Monteggia fracture dislocations can be classic or equivalents. Equivalents, also known as Monteggia like lesions, are very rare especially type III and IV, which have been added to the literature after Luis Bado presented the original classification system of Monteggia fracture dislocations. Type III equivalent is classically defined as a proximal ulna fracture associated with a fracture of the lateral condyle of the humerus. In the literature only seven such cases have been reported so far. Here we present two such cases where one eight-year-old boy had a complex type of injury with a shear type fracture of the lateral humeral condyle and other a seven-year-old boy who had a plastic deformity of the ulna with an avulsion type fracture of the lateral humeral condyle. We also try to describe a novel mechanism of injury, known as, “Barzulla circle”, for the classical as well as equivalent type III Monteggia fracture dislocations.
In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52%) samples grew no organisms while Staph aureus was grown in 43 samples (26.8%) and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4%) and MSSA in 11 (25.6%). These belonged to 23 (71.8%) males and 9 (28.1%) females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%). Linezolid showed highest sensitivity (100%) followed by Vancomycin (96.8%), Clindamycin (37.5%), erythromycin (21%), Amikacin (21%), Levofloxacin (9.3%), cotrimoxazole (9.3%) and ciprofloxacin (3.1%). By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%). However, on further analysis using MIC only one isolate (3.3%) showed intermediate resistance to vancomycin; 12 cultures (37.5%) were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem. KEYWORDSMRSA, Vancomycin Resistance. HOW TO CITE THIS ARTICLE:Farooq S, Kawoosa AA, Mumtaz MU. Current sensitivity pattern of MRSA (methicillin resistant staph aureus) in a tertiary care orthopaedic hospital in Kashmir (J&K).
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