BackgroundTriceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event.Case DetailsWe present a case of triceps tendon avulsion which was missed in the initial workup by a local practitioner. Careful physical examination and evaluation of the X-rays clinched the diagnosis. The patient was treated surgically by transosseous suture technique using the Krakow method. The end result was a good range of movement and a power equal to the uninjured side. A high index of suspicion, physical examination seeking a palpable gap, and search for a ‘flake’ fracture on lateral radiographs will help make the diagnosis of triceps avulsion. Early recognition of these injuries and prompt intervention are the cornerstones of a successful outcome. A second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or during any unclear joint injury. We recommend a primary repair through a transosseous suture technique using Krakow method for optimal results.

No abstract

BACKGROUND: Surgical site infections in orthopaedic implant surgery is devasting complication range from 1-2% to 22%. It leads to increase case cost, prolongs antibiotic use/abuse, increases morbidity and rehabilitation. METHOD: This prospective cross sectional study was conducted on 624 patients with closed fracture cases undergoing clean and elective orthopaedic implant surgeries admitted at Gandhi Medical College and Hamidia Hospital, Bhopal (Madhya Pradesh), India between '1st November 2013 to 31st October 2014'. RESULTS: The surgical site infection was diagnosed in 43 (6.89%) patients within 30 days after surgery. Klebsiella was most common infective organism islolated in 39.53% cases. On data analysis SSI was significantly associated with increasing age, duration of hospital stay more than 7 days, duration of surgery more than 120 minutes, pre-operative Hb less than 12 gm%, diabetes mellitus, use of intra-operative negative suction and tourniquet. CONCLUSION: Incidence of SSI in implants surgeries are quite high, proper measure are needed to control it. In this study gram negative organism has emerged as major threat in contrast to staphylococcus aureus. KEYWORDS: Surgical site infection, orthopaedic surgery, risk factors. INTRODUCTION:Surgical site infection is an infection that develops within 30 days after an operation or within one year if an implant was placed and infection appears to be related to the surgery. (1) Surgical site infection in orthopaedic implant surgery is devasting complication for both patient and surgeon. Infection is a common post-operative event with incidence ranging from 1-2% to 22 % after orthopaedic implant surgeries. (2)(3)(4) Infection in orthopaedics increase case cost by 300% prolongs antibiotic use, increases morbidity and rehabilitation. (5) Infection in implant surgeries is very difficult to eradicate, because implants provide surfaces for bacterial adherence & formation of biofilm that inhibits penetration of antibiotics. (6) Main risk factors for occurrence of infection are advanced age, diabetes, smoking, malnutrition, obesity, immune impairment, rheumatoid arthritis, infection in other part of body and anemia. (7) An early SSI present within 30 days of surgical procedure, where as an infection is described as intermediate if it occurs between one and three months and late if it develops more than three month after surgery. (8) Early infections are mainly caused by highly virulent microorganisms eg. Staphylococcus aureus and gram negative bacilli, while delayed and late SSI are caused by low virulence microorganism like coagulase-negative staphylococci. (9) The purpose of this study to evaluate incidence of post-operative wound infection, to evaluate risk factor associated with SSI, to know spectrum of organism in clean orthopaedic implant surgeries.

No abstract

BACKGROUND:Plate osteosynthesis is the most commonly used technique for the treatment of diaphyseal forearm fractures in adults. However, application of a plate can disrupt the periosteal blood supply and necessitates skin incision that may be unsightly, and there is a risk of refracture if the implant is removed. The purpose of this study was to assess the early results of the use of closed intramedullary nail to stabilize displace diaphyseal fractures of both bones forearm. AIMS OF STUDY: 1.To evaluate the results of internal fixation of diaphyseal fractures of both bones forearm treated by plate osteosynthesis and closed intramedullary nailing. 2. To compare the functional results of the two groups treated with plate osteosynthesis and closed intramedullary nailing. 3. To review the literature on the treatment of diaphyseal fractures of forearm bones. METHODS: From September 2006 to October 2008 in the Department of Orthopaedics and Traumatology, Gandhi medical college and associated Hamidia Hospital, Bhopal, total of 38 patients of both bones forearm fractures were treated. Eighteen (18) patients with were treated with plate osteosynthesis and 20 patients with closed intramedullary nailing using the square nails. Total 31 patients were available for the follow up. Average follows up in plate osteosynthesis group was 14.1 months and in closed intramedullary nailing group was 15 months, with range from 12 months to 21 months. Functional results were assessed by Anderson et al criteria (1975). RESULTS: Average surgery time in plate osteosynthesis group was 68 minutes, and in closed nailing group was 43 minutes. In plate osteosynthesis group radius showed union in 14 (93.2%) patients and ulna in 13 (86.8%) of patients, in closed nailing group both radius and ulna resulted in 100% union rate. In plate osteosynthesis group there was 1 deep infection, 1 implant failure, and 3 nonunion. Functional results in plate osteosynthesis group were excellent in 12 (80%) of patient, satisfactory in 1(6.6%), failure in 2(13.2%). There was no unsatisfactory result in this group. In closed nailing group result were excellent in 11(68.7%), satisfactory in 4(24.8%), unsatisfactory in 1(6.2%) and no failure. CONCLUSIONS: Our experience indicates that the advantage of closed intramedullary nailing for fractures of both bones forearm are that it is technically straightforward, it allows high rate of osseous union, and it requires less surgical exposure and operative time, less risk of infection than does plate osteosynthesis for diaphyseal fractures of both bones forearm in adults. The disadvantage of this system is that post-operative immobilization is required until bridging callus is observed at the fracture site and radiation hazard to patient and surgeon. We conclude that closed intramedullary nailing is not superior to plate fixation but can be considered as an alternative to that method for diaphyseal forearm fractures in adults. KEYWORD: forearm nailing, forearm plating. INTRODUCTION:Fractures of the radius or ulna...