Management of Infected Non – Unions

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Vol 2 | Issue 2 |  July – Dec 2017 | Page 25-31 | John Mukhopadhaya

Authors: John Mukhopadhaya [1]

[1]Department of Orthopaedics and Joint Replacement, Paras HMRI Hospital, Patna, Bihar, India.

Address of Correspondence
Dr. John Mukhopadhaya
Department of Orthopaedics and Joint Replacement,
Paras HMRI Hospital, Patna, Bihar, India.
Email: mukhoj@gmail.com

Abstract

Infected nonunions are difficult problems to tackle. The treatment is often multistaged and involves high expenses and has major impact on both patient as well as surgeons. Understanding of the basics of infected non-union including etiopathology, diagnostic criteria and management algorithms is helpful in successfully managing this complication. This article provides a basic overview of infected nonunions along with new methods of management including Masquelet technique and techniques of managing bone gaps
Keywords: infected non-union, diagnosis, management

References

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How to Cite this article:  Mukhopadhaya J. Management of Infected Non-unions. Journal of Clinical Orthopaedics July-Dec 2017; 2(2):25-31

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Acute Osteomyelitis and Septic Arthritis in Children – Current Concepts in Diagnosis and Management

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Vol 2 | Issue 2 |  July – Dec 2017 | Page 16- 24 | Chintan Doshi, Kailash Sarathy, Alaric Aroojis

Authors: Chintan Doshi [1], Kailash Sarathy [1], Alaric Aroojis [1]

[1] Dept of Paediatric Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, India.

Address of Correspondence
Dr. Alaric Aroojis
Department Of Paediatric Orthopedics,
Bai Jerbai Wadia Hospital For Children,
Parel, Mumbai – 400012, Maharashtra, India
Email : aaroojis@gmail.com

Abstract

Acute osteomyelitis and septic arthritis are the most common cause of morbidity in childhood. These occur more commonly in children upto 5 years of age. The most common organism responsible is Staphylococcus aureus, however, many other organisms are also known to cause osteoarticular infections in children. These infective conditions demand a prompt diagnosis and management, as any delay can lead to joint destruction, instability, deformity and significant limb length discrepancy. Thus early diagnosis and prompt management are of importance to achieve optimal goals. The clinical presentation of a child with osteoarticular infection is typical; with presence of fever, swelling and inability to move the affected extremity. However, sometimes the typical clinical findings are missing. Therefore it is important to follow a specific clinical, laboratory and imaging work-up to reach a definitive diagnosis. Following appropriate diagnosis, the further management protocol should be followed, with appropriate choice and dose of antibiotics and surgical debridement as required. The aim of this review article is to discuss the current concepts in acute osteomyelitis and septic arthritis in children. This article discusses the recent literature on etiological organisms, pathophysiology, current trends in investigations and management of osteoarticular infections in children.
Keywords : Acute osteomyelitis, Septic arthritis, Osteoarticular Infection.

