Introduction: Hot swollen knee joints are a common presentation in clinical practice. It has wide differential diagnoses, the most serious being septic arthritis. Delayed or inadequate treatment leads to joint damage. Arthroscopic lavage should be planned appropriately after proper clinical assessment and investigation. Other differential diagnoses like crystal arthritis, reactive arthritis, monoarticular inflammatory arthritis should be considered.

Patients and Methods: This retrospective audit involved 44 patients who had arthroscopic knee lavage for suspected septic arthritis from January 2005 to May 2007. Analysis included the aspects of adequate backup supportive evidence for the procedure, the time from diagnosis to operation and postoperative antibiotic regime.

Results: There were 29 males and 15 females with age group ranging from 11 to 91 yrs. Fever was present in 15 patients(34%), preoperative joint aspiration done in 22(50%), peri-operatively pus found in 11(25%). 13 patients(29.5%) had procedure done within 6hrs, causal organism identified in 25%. Follow-up ranged upto 12 months without persistence or reactivation.

Discussion: Arthroscopic lavage is a useful adjunct in treatment of septic arthritis of knees but proper patient selection with systematic approach considering other possible differential diagnoses is important for avoiding unnecessary operations.

In 1990 an estimated 1.3 million hip fractures occurred worldwide. Clostridium difficile diarrhoea has emerged as a healthcare associated infection of great clinical and economic significance especially in the frail and vulnerable group of fracture neck of femur patients. The major risk factor is peri-operative antibiotic exposure especially cephalosporins. A retrospective audit was performed to study the effect of C. Difficile in operated fracture neck of femur patients.

All the patients who were diagnosed with C. Difficile infection after an operated fracture neck of femur at the District general hospital from April 2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intravenous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

A total of 1023 patients underwent surgery for fracture neck of femur during the three years of study period. The average age of the patients was 81 years. 80% of the patients were females. A total of 62 patients suffered from C. Difficile diarrhoea (6%) after the arthroplasty procedure, and within this cohort, 29 patients died during the same admission to the hospital (47%). The average length of stay for a patient with fracture neck of femur was increased from 23.4 to 60 days in those affected with C. Difficile.

The patients with fracture neck of femur are generally elderly with poor body reserves. C.difficile infection in such patients not only adds to the morbidity, but also causes significant increase in the mortality rate. Propagation of simple infection control measures such as hand-washing and isolation and change of peri-operative antibiotic protocol led to a statistically significant reduction in the incidence of C.Difficile infections after fracture neck of femur surgery.

Introduction: In 1990 an estimated 1.3 million hip fractures occurred worldwide, a figure which is expected to double by 2025 and increase to 4.5 million by 2050.

Clostridium difficile associated diarrhoea (CDAD) has emerged as a healthcare associated infection of great clinical and economic significance especially in the frail and vulnerable group of fracture neck of femur patients. A major risk factor for the development of CDAD in patients who undergo operation for fracture neck of femur is the perioperative antibiotic exposure, with cephalosporins being particularly implicated. The type ‘027’ strains of C. Difficile are multi-resistant and cause severe morbidity and mortality. A retrospective audit was performed to study the effect of C. Difficile infection in operated fracture neck of femur patients.

Material and Methods: All the patients who were diagnosed with C. Difficile after an operated fracture neck of femur at the District general hospital during the three year study period from April 2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intravenous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

Results: A total of 1023 patients underwent surgery for fracture neck of femur during the three years of study period. The average age of the patients was 81 years. 80% of the patients were females. A total of 62 patients suffered from C. Difficile diarrhoea (6%) after the arthroplasty procedure, and within this cohort, 29 patients died during the same admission to the hospital (47%). The average length of stay for a patient with fracture neck of femur was increased from 23.4 days to 60 days in those affected with C. Difficile diarrhoea.

Discussion: The patients with fracture neck of femur are generally elderly, frail and with poor body reserves. C.difficile infection in such patients not only adds to the morbidity, but also causes significant increase in the mortality rate. The broad spectrum peri-operative antibiotics used to prevent infection generally render the patient vulnerable to this highly lethal hospital bug. Introduction of simple infection control measures such as hand-washing and isolation, and change of peri-operative antibiotic protocol led to a statistically significant reduction in the incidence of C. Difficile infections after surgery for fracture neck of femur.

Introduction: Clostridium difficile associated diarrhoea (CDAD) has emerged as a healthcare associated infection of great clinical and economic significance. C. difficile is thought to cause about a quarter of cases of antibiotic-associated diarrhoea overall, but accounts for a greater proportion of more severe disease. The type ‘027’ strains are multi-resistant and cause severe morbidity and mortality. A retrospective audit was performed to study the effect of C. Difficile infection in elective orthopaedic surgery patients (hip/knee arthroplasties)

Material and Methods: All the patients who were diagnosed with C. Difficile after a primary elective joint arthroplasties, performed at the District general hospital during the three year study period from April2004 till March 2007 were included in the present study. All patients received the routine peri-operative antibiotic prophylaxis of three doses of intra-venous cefuroxime. Data collected included age, sex, duration between operation and the onset of diarrhoea, length of stay and associated mortality.

Results: A total of 1430 patients underwent primary hip or knee arthroplasties during the three years of study period. A total of 32 patients suffered from C. Difficile diarrhoea (2.2%) after the arthroplasty procedure, and within this cohort, 5 patients died during the same admission to the hospital (0.35%). The average length of stay for an elective lower limb joint arthroplasty was increased from 10 days to 43 days due to the affection with C. Difficile diarrhoea.

Discussion: C. difficile infection not only adds to the morbidity, but also causes significant increase in the mortality rate after elective joint replacement. The broad spectrum peri-operative antibiotics used to prevent infection after a joint replacement generally render the patient vulnerable to this highly lethal hospital bug. Introduction of simple hygiene measure such as hand-washing and change of peri-operative antibiotic protocol lead to a statistically significant reduction in the incidence of C. Dificcile infections after elective joint replacement surgery without compromising arthroplasty results.

Aim: To assess the implications of implementation of the NICE Guidelines for indication for CT scan in head injury patients.

Methods and Materials: A retrospective audit of the patients attending our district general hospital with head injuries over a period of one year from October 2004 till Sept 2005. A total of 3150 patients attending the A & E during the study period were diagnosed to have head injuries. The study involved review of the case notes and radiology results of the 135 patients requiring inpatient treatment for head injury. During this tenure the CT scan was requested depending of the clinical judgement of the attending physician.

Results: Rigid compliance with the NICE Guidelines during the study tenure would have entailed an additional workload of 36 patients requiring a CT scan, of which 28 patients justified the scan during out of hours period.

One elderly patient with a fatal intracerebral bleed was found to have justified an early CT scan on the criteria of more than one vomiting episode and a history of unconsiousness.

Discussion: The NICE Guidelines were found to be implemented in most cases admitted during working hours. A reluctance to perform CT scan was encountered during out of hours. A strict compliance with the guidelines would entail on average one additional CT scan every fortnight during the ‘out of hours’ period. Implementation of NICE Guidelines was found to tighten the net (justify CT scan) in order not to miss subtle early signs of potentially fatal head injuries.