aims to determine the indications and outcome of dynamic compression plating in children and adolescents. This was a-10-year prospective study of open reduction and internal fixation carried out in three hospitals in North Central Nigeria. Data analysed included personal demographic data, aetiology, hospital of primary treatment, indications for surgery, methods chosen, duration of hospitalization and time to mobilization. Follow upwas till removal of implants. Thirty-one patients were treated by dynamic compression plating during this period.Therewere 20males (64.5%) and 11 females (35.5%), with a mean age of 12.1(±3.3) years. Twenty-one (67.7%) fractures resulted from road traffic accidents, 9 (29.0%) from falls and one (3.3%)was spontaneous pathological fracture. Twenty patients (64.5%) presented first to the traditional bone setters while 11(35.5%) to orthodox hospitals.The indications for interventionweremainly due to malunion of fractures in 20 (64.5%) and surgeons\'/parents\' preference in six (19.4%) patients. The mean duration of hospitalization was 4 (SD±1.7) weeks. Fracture union was achieved in 8-13 weeks (mean = 10 ±1.7) weeks. Infection rate was 3.2% and mal-union occurred in one (3.2%) patient who had osteogenesis imperfecta. Compression plating is a suitable option in treatment of childhood and adolescent femoral fractures. Keywords: Femoral shaft fracture, Compression plating, traditional bone setters, children and adolescents.African Journal of Paediatric Surgery Vol. 4 (1) 2007: pp. 33-3

Cost of treatment of paediatric femoral shaft fractures: compression plating versus conservative treatment

Objective: Economic considerations are an essential part of good surgical practice especially in the face of ever rising cost of health care in a depressed economy. This paper compares the cost effectiveness of compression plating and traction in paediatric femoral shaft fractures. Methods: A-ten-year comparative multi-centre study in which children 5-16 years who had open reduction and internal fixation (ORIF) with dynamic compression plates were compared with children who had conservative management by traction. A cost analysis was done using duration of hospitalization and direct cost as economic indices. Patients were matched for age, sex, area and type of fracture, cause of injury (one case of osteogenesis imperfecta is on record) and indication for surgery. Results: Thirty-one patients who had ORIF and 31 matched controls were recruited from a pool of 775 children who sustained femoral fractures over the study period. There were 42 (67.7%) males and 20 (32.3%) females. Forty-seven (71.0%) resulted from road traffic accidents, 17 (27.4%) from fall from heights and one (1.6%) pathological fracture from osteogenesis imperfecta. The right femur was affected in 34 (54.8%) and the left in 28 (45.2%) cases. The commonest type of fracture was oblique in 30 (48.4%), transverse in 19 (30.6%) and spiral in 13 (21.0%) patients. The mean duration of hospital stay for ORIF was 3.9(±1.7) and 6.4(±1.2) weeks for the conservative group (

Microbiology of post-operative wound infection in implant surgery

Background: Open reduction and internal fixation (ORIF) of fractures with implants and prosthesis has become the first line in the management of fractures in most trauma centres. Incidentally, this is associated with post-operative wound infection which is accompanied by significant morbidity, cost and mortality. The objective of this paper was to identify the pattern of the bacteriological isolates responsible and their antimicrobial sensitivity Method: We prospectively studied two hundred and fifty-four patients who had ORIF with implants and prosthesis that fulfilled a set of inclusion criteria. Post-operative wound infection was diagnosed based on the criteria of the National Research Council and follow-up was for twelve weeks. Aerobic and anaerobic cultures were carried out on each specimen. Results: Two hundred and fifty-four patients were recruited and 19 had post-operative wound infection. The infection rate was 7.5%.Plates and screws were the commonest implant. Thirty-six bacterial isolates were recovered. Staphylococcus aureus was the commonest in 16 cases (44%), Bacteroides fragilis 4(11%), Escherichia coli 4(11%), Proteus spp.4 (11%).Others were Pseudomonas spp, Klebsiella spp. and Peptostreptococcus. Cephalosporins were found to be the most potent against Staphylococcus aureus while the anaerobes responded favourably to metronidazole. Conclusion: Staphylococcus aureus remains the most important microorganism responsible for POWI in implants and prosthesis. Resistant strains have emerged and previously reserved drugs have become first line. Anaerobic organisms remain important isolates were such are feasible. Metronidazole should be a component of the antibiotic regimen where such cultures are not feasible

Femoral neck fractures: A prospective assessment of the pattern, care and outcome in an orthopaedic centre

OBJECTIVE: To review the pattern of femoral neck fractures, complications and outcome following fixation with Austin-Moore endoprosthesis. METHOD: A two year prospective study in patients who had fracture of the femoral neck based on strict inclusion criteria. All the patients were treated by Austin-Moore hemiathroplasty via the classical southern approach. Complications were ocumented as they developed and probable causative factor evaluated. Minimum follow up was 32 completed weeks. OUTCOME MEASURES: Interval between surgery and mobilization, return to full activity and modification of lifestyle after surgery. RESULTS: Thirty patients were recruited, 21 males and 9 females with a mean age of 67.4 years. Twenty (66.7%) sustained injuries in a road traffic accident. Garden's grade 3 and 4 were the most common types. The presence of co-morbid factors and initial management by traditional bonesetters caused delay in instituting definitive surgery. Infective complication was the most common complication; mainly post operative wound infection (20.0%) urinary tract infection (23.3%) and upper respiratory tract infection(30.3%).Existing co-morbid factors, prolonged pre-operative stay, duration of operation and invasive ancillary procedures were responsible for these. Twenty (66.7%) patients had returned to full mobilization at 12 weeks of follow-up. CONCLUSION: Austin-Moore hemiathroplasty is the preferred choice of fixation in elderly Nigerians especially if displaced. Correction of co-morbidfacors pre-operatively, antithrombotic prophylaxis, perioperative antibiotics and early mobilization should form the cornerstone of treatment if good outcome is to be expected. KEY WORDS: Femoral neck, Austin-Moore endoprosthesis, co –morbid factor. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 42-4

Orthopaedic Implants And Prosthesis: Economic Costs Of Post-Operative Wound Infection

OBJECTIVE: To assess the economic impact of post-operative wound infection in trauma patients who had open reduction and internal fixation with implants and prostheses following fractures of the femur. METHOD: This is a 2-year case controlled prospective study carried out at the National Orthopaedic Hospital, Lagos. Patients who had ORIF for femoral fractures with plate/screws, Kuntscher nails or Austin-Moore endo- prosthesis were recruited bases on strict inclusion criteria. Infection was diagnosed using the epidemiological criteria defined by the National Research Council. Matched controls were manually selected for patients who developed POWI. RESULTS: Two hundred and fifty-one patients fulfilled the inclusion criteria out which 17 developed POWI (rate 6.8%). Each of these was matched with a control. Thirty-four patients were therefore recruited into the study. There were 17 males and 17 females (M:F=I:I).The mean age for the test group was 49.2 (20-76)years and the control was 49.6(21-82)years. There was no statistically significant difference in any of the matched parameters. Mean duration of post-operative hospitalization was 38.80 days for the test and 20.60 days for the controls (