Surgical anatomy II [January 2018]

basic lecture on applied surgical anatomy principles in orthopaedic

Approach to OSCE [January 2018]

tips and tricks on facing the part 1 orthopaedic masters OSC

Approach to OSCE [June 2018]

tips and tricks on how to face the orthopaedics masters part 1 OSC

Surgical anatomy II [June 2018]

an introductory lecture for budding surgeons on applied surgical anatomy in orthopaedic

Hip fixation

lecture on the most recent concepts on hip fixations and the biomechanics behind i

Low back pain - an update

latest low back pain updates in literatur

Bone and joint reconstruction using ilizarov circular external fixation device

Introduction: Ilizarov circular external fixation device is a versatile external fixation device which can be used for bone and joint reconstruction such as fracture fixation, bone transport, lengthening, shortening, and correction of deformity and contracture. It is a complex procedure and requires patients understanding, motivation, pin site care and rehabilitation to ensure successful treatment and avoiding complication. The aim of this study was to review cases of bone and joint reconstruction using Ilizarov external fixation device. Materials and Methods: From 2006 till 2018, 59 patients with the mean age of 34.8 (10-69) years old underwent these procedures. There were 49 tibias, three femurs, one humerus, three elbows, two knees and one ankle reconstruction. 18 open fractures, 16 non- union, seven tibial plateau fractures, 10 implant related infections, one valgus mal-union and one shortening. There were also 4 dislocations and two flexion contracture. The procedure that were done include 31 bone transport, 18 fracture fixation, three joint reduction, two correction of flexion contracture, two shortening of tibia and one each for lengthening, deformity correction and arthrodesis. Results: Forty seven (80%) patients achieved the objective of operation: 41 fractures united, three joints were reduced, two achieved knee extension and one deformity corrected. Five developed non-union, of which two not compliant to treatment, two had failed bone transport and one died during the treatment due to medical problem not related to the Ilizarov fixation. Conclusion: Ilizarov circular external fixation is an effective device for joint and bone reconstruction in majority of patients

Outcome following treatment of diaphyseal femoral osteomyelitis using a monolateral external fixation system

Background: The traditional monolateral fixation is not strong enough to overcome the strong deforming force of the strong adductor muscles which lead to varus deformity. The ring fixation, although provide a stable fixation of bone, is bulky and uncomfortable for the patients. This paper presents our result of treating patients with femoral osteomyelitis treated with a modern unilateral external fixation device. Methods: This was a prospective study of 22 consecutive patients treated for femoral osteomyelitis from 2010 till 2014. Only patients with minimal 2 years follow up were included in the study. The mean age of the patients was 28.7 (range 13 to 71) years old. Patients with osteomyelitis were divided into 3 types. type I is haematogenous osteomyelitis with pathological fracture (4 patients); type II is infected open fracture (3 patients) and type III is implant related infection (15 patients). Patients with type I osteomyelitis is treated initially with incision and drainage, and skeletal traction. External fixation is inserted after 2 to 3 weeks when the thigh swelling has reduced. In patients with type II osteomyelitis, the fracture end is resected until healthy bone. In type III osteomyelitis, the implants (2 intramedullary nails and 13 plates) are removed during the initial debridement. In 18 cases, acute compression was done after resection. In 4 cases, bone transport was done to fill the defect after the infection has been controlled. Results: Infections were resolved in all patients. All except one achieve union with mean union time of 8.5 (range 4-30) months. The mean limb length discrepancy is 2.2 cm (range 0-6 cm). Six patients (27%) have refracture following removal of the external fixation. One refracture because of persistence infection at the docking site. Three refracture at the docking site; one underwent interlocking nail, one reinsertion of LRS and one refuse further intervention. One patient had refracture at the thin bone segment. The fracture end was allowed to be overlap to get a bigger bone diameter and he was treated with reinsertion of external fixation and lengthening. One adolescent patient had fracture at the screw site was treated with skin traction. Conclusions: Monolateral external fixator is an effective alternative for stabilisation and reconstruction of femoral osteomyelitis. Caution should be taken when removing the frame to reduce the incidence of refracture. Acknowledgements: We do not have any conflict of interest in this study

Microbiological study of etiological pathogen in early infection of open fracture in orthopedics

Introduction: Infection is a dreaded complication of open fracture in the field of orthopaedics. This study was conducted to evaluate the susceptibility of microorganism involved in early infection of open fractures to current prophylactic antibiotics practice and determine the association of various characteristics to the resistance of such microorganisms. Materials and Methods: This cross sectional study was conducted from January 2015 to December 2017 in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia. A total of 179 cases were collected from the operating record with 110 cases fulfilling the inclusion and exclusion criteria. The patients underwent routine debridement where culture and sensitivity were followed up. Previous notes were traced to identify the various risk factors involved and evaluated against resistance of microorganism. Statistical analysis was done with SPSS version 23 applying Pearson chi-square tests and Fisher's exact test. Results: Admission to intensive care unit, blood transfusion, antibiotic regime and duration, fracture grade, injury severity score and duration of admission were all significantly associated with resistance of microorganism (p < 0.0001). This study also demonstrated 65.9% predominance of Gram-negative microorganisms. These gram-negative microorganisms were seen more in higher fracture grades, injury severity score, and longer duration of admission or antibiotics prescribed. The overall resistance to cefuroxime and gentamicin were 68.6% and 36.9% respectively. Conclusion: The shift of microorganism species to gram-negative and the high rate of resistance suggested that current antibiotic guidelines and regime needed to be fine-tuned to achieve optimal results in managing open fracture

Microbiological study of etiological pathogen in early infection of open fracture in orthopedics

PURPOSE: To evaluate the susceptibility of microorganism causing early infection in open fractures to current antibiotic prophylaxis and determine contributing factors towards development of resistance. METHODS: A total of 110 cases of open fractures were selected in this study. They underwent routine debridement and C&S were followed up. Risk factors to antibiotic resistance were identified. RESULTS: Admission to ICU, blood transfusion, antibiotic regime and duration, fracture grade, injury severity score and duration of admission were significantly associated with resistance of microorganism. There was Gram-negative predominance of 65.9%. The overall resistance to Cefuroxime was 68.6% and 36.9% to Gentamicin. Staphyloccoccus aureus and MRSA were the commonest Gram-positive while Pseudomonas and Acinetobacter Gram-negative. DISCUSSIONS: Resistance in open fracture is not well established unlike rate of infection. Previous studies reported predominant Gram-postive microorganisms which form the basis of prophylactic antibiotics1 . Hannigan et al. reported increasing multi-drug resistance bacterias in open fractures2 . Carsenti-Etesse et al. reported resistance was influenced by type and duration of antibiotics while others have described various other factors3 . CONCLUSION: The high resistance of microorganisms and shift to predominantly Gram-negative microorganisms is alarming. Further measures are needed to achieve optimal outcome. REFERENCES: 1. Gustilo, R.B., (1971). Management of open fractures. An analysis of 673 cases. Minnesota Medicine, 54(3), pp.185–189 2. Hannigan, G.D. et al., 2014. Cultureindependent pilot study of microbiota colonizing open fractures and association. Journal of Orthopaedic Research, 32