Temporary hemiepiphysiodesis using 8 plate guided growth has gained widespread acceptance for the treatment of paediatric angular deformities. This study aims to look at outcomes of coronal lower limb deformities corrected using temporary hemiepiphysiodesis over an extended period of follow up. A retrospective analysis was undertaken of 56 children (92 legs) with coronal plane deformities around the knee which were treated with an extraperiosteal 2 holed titanium plate and screws between 2007 and 2015. Pre and post-op long leg radiographs and clinic letters were reviewed.Background
Methods
We aim to demonstrate the value of deep tissue biopsies to guide antimicrobial treatment of diabetic ulcers. Some recent studies have advocated the role of superficial swabs to guide antibiotic treatment in comparison to deep tissue biopsies previously perceived as the gold standard of microbiology diagnosis. We performed a retrospective analysis of microbiology culture results of patients with infected diabetic ulcers comparing superficial versus deep biopsy microbiology results. Forty-one diabetic ulcers in 41 patients were included. The mean numbers of isolates from soft tissue and bone biopsies were 2.1 and 1.8 respectively. 39/41 combined soft tissue and bone biopsies were culture positive. The most prevalent organism seen in deep samples was Staphylococcus aureus (14) followed by anaerobes (9), and enterococcus (9). In superficial swab cultures 21 patients (51%) cultured non-specific, mixed skin flora and enteric species. The remaining 20 patients cultured Staphylococcus aureus (11), Streptococcus (6), Pseudomonas (2) and anaerobes (6). Three superficial swabs matched deep tissue biopsy cultures. 16 deep biopsies grew organisms seen none specifically in superficial swab cultures with 22 deep tissue biopsies cultures growing organisms not seen on superficial swab with 8 being anaerobes. We have shown that in 54% of cases, deep tissue cultures isolated organisms that were not grown by superficial swab cultures. We highlight the importance of deep tissue biopsies to guide effective treatment.
Diabetic ulcer superficial swab cultures have a low specificity for guiding antibiotic treatment. Some studies have recently re-assessed and advocated the role of superficial swabs. We have performed an analysis of microbiology results in patients with infected diabetic ulcers to further appraise the need for using deep tissue cultures as a guide for antimicrobial treatment. We reviewed 23 consecutive diabetic patients in 2013. All patients underwent investigation and treatment by the Orthopaedic department for deep, intractable diabetic ulceration. Microbiology culture results from superficial swabs were compared to deep tissue and bone biopsies.Introduction:
Methods:
Informed consent is integral to good-practice. It protects the patient and offers proof of discussion and interaction between the surgeon and the patient. We compare efficacy of last clinic consent, specialised consent clinic with or without provision of patient specific literature. Group A patients underwent written consent at their last outpatient clinic and conformation of consent on the morning of surgery. Group B underwent consent in designated pre-admission clinic in the week prior to surgery. Group (C) attended the same preadmission clinic and were provided with a surgeon dictated written explanation of their surgery and particular risks. This included a explanation of the procedure, complications, risks and rewards in layman's terms, aimed at patients with a reading age of 14 years, with advice concerning alternative procedures and the consequences of taking no action. The risks are graded: common, less common and rare. All patients undertook a pre-surgery questionnaire on the morning of surgery by an independent observer prior to any contact with the surgical team. Questions focused on their planed procedure, post-operative instructions and possible complications in order to assess the recall of the consent process. A VAS-scale was added to assess overall satisfaction. Statistical analysis was undertaken by a T-test. In total 162-patients were assessed, the response rate was 68.5% (n=111). In-group A (n=16) 18.8% patients remembered 3 relevant complications, 56.2% recalled their post-operative considerations their overall satisfaction was 4/10. In-group B (n=57) 45.5% remembered three complications, 63.7% recalled their postoperative considerations and had a patient satisfaction of 5/10. In-group C (n=38) 48.3% remembered three complications, and 70.7% recalled postoperative considerations, the overall satisfaction improved to 6/10. We observed that the consent process is improved by the use of routine pre-operative consent clinics; however the addition of patient specific literature is observed to further improve recall and satisfaction.
We conducted a single centre prospective observational study comparing post-operative infection rates in HIV positive and HIV negative patients presenting with tibial shaft fractures managed with surgical fixation. Twenty eight patients were incorporated over a six month period and followed up for three months post operatively. 25 open fractures including 6 HIV positive patients and 3 closed fractures including 1 HIV positive patient were assessed for signs of wound sepsis assessed with the asepsis wound score. 21 patients treated with external fixation including 4 HIV positive patients were also assessed using Checkett's scoring system for pin site infection. There was no significant difference in post-operative wound infection rates between the HIV positive (mean wound score = 7.7) and HIV negative (mean = 3.7) patients (p=0.162). HIV positive patients were also found to be at no increased risk of pin site sepsis (p=0.520). No correlation was found between CD4 counts of HIV positive patients and wound infection rates.Methods.
Results.
