We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.
The aim of this study was to introduce a modern, engaging and easily accessible approach to medical education. A virtual journal club (VJC) was established for the orthopaedic trainees of Ethiopia using instant messaging via Viber. Group discussions included research articles, case reports and radiographs. In addition, senior participants posed quiz questions, with a leaderboard for best performance. Finally, a satisfaction survey was conducted using Google Forms. We have accumulated data from the first five months of educational activity with 73 participants. Seven articles were analysed and debated, covering a broad range of orthopaedic topics, with 56 messages per article on average and 60 quiz questions overall. Our survey received 20 responses, where 95% perceived the VJC as superior to the traditional journal club. Instant messaging is recommended as an educational tool, utilised as an effective VJC. It provides continuous interactive distance learning, without the restrictions of traditional methods.
Locked posterior shoulder dislocation is a rare injury and is often missed on examination, usually due to inadequate imaging and potentially resulting in significant loss of shoulder function. An important feature of the physical examination is identification of the patient's inability to externally rotate their arm. These injuries are associated with defects in the humeral head articular surface, also known as reverse Hill-Sachs lesions. Medium-sized defects involving 25% to 50% of the articular surface can be reconstructed using several methods, including subscapularis or lesser tuberosity transfer, rotational osteotomy of the humerus, osteochondral autografting, and allograft reconstruction. We describe reconstruction of a 40% anteromedial humeral head articular surface defect associated with a missed locked posterior shoulder dislocation. Our technique used a deltopectoral approach with soft tissue dissection through the rotator interval to enable direct access to the defect with preservation of the rotator cuff muscles. The impacted articular surface was elevated, and the void was filled with moldable putty consisting of tricalcium phosphate with carboxymethylcellulose (Calstrux; Stryker Biotech, Hopkinton, Massachusetts). The articular fragment was then secured in position with size 5 Ethibond (Ethicon, Inc, Somerville, New Jersey) bone sutures. The patient regained excellent function and range of motion, with computed tomography scanning at 9 months demonstrating a smooth humeral articular surface with excellent graft incorporation. This technique avoids donor site morbidity and potential risks with allograft use while maintaining normal shoulder joint anatomy with preservation of the rotator cuff muscles for less complicated prosthetic reconstruction if required in the future.
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