References

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3. Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ. 2014;20;348.
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6. Godley DR. Managing musculoskeletal infections in children in the era of increasing bacterial resistance. JAAPA. 2015;28(4):24-9.
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8. García-Arias M, Balsa A, Mola EM. Septic arthritis. Best Pract Res Clin Rheumatol. 2011;25(3):407-21.
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10. Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A, Ontario Group A Streptococcal Study Group. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Pediatrics 2000;105(5):e60-.
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15. Song KM, Sloboda JF. Acute hematogenous osteomyelitis in children. J Am Acad Orthop Surg. 2001;9(3):166-75.
16. Copley LA. Pediatric musculoskeletal infection: trends and antibiotic recommendations. J Am Acad Orthop Surg. 2009;17(10):618-26.
17. Hollmig ST, Copley LA, Browne RH, Grande LM, Wilson PL. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. 2007;89(7):1517-23.
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19. Unkila-Kallio L, Kallio MJ, Peltola H, Eskola J. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994;93(1):59-62.
20. Chou AC, Mahadev A. The use of C-reactive protein as a guide for transitioning to oral antibiotics in pediatric osteoarticular infections. J Pediatr Orthop. 2016;36(2):173-7.
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22. Caird MS, Flynn JM, Leung YL, Millman JE, Joann GD, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. J Bone Joint Surg Am. 2006;88(6):1251-7.
23. Rosenfeld S, Bernstein DT, Daram S, Dawson J, Zhang W. Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 2016;36(1):70-4.
24. Maharajan K, Patro DK, Menon J, Hariharan AP, Parija SC, Poduval M, Thimmaiah S. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. J Orthop Surg Res. 2013;8(1):19.
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27. Song KM, Boatright KC, Drassler J, Strom MS, Nilsson WB, Bevan W, Burns JL. The use of polymerase chain reaction for the detection and speciation of bacterial bone and joint infection in children. J Pediatr Orthop. 2009;29(2):182-8.
28. Choe H, Inaba Y, Kobayashi N, Aoki C, Machida J, Nakamura N, Okuzumi S, Saito T. Use of real-time polymerase chain reaction for the diagnosis of infection and differentiation between gram-positive and gram-negative septic arthritis in children. J Pediatr Orthop. 2013;33(3):28-33.
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30. Laine JC, Denning JR, Riccio AI, Jo C, Joglar JM, Wimberly RL. The use of ultrasound in the management of septic arthritis of the hip. J Pediatr Orthop B. 2015;24(2):95-8.
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32. Browne LP, Mason EO, Kaplan SL, Cassady CI, Krishnamurthy R, Guillerman RP. Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children. Pediatric radiology. 2008;38(8):841-7.
33. Kan JH, Young RS, Yu C, Hernanz-Schulman M. Clinical impact of gadolinium in the MRI diagnosis of musculoskeletal infection in children. Pediatr Radiol. 2010;40(7):1197-205.
34. Peltola H, Pääkkönen M, Kallio P, Kallio MJ, Osteomyelitis-Septic Arthritis Study Group. Short-versus long-term antimicrobial treatment for acute hematogenous osteomyelitis of childhood: prospective, randomized trial on 131 culture-positive cases. The Pediatric infectious disease journal. 2010;29(12):1123-8.
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How to Cite this article: Doshi C, Sarathy K, Aroojis A. Acute Osteomyelitis And Septic Arthritis In Children – Current Concepts In Diagnosis And Management. Journal of Clinical Orthopaedics July-Dec 2017; 2(2): 16-24

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Changing paradigms in the management of Open Injuries

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Vol 2 | Issue 2 | July – Dec 2017 | Page 5-10 | Dheenadhayalan Jayaramaraju, Sivakumar SP, Raja Bhaskara Kanakeshwar, Devendra Agraharam, Ramesh Perumal, Arun Kamal C, Rajasekaran Shanmuganathan

Authors: Dheenadhayalan Jayaramaraju [1], Sivakumar SP [1], Raja Bhaskara Kanakeshwar [1], Devendra Agraharam [1], Ramesh Perumal [1], Arun Kamal C [1], Rajasekaran Shanmuganathan [1]

[1] Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, Coimbatore, Tamil Nadu

Address of Correspondence
Dr Raja Bhaskara Kanakeshwar
Ganga Hospital, Coimbatore
Email : rajalibra299@gmail.com

Abstract

Open injuries still pose a major problem as they are prone to higher rates of infection and non-union and are usually associated with life threatening polytrauma. Nowadays, specialized trauma centres and a multimodal team approach have shown to give superior results in the outcome following open injuries. Early aggressive wound debridement followed by early fracture stabilization with early wound closure to achieve bone and soft tissue healing are important components as nowadays we focus on the ‘Era of functional restoration’. Serum Lactate is a widely used biochemical marker to assess the adequacy of tissue resuscitation and the Ganga Hospital Open Injury score (GHOIS) has a higher specificity towards limb salvage and also gives guidelines regarding timing and type of soft tissue reconstruction. A combined ‘Orthoplastic’ approach in the management of open injuries and adherence to the ‘revised reconstruction ladder’ with regarding to wound coverage has shown to a favourable outcome.
Keywords : Open fractures, Debridement, Serum lactate, Ganga Hospital Open Injury score.

