Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.
Background & objective: Intertrochanteric fractures are becoming increasingly common as our population ages. These fractures typically occur in frail patients with multiple comorbidities The morbidity associated with the fracture can be minimized by choosing appropriate fixation device for the fracture pattern, recognizing the stability of fixation, and performing accurate reduction with ideal implant placement. So, these fractures should be treated expeditiously so that there are minimum fixation failures. In BIRDEM hospital a large number of elderly patients having intertrochanteric femur fractures with multiple comorbidities, are treated by primary hemiarthroplasty. The purpose of this study is to see the clinical outcome of these hemiarthroplasty patients. Methods: This retrospective study was carried out over four years from 2015 to 2019 on 60 patients (42 females and 18 males). All patients had diabetes in common along with other co-morbidities like ischaemic heart disease, hypertension, chronic kidney disease and stroke. The outcome was evaluated by applying Harris Hip Score after intervention. Result: The mean age of the patients was 65.5 years (range: 60-85 years) with male to female ration being 3:7. The mean Harris Hip score at the four-year follow-up was 83.1 ± 10.9. A total of 12(20%) patients were graded as excellent, 30(50%) patients as good, 15(25%) as fair and 3(5%) as poor. It was observed that, patients with AO (Arbeitsgemeinschaft für Osteosynthesefragen) type 31A1 intertrochanteric fractures had better outcome than AO type 31A2 and 31A3 in our study. Conclusion: Primary hemiarthroplasty can provide a stable, pain-free, mobile joint with acceptable complication rates. These fractures must be treated considering patient’s age, bone quality and type of the fracture. Ibrahim Card Med J 2021; 11 (1): 35-40
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