Identification of the causative pathogen in musculoskeletal infection is critical as it directs further treatment. Fracture-related infection is often associated with ‘no growth’ in standard culture. We investigated the efficiency of two alternate methods to identify the causative pathogen, namely extended bacterial culture and 16Sr RNA gene sequence analysis with next generation sequencing (NGS) in ‘culture negative’ fracture related infections. Patients were diagnosed as having fracture related infection based on the MSIS criteria (n=120). All patients had samples taken for culture and sensitivity. All samples which were culture negative by standard culture methods formed the study group. These samples were subjected to further extended culture in both aerobic and anaerobic medium for 14 days to improve recovery of pathogens. Further, DNA isolated from implants from a sub-group of these culture negative patients were subjected to 16SrRNA gene amplification followed by Sanger sequencing. Subsequent sequencing analysis was performed using the Illumina NGS platform which identified and detected the most abundant genera/species present in those samples more precisely.Introduction
Method
Outcome of Type II and III (Sander's CT classification) fracture of the calcaneum who underwent open reduction and internal fixation was assessed. Thirty-three type II and III fractures of the calcaneum (all unilateral) underwent open reduction and internal fixation using the ‘extensile lateral approach’. There were twelve Type II and twenty-one Type III fractures. Patients were followed up for a mean of 40.81 months (Range 28 to 62 months). Patients were assessed clinically by the Creighton Nebraska Health foundation score for assessment of fractures of the calcaneum. Radiologically assessment was done comparing the pre and post operativeBohler's and Gissane angles and measuring the calcaneal width on the axial xrays.Background
Methods
Treatment of severe radiocarpal arthritis remains controversial. Since 1992, the newly designed universal total wrist arthroplasty has been used as an alternative to radiocarpal fusion. A total of 49 patients underwent total wrist arthroplasty between 1992 and 1998. A total of 43 patients with 47 wrists were available for follow-up. Thirty-two patients had rheumatoid arthritis, nine patients had osteoarthritis and two patients had Kienboch’s disease. The average age of the patient was 55 years and the average length of follow-up was 42 months. Results at follow-up showed 89% of the wrist were without pain. Neutral alignment was present in 96% of the wrists. A functional arc of motion was present in 87% of the wrists. Ninety-four percent of the patients were satisfied. Radiographs showed excellent alignment of the implant, without evidence of distal migration of the carpal component. Complications occurrred in 12 of 47 wrists (25.5%). Six of the wrists had a dislocation. Three wrists developed metallosis, requiring revision of the prosthesis. One patient required removal of the prosthesis and wrist fusion. The revision rate in this series was 11%. The fusion rate was 2%. Eleven of 12 patients had resolution of their complication with appropriate intervention, and did not require a salvage procedure. This study revealed that total wrist arthroplasty can result in a painless and functional wrist in the majority of patients. We feel that total wrist arthroplasty remains a viable alternative in patients with severe radiocarpal arthritis.