References

1. Dabezies EJ and D’Ambrosia RD. Treatment of the multiply injured patient: plans for treatment and problems of major trauma. Instructional course lectures 1984; 33: 242-52.
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4. Simons R, Eliopoulos V, Laflamme D, and Brown DR. Impact on process of trauma care delivery 1 year after the introduction of a trauma program in a provincial trauma center. The Journal of trauma 1999; 46: 811-5; discussion 815-6.
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6. Pollak AN. Timing of debridement of open fractures. The Journal of the American Academy of Orthopaedic Surgeons 2006; 14: S48-51.
7. Carsenti-Etesse H, Doyon F, Desplaces N, and et al. Epidemiology of bacterial infection during management of open leg fractures. Eur J Clin Microbiol Infect Dis 1999; 18: 315-323.
8. Kreder HJ and Armstrong P. The significance of perioperative cultures in open pediatric lower-extremity fractures. Clinical orthopaedics and related research 1994: 206-12.
9. Lee J. Efficacy of cultures in the management of open fractures. Clinical orthopaedics and related research 1997: 71-5.
10. Patzakis MJ. Orthopedics-epitomes of progress: The use of antibiotics in open fractures. The Western journal of medicine 1979; 130: 62.
11. Edwards CC, Simmons SC, Browner BD, and Weigel MC. Severe open tibial fractures. Results treating 202 injuries with external fixation. Clinical orthopaedics and related research 1988: 98-115.
12. Emami A, Mjoberg B, Ragnarsson B, and Larsson S. Changing epidemiology of tibial shaft fractures. 513 cases compared between 1971-1975 and 1986-1990. Acta Orthop Scand 1996; 67: 557-561
13. Rajasekaran S and Giannoudis PV. Open injuries of the lower extremity: issues and unknown frontiers. Injury 2012; 43: 1783-4
14. Gustilo RB. Management of infected fractures. Instructional course lectures 1982; 31: 18-29.
15. Rajasekaran S, Naresh Babu J, Dheenadhayalan J, Shetty AP, Sundararajan SR, Kumar M, and Rajasabapathy S. A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures. The Journal of bone and joint surgery. British volume 2006; 88: 1351-60.
16. Rajasekaran S and Sabapathy SR. A philosophy of care of open injuries based on the Ganga hospital score. Injury 2007; 38: 137-46.

How to Cite this article: Dheenadhayalan J, Sivakumar SP, Kanakeshwar RB, Agraharam D, Perumal R, Arun KC, Rajasekaran S. Changing paradigms in the management of Open Injuries. Journal of Clinical Orthopaedics July-Dec 2017; 2(2): 5-10.

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Prosthetic Joint Infection – How to Deal with it Rationally

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Vol 2 | Issue 2 |  July – Dec 2017 | Page 11-15 | Shantanu Patil, Anshu Shekhar, Sachin Tapasvi

Authors: Shantanu Patil [1], Anshu Shekhar [2], Sachin Tapasvi [2].

[1] Department of Translational Medicine and Research, Kattankulathur Campus, SRM University, India.
[2] The Orthopedic Speciality Clinic, Pune, India.

Address of Correspondence
Dr Shantanu Patil
Department of Translational Medicine and Research,
Kattankulathur Campus, SRM University, India
Email: shantanusp@gmail.com

Abstract

Prosthetic Joint Infection is a devastating complication both for the patient and the surgeon. It depends on many factors including patient factors, surgeon factors, surgery set up. The most important factor in management of PJI is to take care of all modifiable factors that can bring down the rate of infection. One of the critical steps is in prevention of surgical site infections and raising awareness among the surgeons and patients about the role of various screening procedures and avoiding indiscriminate antibiotic abuse. Management option includes one stage or two stage exchange arthroplasty, but the success rates are less than 90%. At times salvage surgeries like fusion, excision arthroplasty or amputation may also be needed. The present article overviews the prevention and management of PJI
Keywords: Prosthetic Joint Infection, arthroplasty, revision, salvage

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How to Cite this article: Patil S, Shekhar A, Tapasvi S. Prosthetic Joint Infection – How to deal with it Rationally. Journal of Clinical Orthopaedics July-Dec 2017; 2(2):11-15

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