A Study of The Bacteriological Profile of Chronic Osteomyelitis in A Tertiary Care Referral Centre: A Contemporary Study

Chronic osteomyelitis is a huge burden on healthcare, especially in developing and poorer countries. With emerging antibiotic resistance patterns and increase in the incidence of Multi drug resistant (MDR) organisms, this challenge has gotten bigger. The notion that previous patterns would remain is being challenged now. We wanted to examine the trends in chronic osteomyelitis causing organisms in the contemporary era.    Materials and Methods: The study included 76 chronic osteomyelitis patients who were admitted to the hospital during the course of the study period. During surgery, a deep culture was obtained intra-operatively then submitted for bacteriological examination. Results: Males made up 81% of the instances examined in our study, while females made up 19%. With 84.21% of the cases, the lower limb was more often affected. In 44.73% of the cases, the femur was the most commonly impacted bone; the tibia (35.52%), humerus (11.29%), and radius (3.94%) were the next most common affected bones. In 71.05% of the cases, the culture was affirmative with mono-microbial proliferation; in 5.26% of the cases, polymicrobial growth was seen; while in 23.68% of the cases, the culture was sterile. In haematogenous osteomyelitis (HOM), which accounted for 65.21% of cases, Staphylococcus aureus was more prevalent than in implant- or trauma-related infections (26.41%). Younger age groups have higher rates of HOM. 40.32% of isolates were Gram-negative bacteria, while 59.67% were Gram-positive bacteria. Escherichia coli dominated the group of isolates that were Gram-negative (9.67%). Gram-negative organisms were uncommon in HOM cases and abundant in those with a history of trauma or implant in situ. The most frequent predisposing factor was a history of prior orthopaedic surgery with implant in situ (74.19%), and in 37.09% of the cases, hemorrhagic infection was discovered. Conclusion: The most frequent predisposing factor (74.19%) overall in our analysis of chronic osteomyelitis was a history of previous orthopaedic surgery with implant in situ, while 37.09% of the cases had a haematogenous infection. Gram-negative organisms were frequently linked to cases with a history of trauma. But Staphylococcus aureus (46.77%) continues to be the most prevalent agent, followed by Psuedomonas aueroginosa (8.06%), Escherichia coli (9.67%), and Enterobacter cloacae complex (8.06%). 58.62% of the isolates of Staphylococcus auerus were resistant to methicillin. Staphylococcus aureus was the most frequent cause of HOM, accounting for 65% of cases. Gram-positive bacteria remain more prevalent than Gram-negative bacteria, despite the rise in the prevalence of the latter. Of the cultures, 59.67% showed Gram positivity, whereas 40.32% contained Gram-negative organisms

Wide resection and stabilization of ulnar stump by extensor carpi ulnaris for giant cell tumor of distal ulna: two case reports

The distal end of ulna is an extremely uncommon site for primary bone tumors in general and giant cell tumor in particular. Wide resection is usually indicated in such cases and at times it may be necessary to remove of a long segment of the distal ulna. Any ulnar resection proximal to the insertion of pronator quadratus can lead to instability in the form of radio-ulnar convergence and dorsal displacement (winging) of the ulnar stump. This can result in diminution of forearm rotation and weakness with grasp. Stabilization of the ulnar stump after resection for a giant cell tumor was described by Kayias & Drosos. We are adding two more cases to the literature. Both patients had excellent functional outcome and there were no instances of recurrence at three years of follow-up