Open fractures of the long bones of the limbs are associated with an increased risk of osteomyelitis and few studies investigate this complication in circular frames. We reviewed the incidence of and contributory factors toward infection-related outcomes in Grade 3 open fractures, managed with a circular frame, at a single centre. We performed a retrospective study of consecutive adult patients presenting with a Grade 3 open fracture, who required a circular frame for definitive skeletal fixation from 2005 to 2014. Patient case notes, microbiology results and radiological studies were reviewed for demographic details and surgical management. Infection-related outcomes were classified as ‘possible’ and ‘definitive’, based on clinical findings, microbiology and imaging features at follow-up at 6 and 12 months. 74 patients were identified with an average age of 43 years. There were 70 unilateral and 4 bilateral limb injuries. Most treated limbs had a tibial fracture (97%). There were 24 Gustillo-Anderson grade 3A, 37 grade 3B, 4 grade 3C and 9 not sub-classified. 33% of patients were debrided on the day of injury. Average time to circular frame installation was 14 days. 27 Ilizarov, 44 Taylor spatial and 3 other circular frames were used. A variety of plastic surgery reconstruction was used to provide wound coverage: skin grafts, local and free flaps. Circular frames were in place for 259 days on average. 10 patients (1 bilateral limb fracture) still have their frames in-situ. Additional bone grafting to the fracture site was carried out in 13 patients and 15 limbs (1 patient had 2 episodes of bone grafting to the same limb). 8 limbs in 8 patients were excluded from infection-related outcome analysis: 4 patients lost to follow-up, 2 patients who went on to below knee amputation and 2 patients had <6 months’ follow-up. 13 patients (14 limbs) had only 6 months’ follow-up and 53 patients (56 limbs) had 12 months’ follow-up. There were 5 patients (5 limbs) with ‘possible’ infection (7%): 1 screw infection and 4 soft tissue infections. 1 patient (1 limb) had a tissue-confirmed ‘definitive’ infected non-union (1.4%). Patients managed with circular frames typically have complex fracture configurations less amenable to other methods of definitive fixation. Our patient cohort has a limb salvage rate (97%) and a soft tissue infection rate (‘possible’ infection) comparable to other reported series. We report a low rate of osteomyelitis (‘definitive’ infection) in consecutive patients managed using our protocol.
Chronic osteomyelitis is a challenging problem and a growing burden for the National Health Service. Conventional method of treatment is 2 stage surgery, with debridement and prolonged courses of antibiotics. Recently single stage treatment of chronic osteomyelitis is gaining popularity due decreased patient morbidity and cost effectiveness. Dead space management in single stage treatment is accomplished by either a muscle / myocutaneous or antibiotic loaded calcium sulphate beads. We analysed the cost effectiveness of two dead space management strategies in single stage treatment of osteomyelitis. Study is designed to analyse the health economics at 2 time points; 45 days post surgery and 2 years post surgery. We report preliminary results at 45 days post surgery. Setting – Level 1 trauma centre and university hospital Approval – Ethics committee approved study 10 patients in each group were retrospectively analysed through patient records. Each group was identified for standard demographics, duration of procedure, hospital stay, type and duration of postoperative antibiotics, number of out patient visits in first 45 days and recurrence of infection. Table attached details the results of both groups In health technology assessment four quadrant model, CSB appears in quadrant II suggesting that it is more cost effective. Based on small data set and on assessment only evaluating cost, at 45 days assessment, antibiotic calcium sulphate beads from a Health Economic Cost Effectiveness Analysis offers a better economic outcome. This is holding constant the morbidity of the patients and effectiveness, assuming both treatments are standards of care, which is best evaluated at 24 months. Biocomposites for funding the cost of health economist.Acknowledgements
Flexor tendon injuries of the hand are common with an incidence of over 3000 per annum in the UK. These injuries can affect hand function significantly. Early treatment with optimal repair is crucial to prevent disability. This study aimed at investigating the re-rupture rate following primary flexor tendon repair at our institution and to identify potential risk factors for re-rupture. 100 flexor tendons' injuries that underwent primary repair over a one-year period were reviewed retrospectively. Data was collected on age, gender, occupation, co morbidities, injured fingers, hand dominance, smoking status, zone of injury, time to surgery, surgeon grade, type of repair and suture, and antibiotic use on included patients. Causes of re-rupture were examined. We compared primary tendon repairs that had a re-rupture to those that did not re-rupture. Univariate and multivariate analysis was undertaken to identify the most significant risk factors for re-rupture.Introduction/Aim
Methods
Chronic osteomyelitis still remains challenging and expensive to treat in spite of advances in antibiotics and operative techniques. We present our experience with free muscle flap after radical debridement of chronic osteomyelitis, performed as a single stage procedure. We retrospectively identified eight patients (5 Females) with mean age of 63 yrs (Range 40–71 yrs) Case notes were reviewed for co morbidities, Pre and post treatment inflammatory markers (plasma viscosity and CRP) and clinical staging. Mean follow up was 3 yrs (Range 1–6 yrs) All the patients were jointly operated by orthopaedic and plastic surgeons and underwent thorough debridement and muscle flap (Seven free flaps and one rotational flap) in the same sitting. All the patients were reviewed regularly by plastic and orthopaedic surgeons. Seven patients had free Gracilis flap and one had Triceps flap. Clinical assessment of reinfection was made on presence of erythema and wound discharge. Primary outcome measure was resolution of infection.Aim
Methods
Chronic osteomyelitis still remains challenging and expensive to treat inspite of advances in antibiotics and operative techniques. We present our experience with free muscle flap after radical debridement of chronic osteomyelitis, performed as a single stage procedure. We retrospectively identified eight patients (5 Females) with mean age of 63 yrs (Range40–71 yrs) Case notes were reviewed for co morbidities, Pre and post treatment inflammatory markers (plasma viscosity and CRP) and clinical staging. Mean follow up was 3 yrs (Range 1–6 yrs) All the patients were jointly operated by orthopaedic and plastic surgeons and underwent thorough debridement and muscle flap (Seven free flaps and one rotational flap) in the same sitting. All the patients were reviewed regularly by plastic and orthopaedic surgeons. Seven patients had free Gracilis flap and one had Triceps flap. Clinical assessment of reinfection was made on presence of erythema, wound discharge, pain and swelling. Primary outcome measure was resolution of infection.AIM
METHODS
