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Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 30-33  | Sujayendra D M, Mahesh S Kulkarni, Aditya Mukadam, Sharath K Rao

Authors: Sujayendra D M [1], Mahesh S Kulkarni [1], Aditya Mukadam [1], Sharath K Rao [1]

[1] Department of Orthopaedics, Kasturba Medical College, MAHE, Manipal, India.

Address of Correspondence
Dr. Sujayendra D M,
Kasturba Medical College, MAHE, Manipal, India.
E-mail: sujayendra16@gmail.com

Abstract

Introduction: The classic presentation of chronic osteomyelitis is characterized clinically by the presence of a draining sinus, and radiologically by sequestrum. Despite adequate treatment when the sinus fails to heal, one has to evaluate for its persistence. The presence of sequestrum and foreign body is one of the common causes for failure of the treatment. Except for one report, there are no described cases in the literature, where the surgeon’s glove piece has been left inside a bone and caused osteomyelitis. We are reporting a case of chronic osteomyelitis of tibia due to a retained glove piece following surgical management of proximal tibia fracture.
Case Report: A 36-year year-old male, with nil pre-morbid conditions, presented with complaints of discharging sinus from the anterior aspect of the proximal part of the left leg since for 2.5 years. He had undergone implant removal for sinus discharge following healed proximal tibial fracture which was managed with open reduction and internal fixation. Radiological evaluation revealed a cavity with sequestrum. During planned debridement and sequestrectomy, one surgical glove piece was as well retrieved from the cavity. Pseudomonas aeruginosa was isolated and he received appropriate antibiotic therapy. The patient after the procedure improved and during the last past one 1 year of follow-up, there is no recurrence of discharge and sinus has healed.
Conclusion: Chronic osteomyelitis is a debilitating condition. All precautions are to be taken to prevent osteomyelitis while performing orthopaedic surgeries, more so while dealing with closed fractures. A high index of suspicion of foreign body retention is suggested while evaluating these cases,.While while performing procedures that involve instrumentation with sharp objects, one must regularly inspect and if the need be, replace the gloves regularly.
Keywords: Chronic osteomyelitis, Foreign body, Glove perforation, Fracture complication, Non-healing sinus, Infection.

References

1. ParsonsB, StraussE. Surgical management of chronic osteomyelitis.Am J Surg2004;188:57-66.
2. Radcliffe G. Osteomyelitis: A historical and basic sciences review. Orthop Trauma 2015;29:243-52.
3. WalterG, KemmererM, KapplerC, HoffmannR. Treatment algorithms for chronic osteomyelitis.DtschArzteblInt2012;109:257-64.
4. GitelisS, BrebachGT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant.J OrthopSurg (Hong Kong)2002;10:53-60.
5. CiampoliniJ, HardingKG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often?Postgrad Med J2000;76:479-83.
6. JohnstonBR, HaAY, KwanD. Surgical management of chronic wounds.R I Med J (2013)2016;99:30-3.
7. AgarwalA, AgarwalS. Retained foreign body masquerading as chronic osteomyelitis: A series of 3 cases and literature review.J ClinOrthop Trauma2019;10:816-21.
8. LiawF, MurrayO, TanYY, HemsT. Retained foreign body in a diabetic patient’s hand.Open Orthop J2018;12:203-7.
9. VidyadharaS, RaoSK. Thorn prick osteomyelitis of the foot in barefoot walkers: A report of four cases.J OrthopSurg (Hong Kong)2006;14:222-4.
10. ChandrashekaraCM, GeorgeMA, Al-MarboiBS. Neglected foreign body, the cause of navicular osteomyelitis in a paediatric foot: A case report.J Orthop Case Rep2013;3:26-9.
11. ChangHC, VerhoevenW, ChayWM. Rubber foreign bodies in puncture wounds of the foot in patients wearing rubber-soled shoes.Foot Ankle Int2001;22:409-14.
12. SidharthanS, MbakoAN. Pitfalls in diagnosis and problems in extraction of retained wooden foreign bodies in the foot.Foot Ankle Surg2010;16:e18-20.
13. SivakumarR, SinghiPK, ChidambaramM, SomashekarV, ThangamaniV. A sub-acute septic arthritis of the knee; a sequelae to thorn prick injury of patella: A case report.J Orthop Case Rep2016;6:100-3.
14. MeurerWJ. Radial artery pseudoaneurysm caused by occult retained glass from a hand laceration.PediatrEmerg Care2009;25:255-7.
15. SurovA, ThermannF, BehrmannC, SpielmannRP, KornhuberM. Late sequelae of retained foreign bodies after World War II missile injuries.Injury2012;43:1614-6.
16. Imoisili M, Bonwit A, Bulas D. Toothpick puncture injuries of the foot in children. Pediatr Infect Dis J 2004;23:80-2.
17. Sadat-AliM, MarwahS, al-HabdanI. Retained portion of latex glove during femoral nailing. Case report.Indian J Med Sci1996;50:308-9.
18. González-ReimersE, Trujillo-MederosA, OrdóñezAC, Arnay-da-la-RosaM. A case of calcaneal osteomyelitis from the prehispanic population of El Hierro (Canary Islands).Int J Paleopathol2015;8:36-41.
19. WebbLX, HolmanJ, deAraujo B, ZaccaroDJ, GordonES. Antibiotic resistance in staphylococci adherent to cortical bone.J Orthop Trauma1994;8:28-33.
20. RovereGD, MatternML. Hemidiaphysectomy to control chronic osteomyelitis.South Med J1978;71:874-7.
21. SchneiderT, RenneyJ, HaymanJ. Angiosarcoma occurring with chronic osteomyelitis and residual foreign material: Case report of a late World War II wound complication.Aust N Z J Surg1997;67:576-8.
22. AggarwalAN, KiniSG, AroraA, SinghAP, GuptaS, GulatiD. Rubber band syndrome-high accuracy of clinical diagnosis.J PediatrOrthop2010;30:e1-4.
23. MaffulliN, CapassoG, TestaV. Glove perforation in elective orthopedic surgery.ActaOrthopScand1989;60:565-6.
24. LakomkinN, CruzAI Jr., FabricantPD, GeorgiadisAG, LawrenceJT. Glove perforation in orthopaedics: Probability of tearing gloves during high-risk events in trauma surgery.J Orthop Trauma2018;32:474-9.
25. MisteliH, WeberWP, ReckS, RosenthalR, ZwahlenM, FueglistalerP, et al. Surgical glove perforation and the risk of surgical site infection.Arch Surg2009;144:553-8.
26. HarnossJC, ParteckeLI, HeideckeCD, HübnerNO, KramerA, AssadianO. Concentration of bacteria passing through puncture holes in surgical gloves.Am J Infect Control2010;38:154-8.
27. EidelmanM, BialikV, MillerY, KassisI. Plantar puncture wounds in children: Analysis of 80 hospitalized patients and late sequelae.Isr Med Assoc J2003;5:268-71.
28. ElBouchti I, AitEssi F, AbkariI, LatifiM, ElHassani S. Foreign body granuloma: A diagnosis not to forget.Case Rep Orthop2012;2012:439836.
29. DeSmet L. Metallosis mimicking osteomyelitis from a forearm plate retained for 50 years.ActaOrthopBelg2000;66:289-91.

