Abstract

Aim of the study: to assess the early complication rate following k-wiring of distal radial fractures and their final clinical outcome.

Materials & methods: a prospective study. 48 Patients with 50 distal radial fractures (26 male,22 female) with mean age 34 years(range 4–88) were treated by closed k-wiring during the period jan 2005-june 2005.

They were assessed in terms of early complications following mua and k-wiring and their final clinical outcome.

Results: 12 patients(24%)had discharge, pin tract granulation, loosening out of which 4 required antibiotics. Out of 12 only 2(4%) had positive swab culture requiring i.V. Antibiotics

.3(6%)Had symptoms suggesting superficial radial nerve damage of which 2 recovered completely after pin removal. One had residual symptom which got better before planned exploration.

9 Patients (18%)had stiffness of which only 3(6%)had residual stiffness at the end of 6 months. Crps was noted in 1 patient(2%)who recovered after good physio.

There wer nocases of deep infection, osteomyelitis, tendon rupture, pin migration or significant loss of position.

Conclusion: our data suggests that though early complication rate of k-wiring is alarming, it doesnot affect the final clinical outcome of fracture management and this complication can be avoided by proper technique and care.

There is no rationale in giving antibiotic coverage for all the pintract discharges unless swab positive.

Aim: To evaluate the effect of Warfarin, the prevalence of acceptable level of INR by the anaesthetist, leading to delay of surgery in patients with fracture neck of femur and the outcome of such treatment.

Material and Methods: We retrospectively reviewed all patients admitted with fracture neck of femur who were on Warfarin in the year 2002. In total 9 out of 135 pt were on Warfarin.

Their entire medical records were scrutinised.

A control group of similar age, sex and pre- morbid conditions was identified.

A telephone survey was then conducted

In warfarin group average delay in surgery was 4 days (1 to 7) , needed 76% more blood test, total morphine 40mg and Codeine 960mg, 60% longer stay and after all 78% had General anaesthesia.

The six hospital survey showed the estimated number of such patients averaged 2 (1 to 4) per year, delay in surgery of 2 to 5 days and acceptable INR between 1.5 to under 3.

Conclusion: We found that we under estimate the number of patients on Warfarin. These patient had a significant delay in surgery requiring more analgesic both oral and parental, no significant post- op complications but a much longer hospital stay causing significant increase in morbidity, bed block and expenditure. We were surprised that there is no consistently acceptable level of INR to perform the surgery and type of anaesthesia.