Introduction: Tourniquets are commonly employed in surgical procedures of the knee. The use of the same tourniquet on a repetitive basis without a standard protocol for cleaning has recently been questioned as a potential source of cross-infection. This study examines the contamination of the tourniquets in our institution and results of cleaning the tourniquets with a disinfectant and detergent wipe.

Material and methods: Tryptone soya agar plates were used to take samples from 20 tourniquets employed in knee replacement. Four specified sites on each tourniquet were cultured and incubated at 37° for 48 hrs.

Results: All sampled tourniquets were contaminated with colony counts varying from 9 to > 385.

Coagulase negative Staphylococcus was the most commonly grown organism from the tourniquets (96%).

Some tourniquets had growths of important pathogens including MRSA, Pseudomonas and Staphylococcus aureus (these organisms have not been previously cultured from tourniquets). On cleaning five tourniquets with clinell (detergent and disinfectant) wipes, there was a 99.2% reduction in contamination of the tourniquets five minutes after cleaning.

Conclusion: Contamination is more worrying in relation to pneumatic tourniquets, as they are commonly employed in knee surgery where implants are frequently used with the tourniquet lying within inches of the operative wound.

We have found a 99% reduction in contamination of tourniquets by employing disinfectant wipes. This is a simple, cost-effective and quick method to clean tourniquets and we recommend the use of wipes before every case in addition to the manufactures guidelines for general cleaning of tourniquets.

AIM: Operative treatment is the choice of management for unstable sub-trochanteric fractures because it allows early mobilisation thus preventing serious and fatal complications. This study was conducted to compare the results, advantages and disadvantages of using dynamic condylar screw and interlocking nail for treatment of subtrochanteric fractures.

METHOD: A prospective randomised controlled study was carried in our centre. The study included 64 patients presenting to our Trauma and Orthopaedic unit between July 2000 to November 2003. The criterias for inclusion were an age of less than 70 years, a non-pathalogical sub-trochtanteric fracture less than 4 weeks with no previous history of surgery and a femoral anatomy that allowed osteosynthesis with intramedullary nail or a dynamic condylar screw. The patients were randomly divided in 2 groups which was accomplished with use of computer generated random numbers. The group1 treated with DCS and group 2 was treated with interlocking nail. Both groups were comparable with regard to age, gender, body mass index, medical history according to index of Fitts et al and system of American Society of Aneasthesiologists, mental status and mobility score. The pre-injury functional status of the patients was recorded using Sikor-ski and Barrington pain and mobility scale and parker and palmer mobility score. The estimated intraoperative blood loss, operative time and intraoperative complications were recorded. Follow-up was done at 4th, 12th and 24th week and then 1 year. Patients were assessed for range of hip movements, muscle strength while functional recovery was assessed with Sikorski and Barrington pain and mobility scale. The radiograph at 1 year was used to assess the neck shaft angle.

RESULTS: The mean age of the patients was 49 (range 30–65). There were 38 males and 26 females. The intra-operative blood loss, average hospital stay and operative time was more in case of patients undergoing DCS fixation(p< 0.05). The time fracture union and full weight bearing mobilisation was better in patients who had intra-medullary fixation.1 patient in group1 had screw cut out from femoral shaft, this was treated by change of side plate to longer one with bone graft augmentation.1 patient in group 2 had non-union which was treated by removal of interlocking nail and refixation of fracture with DCS along with bone graft. There was no infection, DVT or mal-union in any group.1 pateint from each group was lost to follow-up. All other patients were evaluated with Sikorski and Barrington’s pain and mobility score. The difference was not significant between the goups(p< 0.05).

CONCLUSION: The results of our study support the use of interlocking nail especially in communited fractures of subtrochanteric region.

During the period of January 1999 and August 2004 there was a policy in our institution of removal for metalwork from patients who underwent open reduction and internal fixation of an ankle fracture. We were not able to find any evidence in the literature as to whether implant removal confers long-term benefit or disability in these patients.

Between January 1999 to August 2003, all patients who underwent ankle metalwork removal were reviewed.

Most patients with mechanical symptoms were improved by implant removal. The two infections resolved. In those patients with pain, about two thirds found were improved.

Following this study the practice in our institution has changed. We do not feel routine removal of metalwork is warranted unless there are specific indications; mainly mechanical symptoms, infection and pain. We are particularly keen to counsel patients from the latter category, that surgery may not resolve their symptoms.