Chandra Shekhar Yadav

In Vivo Efficacy of Antimicrobial-Coated Devices

BACKGROUND Since device colonization is a prelude to infection, an antimicrobial-coated device that reduces bacterial colonization can potentially protect against infection. The objective of this animal study was to assess the efficacy of a coating with minocycline and rifampin to prevent colonization of a grit-blasted titanium implant and subsequent osteomyelitis. METHODS Twenty-five rabbits underwent implantation of a titanium-alloy pin, either coated with minocycline and rifampin (thirteen rabbits) or uncoated (twelve rabbits), into the right femoral medullary canal. The implanted devices were inoculated with 500 CFU (colony-forming units) of Staphylococcus aureus prior to wound closure. The rabbits were killed one week later, and the removed device, femoral bone, a specimen obtained by swabbing the track surrounding the device, and blood were cultured. The rates of device colonization, osteomyelitis, and device-related osteomyelitis were compared between the two groups of rabbits. RESULTS The antimicrobial-coated devices had a significantly lower rate of colonization than the uncoated devices (five of thirteen compared with twelve of twelve, p = 0.0016) and were associated with significantly lower rates of osteomyelitis (six of thirteen compared with twelve of twelve, p = 0.005) and device-related osteomyelitis (five of thirteen compared with twelve of twelve, p = 0.0016). Bacteremia did not develop in any rabbit. CONCLUSIONS Orthopaedic devices coated with minocycline and rifampin significantly protected against device colonization and infection due to Staphylococcus aureus in this in vivo rabbit model. CLINICAL RELEVANCE It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.

Tubercular infection after arthroscopic anterior cruciate ligament reconstruction.

PURPOSE Tubercular infection has not been described, to our knowledge, in the literature after anterior cruciate ligament (ACL) reconstruction, and, hence, the purpose of our case series was to describe our experience, evaluate the clinical and laboratory findings, and assess the treatment outcome. METHODS We performed a retrospective analysis of 1,152 cases of arthroscopic ACL reconstruction with autografts performed at our institution between January 1998 and May 2007. Tubercular infection was considered to be present in the setting of recurrent negative bacterial cultures but a positive result on microscopy, culture, histopathology, or polymerase chain reaction (PCR). All patients underwent arthroscopic lavage and synovectomy, followed by antitubercular therapy for 12 months. RESULTS We identified 8 patients (0.69%) with infection. Bone-patellar tendon-bone graft was used in 1 and hamstring graft in 7. All patients were immunocompetent. The mean time from surgery to presentation was 64.4 days (range, 23 to 152 days). Aspirate fluid staining and culture for acid-fast bacilli was negative in all cases, synovial tissue culture was positive in 3, characteristic histopathology was positive in 7, and PCR was positive in 6. A mean of 1.25 surgeries (range, 1 to 2) were performed. The mean length of follow-up in our series was 43.6 months (range, 25 to 73 months), with no reinfections. The mean postoperative Lysholm knee score was 80. CONCLUSIONS Tubercular infection as a complication after arthroscopic ACL reconstruction, though rare, should be kept in mind as a possible cause of infection in immunocompetent patients in zones endemic for tuberculosis. It should also be kept in mind in nonendemic areas, among immigrants from endemic areas, and in cases with persistent swelling and discharge, effusion with minimal inflammatory signs, and negative cultures. We recommend deoxyribonucleic acid-PCR testing for early diagnosis of tuberculosis. Arthroscopic debridement and antitubercular chemotherapy together are the mainstay of treatment.

Kimura disease of extremity: Unusual manifestation in a long bone

Kimuras disease is a rare, chronic inflammatory disorder, presenting usually as head and neck swellings and regional cervical lymphadenopathy. The disease is more often described from oriental literature but the osseous manifestations and involvement of extremity are rare and unidentified in literature. We present an unusual case of long bone periosteal reaction in a patient of Kimuras disease of extremity. This potentially innocuous disorder must be kept in mind as a radiological differential of periosteal reaction.

Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.

Background: Bicondylar tibial plateau fractures are complex injuries and treatment is challenging. Ideal method is still controversial with risk of unsatisfactory results if not treated properly. Many different techniques of internal and external fixation are used. This study compares the clinical results in single locked plating versus dual plating (DP) using two incision approaches. Our hypothesis was that DP leads to less collapse and change in alignment at final followup compared with single plating. Materials and Methods: 61 cases of Type C tibial plateau fractures operated between January 2007 and June 2011 were included in this prospective study. All cases were operated either by single lateral locked plate by anterolateral approach or double plating through double incision. All cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 10.0 to analyze the data. Results: Twenty nine patients in a single lateral locked plate and 32 patients in a double plating group were followed for minimum 2 years. All fractures healed, however there was a significant incidence of malalignment in the single lateral plating group. Though there was a significant increase in soft tissue issues with the double plating group; however, there was only 3.12% incidence of deep infection. There was no significant difference in Hospital for special surgery score at 2 years followup. Conclusion: Double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate.

Rifampicin use in MRSA infections: will it add to the emergence of multidrug-resistant tuberculosis in developing countries?

disease may develop at any time later, depending on his or her immune status. Trials have shown that the use of rifampicin as monotherapy in latent TB prophylaxis may not lead to the emergence of resistance, whereas in active disease such therapy may do so. The presence of MRSA, as with any infection, may decrease the immune status and may cause a fl are up of a latent disease. The clinical impact of multidrug-resistant (MDR) TB is enormous: the rate of treatment failure with standard regimens is high, and treatment with second-line regimens is toxic, is expensive, and is associated with a substantial incidence of treatment failure and death. For this reason, efforts to “protect” rifampicin have been promulgated by organizations such as the World Health Organization and the International Union Against Tuberculosis and Lung Disease. These measures include restriction of rifampicin use to the treatment of active TB, promotion of the use of fi xed-dose combinations to prevent monotherapy, the use of non-rifampicin-containing regimens during the continuation phase of TB treatment, and supervision of the administration of all rifampicin-based regimens. The use of rifampicin for indications other than active TB, and the self-administration of rifampicin are strongly discouraged by these organizations. An important, unresolved question regarding the use of rifampicin regimens for indications other than TB is whether their use will result in the development of rifampicinresistant TB. However, what is very well known is that rifampicin is the cornerstone of modern therapy for TB. The effective prevention and control of infections caused by MRSA depends on the practice of infection-control measures such as hand-washing, theater discipline, and respect for soft tissues during surgery. Minimizing risk factors and paying attention to alternative cost-effective therapies, as per guidelines, may ease the problem of the management of MRSA infections and at the same time not add to the emergence of MDR TB. Received: April 11, 2008 / Accepted: September 2, 2008

Transverse Tarsal and Tarsometatarsal Cuboid Subluxation: A Case Report

Level of Evidence: V, Expert Opinion

Surgical site infection with methicillin-resistant Staphylococcus aureus after primary total hip replacement

Sir, We read with great interest the paper by Walls et al[1][1] in the March 2008 issue entitled ‘Surgical site infection with methicillin-resistant Staphylococcus aureus after primary total hip replacement’, in which the authors have highlighted the efforts involved in treatment of MRSA

Locking compression plate in treatment of forearm fractures: a prospective study.

I read with interest the article by Tezeren et al.1 They concluded that one-stage combined surgery without preoperative traction is effective in the treatment of developmental dislocation of the hip in older children, by virtue of a lower complication rate. However, the method of traction was not described. Divarication traction has been reported to increase the risk of avascular necrosis because of the extreme abduction.2 The authors further Letters to the Editor Locking compression plate in treatment of forearm fractures: a prospective study