Gentamicin, whether administered either intravenously, incorporated into bone cement or for local intra-operative irrigation, is a commonly used antibiotic in orthopaedic practice. The former two have been well studied, however the literature on the therapeutic efficacy and safety of gentamicin irrigation is sparse. The objective of this study was to assess systemic absorption of gentamicin irrigation in joint replacement surgery. This was a non-randomised, prospective study. Ninety-eight patients (group A) who underwent total joint replacement and 40 patients (group B) who underwent hemi-arthroplasty were treated intraoperatively with gentamicin irrigation. Serum gentamicin levels were assayed at 4 hours and 24 hours post-surgery. Sixteen of 98 patients in group A (16%) and 12 out of 40 patients in group B (30%) were found to have serum gentamicin level above 2mcg/ml at 4 hours post-surgery. We conclude that intra-articular gentamicin irrigation is systemically absorbed at substantial levels.
Radial head and neck fractures are the most frequently seen elbow fractures. The usual cause of this injury is a fall onto an outstretched hand with a partly flexed elbow. We report here an unusual case of bilateral non-displaced radial neck fractures in a patient who presented with complaints of pain in both elbows following a simple fall. This case highlights the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury.
Background: There are increasing incidences of stab injuries in the UK and most of them are alcohol or drug related.Aims: To study the pattern and epidemiology of stab injuries in an inner city teaching hospital.Materials and methods: We studied retrospectively all cases of stabbing injuries by intention reported to the Accident and Emergency Department of an inner city teaching hospital between January and December 2004. A total of 23 cases were reported. All cases of deliberate self harms and accidental injuries were excluded.Results: Majority (35%) of the patients were of the age group 21-30 yrs. 73% of injuries were involving the extremities.44% of these injuries were caused by knife, 22% by screwdrivers and the remaining were pencils (13%), needles (8.7%), broken bottles (4.3%) and unknown objects (8.7%).While 18 patients were treated and discharged from A&E, 7 patients required admission in which 4 required major surgeries under GA.X-rays were the commonest investigation modality performed (12), while 4 of them required CT scans.52% of the patients were not given antibiotics while 30% had IV antibiotics and the remaining was oral.While no follow up was required for 14 patients, 3 left against medical advice despite major chest and abdominal injuries and 2 did not attend the out patient clinic.Conclusion: Vast majority (78%) of patients were of productive workforce of the society. Despite high extremities involvement (75%), Orthopaedic referrals were minimal. The majority of injuries were minor and most of the victims were male and of these, the age group 21-30 yrs form the greatest number. No fatalities were seen in this period from impalement injury. A multidisciplinary team approach is essential in managing major impalement injuries.
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