A DESCRIPTIVE STUDY OF BACTERIOLOGICAL SPECTRUM OF ORTHOPEDIC IMPLANT INFECTION IN CLOSED FRACTURES

Background: Surgical Site Infection (SSI) is defined as pain associated with erythema, induration, local tenderness, pus discharge or any culturepositive or negative discharge from a surgically created wound. Methods: Hospital based Descriptive type of Observational study conducted on Patients in the department of Orthopaedics. Results: Total 5.00% patients have wound infection. Gram positive 80.00% patients have found with Staph. Aureus and Gram negative 20.00%patients have found with Pseudomonas. Conclusion: Infection in closed fractures with implants was quite high. The adverse outcome of SSIs related to a clean orthopedic surgical procedure can be associated with significant morbidity, cost, and even mortality. Keywords: Infection, SSI, Fracture

A DESCRIPTIVE STUDY OF BACTERIOLOGICAL SPECTRUM OF ORTHOPEDIC IMPLANT INFECTION IN CLOSED FRACTURES

Background- Surgical Site Infection (SSI) is defined as pain associated with erythema, induration, local tenderness, pus discharge or any culture positive or negative discharge from a surgically created wound. Methods- Descriptive type of Observational study conducted on Patients in the department of Orthopaedics. Results- 6.00% patients have wound infection. Gram positive 83.33% patients have found with Staph. Aureus and Gram- negative 16.67% patients have found with Pseudomonas. Conclusion- Infection in closed fractures with implants was quite high. The adverse outcome of SSIs related to a clean orthopedic surgical procedure can be associated with significant morbidity, cost, and even mortality. Keywords- SSI, Closed, Implants

Droopy swelling behind the ear lobe mimicking cyst or cancer

Epidermoid and dermoid cysts occur anywhere from the skin covering the body. Clinicians and Surgeons often have an indicative impasse as there are plenty of cystic lesions in the Head and Neck region. Clinically, these cysts are asymptomatic that appear as uniform, round, doughy masses with a tiny surface opening. If by chance cyst gets infected the lining ruptures that spills out cheesy keratin debris into surrounding soft tissue giving rise to local tenderness and swelling.

A DESCRIPTIVE STUDY OF BACTERIOLOGICAL SPECTRUM OF ORTHOPEDIC IMPLANT INFECTION IN CLOSED FRACTURES

Background: Surgical Site Infection (SSI) is defined as pain associated with erythema, induration, local tenderness, pus discharge or any culture positive or negative discharge from a surgically created wound. Methods: Hospital based Descriptive type of Observational study conducted on Patients in the department of Orthopaedics in teaching hospitals attached to S.M.S Medical College and hospital. Results: 6.2% patients have wound infection. Gram positive 87.5% patients have found with Staph. Aureus and Gram negative 12.5% patients have found with Pseudomonas. Conclusion: Infection in closed fractures with implants was quite high. Th e adverse outcome of SSIs related to a clean orthopedic surgical procedure can be associated with significant morbidity, cost, and even mortality. Keywords: Infection, Closed, Implants

An Investigation of Medial Tibial Component Overhang in Unicompartmental and Total Knee Replacements Using Ultrasound in the Outpatient Department

Tibial component overhang is known to be a contributor to worse outcomes in knee arthroplasty. The aim of this study is to investigate the presence of tibial component overhang, and whether overhang correlates to a higher local tenderness in both medial unicompartmental and total knee replacements. Also, to determine if a rotational projection phenomenon is presented with radiographs when investigating tibial component overhang. A prospective study, including 64 participants, was performed, where ultrasound measurements were compared with postoperative radiographs. Local tenderness was measured as a pressure pain threshold, determined at 3 months postoperatively using algometry. Sixty-two of sixty-four patients had an underdiagnosed medial overhang on radiographs, with a mean difference of 2.4 mm between radiographs and ultrasound (p < 0.001), presenting a rotational projection phenomenon. When comparing sites with ultrasound measured overhang to sites without overhang measured by ultrasound, a higher local tenderness was observed (p < 0.001). A positive linear correlation was found between patients' overhang and local tenderness (r = 0.2; p = 0.045). Subgroup analysis of medial overhang showed significantly higher tenderness than all other locations. No significant differences were seen for lateral overhang. An apparent rotational projection phenomenon of overhang on radiographs was seen, and a linear association between overhang and local tenderness was demonstrated. This study warrants the use of ultrasound when a surgeon is presented with a patient with postoperative medial tenderness, but no overhang can be seen on radiographs. It should also raise awareness of implant selection and positioning during surgery, especially avoiding the overhang to be localized directly medially.

