Background: Among the Health care associated infections (HAI), orthopaedic surgical site infections (OSSI) previously termed as post-operative wound infections are one of the most common HAI in low and middle income countries. Increase in OSSI is associated with increased morbidity, as well as mortality due to emergence of antimicrobial resistant pathogens. Understanding the pathogens implicated in causing the OSSIs and their antimicrobial sensitivity place a good role in reducing the mortality and morbidity. Methods: A prospective study was conducted at a tertiary care hospital to all the patients admitted in Department of Orthopaedics for 2 years from January 2017 to December 2018. The demographic data, inclusion criteria and exclusion criteria, risk factors, clinical history, laboratory data with gram stain, culture results and antibiotic sensitivity of the isolates were collected. Results: Two hundred patients were recruited in the study and the prevalence of OSSI in the study was 3.83%. Patients who underwent emergency operations and diabetics were at higher risk of acquiring OSSI. The most commonly isolated pathogens in the study were Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Pseudomonas aeruginosa was most common isolate from orthopaedic cases of OSSI. Conclusions: Study clearly explains the various causes and risk factors associated in development of OSSI. The study guides in the type of the organism isolated and possible antibiotic of choice in treatment and management of OSSI. The prevalence of OSSI was 3.83%, which is comparable with some of the studies and lower than many of the studies.

Unstable osteoporotic intertrochanteric fractures are common in the elderly population. Failure rate of as high as 56% have been noted with internal fixation of unstable fractures mainly due to inadequate purchase in the osteoporotic bone and early full weight bearing. Hemiarthroplasty is a frequently employed alternative as it gives stability and allows immediate full weight bearing. This study evaluates the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. 30 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively from July 2017-july 2019. Patients who were less than 60 years of age, non ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through posterior (Moore's) approach. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. This study included 12 males and 18 female patients with mean age of 73. There were 24 patients with a byod and griffin type 2 injury and 6 patients sustained a byod and griffin tye 3 injury. The average intra operative blood loss was 357 ml and average operative time was 75 mins. On an average patients were allowed to bear full weight on 7 th post operative day. 2 patients had superficial infection and 1 patient had a shortening more than 2 cms. 9 patients had abductor weakness. There were no cases of prosthetic dislocation, periprosthetic fracture, acetabular erosion and stem loosening. Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.

To assess the effectiveness of the two techniques (MIPPO & IMILN) & Compare outcome. Methods: This is a Prospective, Randomized control trial involving 52 cases of extra-articular proximal tibial fractures treated either with MIPPO or IMILN in the Department of Orthopaedics, IMS and SUM Hospital, Bhubaneswar during September 2017 to September 2019. Functional outcome was calculated with Lower extremity functional scale and Knee society score and final outcome with Johner Wruhs criteria.Results: Each group had 26 cases in them, cases were followed-up for an average duration of 11.9 months. 2 cases from MIPPO group and 4 from IMILN group lost follow up. The average time to radiological union in MIPPO group was 16.1 weeks and that in IMILN group was 16.9 weeks. IMILN group had a higher rate of mal-reduction (19.1%) than MIPPO (15.4%). anterior angulation of the proximal fragment was commonest. Superficial infection occurred in 8.3% cases of MIPPO group and 4.5% in IMILN group. Non-union occurred in 1 (4.2%) and 1 delayed union (4.2%) in MIPPO group. Non-union developed in 1 case in IMILN group (4.5%) and 2 cases of delayed union (9.1%). Implant irritation was seen in 2 of our cases (8.3%) in MIPPO group. Anterior knee pain was observed in 2 patients in IMILN group (9.1%). LEFS in MIPPO was 45.8% and IMILN was 40.9%. Final outcome showed excellent result in 50% and 45.4% in MIPPO and IMILN respectively. Conclusions: If principles of treatment are correctly followed, most of cases will have excellent result with either modality of treatment.

Background: Prosthetic Joint Infection that develops at a variable length of time after an index joint replacement procedure is known as LateProsthetic Joint Infection.There must be an asymptomatic period clinical and/or radiographic signs, after an initially successful index procedure. The current study aims to retrospectively identify the risk factors for late PJI following primary total joint arthroplasty and classify those significant risk factors as either non-modifiable or potentially modifiable for intervention prior to surgery. Till date not many studies has been done in Indian subcontinent, which prompted us for the study. Material and Methods: We report our experience in 33 cases of Late PJI and its causative factors including microorganisms and its subsequent management, of deep infection following over 5000 primary joint replacements carried out over 6 years (2013 may to 2019 September) at IMS & SUM Hospital, Bhubaneswar. All patients were followed up for delayed PJI for a minimum period of one year postoperatively involving review of all readmissions, returns to the operating room, positive cultures, morbid obesity, UTI, dental procedures, UGI endoscopy, skin diseases etc. Results: Significant risk factors for late PJI after primary TJA included active tobacco use, diabetes and related comorbidities, S. aureus colonization, UTI, morbid obesity, skin diseases, UGI endoscopy, male gender, age>=55yrs. These risk factors can be broadly divided into modifiable and non-modifiable risk factors. Modifiable risk factors like such active tobacco use and S. aureus colonization can be eliminated to reduce the incidence of late PJI. Conclusion:The current study aims to identify the risk factors of late PJI after primary arthoplasty, thus patients can be counselled properly prior to undergoing TJA, which should help them make treatment decisions regarding these procedures. Apart from this the modifiable risk factors can be addressed prior to surgery, thus the overall incidence of late PJI can be reduced.

With improved life expectancy and ever-increasing geriatric population with concomitant osteoporosis, there is increase in osteoporotic intertrochanteric hip fractures. Even the best surgical advances fail to provide satisfactory and early results. As a result, researchers' focus has lately shifted to developing a more integrated approach that combines the pharmacotherapeutic capabilities of teriparatide, a recombinant version of human parathyroid hormone (1-34), a new anabolic drug that enhances bone mass and strength by promoting osteoblastic activity and hastens fracture union in both human and animals. We attempted to evaluate the therapeutic efficiency of teriparatide therapy on outcomes of surgically managed Intertrochanteric hip fractures in osteoporotic patients. A total of 31 patients with established osteoporosis and Intertrochanteric fractures were selected and divided into two groups, managed surgically with proximal femur nailing, and then prospectively compared with one group receiving teriparatide therapy in addition to standard treatment after taking necessary consent and allocation into two groups based on the preference of patients to take additional teriparatide or not after understanding the benefits and risks involved. We aimed to assess the functional and radiological effects of teriparatide on bone mineral density, the time taken for fracture union, and other fracture-related postoperative complications such as weight bearing and residual bone pain. All patients were followed up at 6, 12, and 24 weeks. Time to fracture union was significantly shortened, with considerable improvement in bone density and functional outcome in the teriparatide group. Varus collapse, the rate of migration of the helical blade, and shortening of the femoral neck were also significantly less in the study group. From the assembled data, we can safely assume that with early union rates with better functional improvement with additional advantage of increased bone mass, we favor supplemental teriparatide therapy in the management of osteoporotic patients with femoral intertrochanteric fractures to augment healing. Further studies with a larger sample size are required to support our observation.