Dr. Chaitanya Kishore Gopisetty

Description:Femoral shaft fractures are the most common major paediatric injuries managed by the orthopedic surgeon. Non-surgical management, usually with early spica cast application, is preferred in younger children. In the older child, traction followed by casting, external fixation, flexible IM Nails and plate fixation have specific indications. Potential complications of treatment include shortening, angular or rotational deformity, delayed union, Nonunion, over growth, skin problems and scarring. Risks of surgical management includes re-fractures after external fixator or plate removal, osteonecrosis after rigid IM nails fixation and soft tissue irritation caused by ends of flexible nails.

Description:Introduction Peri-prosthetic joint infection (PJI) is one of the most challenging complications after total joint arthroplasty (TJA) surgeries. This study aims to (i) compare overall PJI rates with and without pre-operative nasal screening and decolonization for Staphylococcus aureus ; (ii) estimate the difference in SSI rates between carriers and non-carriers undergoing TJA; and (iii) determine the efficacy of decolonization in reducing PJI rate in nasal carriers. Methods A total of 760 patients were included in the study; with 399 patients in the study group, who underwent pre-operative screening and decolonization for nasal colonization with S. aureus ; and 361 patients in the control group, who did not undergo pre-operative screening for nasal colonization. Patients were followed for 90 days post-surgery, and PJI rates were recorded following the Centers for Disease Control SSI criteria. Results Twenty-one (5.26%) out of 399 patients in the study group developed PJI as opposed to 38 (10.53%) out of 361 patients in the control group. PJI rate due to either MSSA or MRSA was 2.5% in the study group (10/399) as opposed to 7.75% in the control group (28/361), with “ P value” of 0.002 (<0.05). Discussion The overall SSI incidence was reduced by 51% after implementing the decolonization protocol. Regarding specific S. aureus SSI, 7.5% of the SSIs in the control group were caused by S. aureus, while only 2.5% were caused by this microorganism after implementing the screening and decolonization protocol. Conclusion Implementing a screening and decolonization protocol for S. aureus before TJA can lead to a significant reduction in S. aureus surgical site infections.