Incidence of tennis elbow and association of hand grip strength among college students

Background: Lateral epicondylitis is an overuse injury involving the origin of common extensor tendon at elbow joint. Among the college students there is more complaint on wrist and elbow. Objective was to find out the incidence of tennis elbow & grip strength among the students during the entire academic year.Methods: Three hundred and seventy subjects fulfilled the inclusion criteria with age respondents between seventeen to twenty four years. This study is done in those students who have local tenderness on palpation over the lateral epicondyle (grade 2). NPRS was used for measuring the pain intensity. Mill’s test and Cozen’s test was performed to confirm the tennis elbow. The subject is asked to squeeze the dynamometer three times with left and right hand respectively. There was one minute resting period between each squeeze were taken into account.Results: The incidence of confirmed tennis elbow was 4.05% & 2.70% in right and left respectively. Among those participants Mill’s test was positive in 16.2% on right and left side and Cozen’s test was positive in 8.1% on right side and 5.4% on left side. The mean rank of left and right grip strength for the students who are confirmed as tennis elbow were 52.75 Kg and 50.67 Kg and for not-confirmed were 36.56 Kg and 36.41 Kg respectively.Conclusions: The study concluded that 6.7% incidence rate of tennis elbow was observed in college students during the entire academic year. And also concluded there is no much significance correlation between grip strength and tennis elbow incidence rate.

EFFECT OF SRI LANKAN TRADITIONAL MEDICAL FORMULAE (KADUM BIDUM VEDAKAMA) ON FRACTURE HEALING (BHAGNA CHIKITSA) (AN OBSERVATIONAL CASE STUDY)

Distal radius fracture is one of the most common fractures with an incidence of 195.2/100,000 persons per year. The objective of this study was to observe the effect of different drug formulae used in traditional medicine in Sri Lanka for the fractures. 46 years old female patient with distal end radius fracture was se-lected from traditional orthopedic dispensary at Rathnapura district in Sri Lanka. Duration of the study was 5 weeks. It was observed that six prescriptions were used for the treatment. Improvements of main clinical features i.e. Sandhi Shula (Pain), Sandhi Shotha (local swelling), Sparsha Asahyathawa (local tenderness), Sandhi Hanthi (Impairment of functions) and Vikruthitha (Visible and palpable deformity) were analyzed by using prepared scoring system along with the line of treatment. Significant improvements were observed after the treatment. Pharmacodynamic properties of the main ingredients in the formulae support the rapid recovery of the presenting clinical features.

Pressure Algometry for the Detection of Mechanical Nociceptive Thresholds in Horses

The clinical assessment of pain is subjective; therefore, variations exist between practitioners in their ability to identify and localize pain. Due to differing interpretations of the signs or severity of pain equine practitioners may assign varying levels of clinical significance and treatment options. There is a critical need to develop better tools to qualify and quantify pain in horses. Palpation is the most common method to detect local tenderness or sensitivity. To quantify this applied pressure, pressure algometry has been used to gradually apply pressure over specified landmarks until an avoidance response is noted, which is defined as the mechanical nociceptive threshold (MNT). Numerous studies have used pressure algometry in different applications to measure MNTs in horses. There is an acute need to establish normative values within different body regions and to develop standardized methods of testing MNTs to better guide practitioners in the diagnosis and treatment of pain. The aim of this systematic review was to summarize the evidence for the use of pressure algometry in horses. There is good evidence that pressure algometry is a repeatable, semi-objective method that can be used in a wide array of clinical and research applications to assess MNTs in horses.

Synovial plica of the elbow and its clinical relevance

A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies). Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica. Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping. Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis. Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy. The arthroscopic resection is effective and safe if conservative treatment fails. Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027

Pleurisy Can Cause Chest Wall Tenderness: A Case Report

Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also.