How to Cite this article: Sujayendra D M, Kulkarni M , Aditya Mukadam A, Rao S | Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 30-33.

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Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long Bones.

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Volume 7 | Issue 2 | May – August 2019 | Page: 11- 16 | Monappa Naik A, Raviteja Jampani, Mahesh Suresh Kulkarni, Sandeep Vijayan, Sourabh Shetty, Sharath K Rao, Nirish Reddy

Authors: Monappa Naik A [1], Raviteja Singasani [1], Mahesh Suresh Kulkarni* [1], Sandeep Vijayan [1], Sourabh Shetty [1], Sharath K Rao [1], Nirish Reddy [1].

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.

Address of Correspondence
Dr. Mahesh Suresh Kulkarni*,
Department of Orthopaedics, Kasturba Medical College,
Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.
E-mail: maheshskulkarnibmc@gmail.com

Abstract

Background: Open fractures are known to have a multitude of complications. In general, open fractures have been considered as a surgical emergency and treated accordingly with emergency debridement and fixation. Previous animal studies emphasized the need for early debridement and antibiotic administration. However, similar results are not observed and translated in the clinical setting. Hence, we designed an observational study in which our aim was to evaluate the factors which determine union and infections following open long-bone fractures.
Materials and Methods: This is a retro prospective study conducted in a tertiary care hospital from 2015 to 2017. All the open fractures of long bones presented to the casualty not later than 48 h of the injury who were skeletally mature included in the study after obtaining informed consent. All the patients who were presented with the open long-bone injuries were treated as per the institution protocol. Patients were followed up regularly and evaluated.
Results: 59 patients with 69 open fractures were considered for the analysis. Type IIIB and C open fractures were significantly more common in lower-limb injuries. There was no significant difference found between the mean age, gender, involved limb, affected side, presence of the comorbidities, mean time between the injury and the presentation, mean time between injury, and the start of the antibiotics between infected/non-infected and united/non-united open fractures. High-grade injuries took significantly higher number of procedures and time to achieve wound closure. Furthermore, cases with infection and non-union have taken significantly more number of procedures to achieve wound closure. An associated bone loss had a significant increase in the infection, bone grafting, and non-union.
Conclusion: In our study, we noted that open fracture severity and bone loss are the main factors which determine the chances of culture-proven infection. Early antibiotics and wound debridement will not necessarily translate into a decrease in infection rates and non-union.
Keywords: Open fractures, non-union, osteomyelitis, infection, long-bone fractures, bone grafting, soft-tissue injuries.

References

1. Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: Costly burden of nonunions. BMC MusculoskeletDisord2013;14:42.
2. Soni A, Tzafetta K, Knight S, Giannoudis PV. Gustilo IIIC fractures in the lower limb: Our 15-year experience. J Bone Joint Surg Br 2012;94:698-703.
3. Kim PH, Leopold SS. In brief: Gustilo-anderson classification. [corrected]. Clin OrthopRelat Res 2012;470:3270-4.
4. Papakostidis C, Kanakaris NK, Pretel J, Faour O, Morell DJ, Giannoudis PV, et al. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification. Injury 2011;42:1408-15.
5. Hu R, Ren YJ, Yan L, Yi XC, Ding F, Han Q, et al. Analysis of staged treatment for gustiloanderson IIIB/C open tibial fractures. Indian J Orthop2018;52:411-7.
6. Harley BJ, Beaupre LA, Jones CA, Dulai SK, Weber DW. The effect of time to definitive treatment on the rate of nonunion and infection in open fractures. J Orthop Trauma 2002;16:484-90.
7. Spencer J, Smith A, Woods D. The effect of time delay on infection in open long-bone fractures: A 5-year prospective audit from a district general hospital. Ann R Coll Surg Engl2004;86:108-12.
8. Crowley DJ, Kanakaris NK, Giannoudis PV. Debridement and wound closure of open fractures: The impact of the time factor on infection rates. Injury 2007;38:879-89.
9. Webb LX, Bosse MJ, Castillo RC, MacKenzie EJ, LEAP Study Group. Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fractures. J Bone Joint Surg Am 2007;89:923-8.
10. Yokoyama K, Itoman M, Uchino M, Fukushima K, Nitta H, Kojima Y, et al. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing. Indian J Orthop2008;42:410-9.
11. Schenker ML, Yannascoli S, Baldwin KD, Ahn J, Mehta S. Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Joint Surg Am 2012;94:1057-64.
12. Hull PD, Johnson SC, Stephen DJ, Kreder HJ, Jenkinson RJ. Delayed debridement of severe open fractures is associated with a higher rate of deep infection. Bone Joint J 2014;96-B:379-84.
13. Singh A, Jiong Hao JT, Wei DT, Liang CW, Murphy D, Thambiah J, et al.Gustilo IIIB open tibial fractures: An analysis of infection and nonunion rates. Indian J Orthop2018;52:406-10.
14. Brown KV, Walker JA, Cortez DS, Murray CK, Wenke JC. Earlier debridement and antibiotic administration decrease infection. J Surg Orthop Adv 2010;19:18-22.
15. Penn-Barwell JG, Murray CK, Wenke JC. Early antibiotics and debridement independently reduce infection in an open fracture model. J Bone Joint Surg Br 2012;94:107-12.
16. Al-Arabi YB, Nader M, Hamidian-Jahromi AR, Woods DA. The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: A 9-year prospective study from a district general hospital. Injury 2007;38:900-5.
17. Singh J, Rambani R, Hashim Z, Raman R, Sharma HK. The relationship between time to surgical debridement and incidence of infection in grade III open fractures. Strategies Trauma Limb Reconstr2012;7:33-7.
18. Crowley DJ, Kanakaris NK, Giannoudis PV. Irrigation of the wounds in open fractures. J Bone Joint Surg Br 2007;89:580-5.
19. Halawi MJ, Morwood MP. Acute management of open fractures: An evidence-based review. Orthopedics 2015;38:e1025-33.
20. Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AH. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116-21.
21. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 2010;68:629-32.
22. Morshed S. Current options for determining fracture union. Adv Med 2014;2014:708574.
23. Kulkarni MS, Aroor MN, Vijayan S, Shetty S, Tripathy SK, Rao SK, et al. Variables affecting functional outcome in floating knee injuries. Injury 2018;49:1594-601.
24. Fong K, Truong V, Foote CJ, Petrisor B, Williams D, Ristevski B, et al. Predictors of nonunion and reoperation in patients with fractures of the tibia: An observational study. BMC MusculoskeletDisord2013;14:103.
25. Rajasekaran S, Dheenadhayalan J, Babu JN, Sundararajan SR, Venkatramani H, Sabapathy SR, et al. Immediate primary skin closure in type-III A and B open fractures: Results after a minimum of five years. J Bone Joint Surg Br 2009;91:217-24.

How to Cite this article: Naik M A, Singasani R, Kulkarni M S*, Vijayan S, Shetty S, Rao S K, Reddy N. Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long. Journal of Karnataka Orthopaedic Association May – Aug 2019 ; 7(2): 11-16.

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