Internal Fixation Essay

My practical competencies have been obtained through working with a general and orthopaedic surgeon. Whilst working with my clinical supervisor, (a consultant orthopaedic surgeon) we decided it would be beneficial to review orthopaedic wound infections. I chose to concentrate on wound infections during a Total Hip Replacement (THR). Wound infections is a massive subject so I have selected specific areas to look at, which are:

Gold standard procedures should be implemented with the aim of providing timely and accurate results. (Schentag) The culture result should be accompanied by its clinical significance, selective reporting of susceptibility testing results in accordance with hospital antimicrobial therapy guidelines and suggested management. (Schentag) This encourages appropriate prescribing and minimises unnecessary use of antimicrobials. The clinical microbiology team should also provide reports to AMS regarding resistant organisms.

In recent years, surgical site infections are verified as one of the most errors that are common in the healthcare; however, they are also preventable. These research papers will synthesis information about surgical infections, patient experience, hospital-acquired conditions and achievement of expected treatment for specific clinical diagnoses. A surgical site infection is an infected condition in the body after surgery has occurred. Surgical site infections are caused by germs, called bacteria. Different types of bacteria from the environment may cause a delay in healing. The infection may come from surgical tools or bacteria on the skin if it is not clean correctly. Healthcare professionals use certain guidelines and

Antibiotic use, particularly with clindamycin and linezolid, may be useful in treating GAS-associated necrotizing fasciitis, as they target both M-proteins and exotoxins (5). Some cases have been treated with hyperbaric oxygen therapy, with recent data suggesting prompt surgical therapy instead is vital for preventing amputations (18). Even after treatment, however, necrotizing fasciitis mortality has been estimated to range from 24%-60% (10).

If an open wound occurs at the site of the fracture that is an open fracture. Sometimes the fractured bone sticks out of the wound. This creates a big risk of infection in the bone.

As we all know, people- particularly students- often believe that when they fail, they are unintelligent. They believe that because they do not know how to do something, they cannot do it. This thinking is most certainly not true. When we fail, our brains make a connection with that failure. This connection is what we call learning from our failures. The idea that intelligence comes at a fixed level is easily disregarded when faced with that fact that IQ scores cannot determine your intelligence whatsoever. However, certain environmental factors and your own mindset on your intelligence affects your potential intellectual capacity. With that being said, intelligence is a potential to be reached, rather than a set limit.

Skin and or soft tissue infections often occur following a break in normal skin integrity from either trauma or skin disease (Brown & Ebright, 2002). The vast majority of these infections are caused by the gram-positive bacteria Staphylococcus aureus, part of the normal flora existing on the skins surface. Abscess has been found to be the most commonly found SSTI in PWID (Brown & Ebright, 2002). Symptoms of abscess include pain and or tenderness at and around the site of infection, swelling, and redness topped with a pustule. If left untreated, spread and progression of the SSTI leading to tissue ischemia and death, gangrene, sepsis and death can occur (Brown & Pieper, 2002). Hospital treatment of a SSTI is costly. Analysis of the Nationwide Inpatient Sample by the Agency for Healthcare research estimated that in 2009, costs associated with hospital treatment of SSTI reached an estimated $4.8 billion, which is approximately $11,000 per patient (Suya et al., 2009).

The current state of the art test to diagnose PJI include: synovial fluid analysis with 3-5 culture, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Interleukin-6 (IL-6) (surprisingly is not potentially available), and FDG-PET scan. However, the cost and availability of some of these test makes lead to (ESR) and (CRP) being the most common one. In addition, normally any implant leads to high levels of CRP and ESR during the first month after the surgery; consequently, distinguishing between normal high results due to the surgery vs. due to infection is difficult. Furthermore, analysis of the organism present in synovial fluid samples is challenged by contamination of the cultures, the different times needed (some samples show presence of bacteria/fungus as early as 3 days other take up to 10 days), small number of cultures leads to low accuracy. Once the infection is diagnosed, extraction of the implant and antimicrobial + antibiotic treatment is required. This brings to another issue, lack of patient compliance to attend follow up appointments and proceed with the

While open reduction and internal fixation (ORIF) methods permits direct visualization of the injured pelvis, there are highly variable wound complication rates ranging from 3.9% to 27% [4]. Critics of ORIF are concerned about the extremely high risk of infection post-operatively, which can increase from 18% to 27% for fractures treated early and late, respectively [5]. It is reasonable to consider a more minimally invasive technique such as percutaneous fixation, which uses screws to mechanically stabilize an unstable sacrum [6]. Percutaneous fixation with iliosacral screws, for example, have led to decreases in surgical time, exposure related hazards, and soft-tissue disruption [7].

Few clinical studies have been able to show the benefit of early wound debridement within 6 hours of the injury (39,40). Kreder and Armstrong (39) evaluated 56 open fractures in 55 children retrospectively. The results show that the infection rate was higher in those patients debrided after 6 hours in comparison to those debrided within 6 hours of injury (Infection rate was 25%, 12% respectively).

Over three hundred thousand hip replacements were performed in 2010. A two hundred percent increase from 2000. The number of replacements has continued to grow as recovery from the surgery has become much faster. Although recovery time has decreased, patients are still at risk of infection from their bodies rejecting the metal replacement hip. Infection from the bodies’ reaction to the metal hip will soon become a problem of the past as researchers have begun making replacement hips out of bone-like material infused with antibiotics. These new replacements will allow the body to heal with the new structure instead of fighting the foreign material. Patients will recover even faster with less chance of infection. Each patient’s hip will be custom-made to model the patient's bone with a new technique called Fused Filament Fabrication

days but with the antibiotic treatment can be reduced to 2-4 days. Bacterial conjunctivitis is highly communicable and is easily passed from person to person. 4. Natural defenses that help prevent eye infections include: the blinking reflex, tears, barriers such as the eyelid and orbital septum, presence of leukocytes and Langerhans’ cells also help as defense mechanisms. 5. There are preventative measures that could be taken to prevent the spread of this infection. Such measures are washing hands frequently, disinfecting common areas within the class room and simply educating the students on how the infection is spread. Case 1.5 1. This patient had necrotizing fasciitis caused by Streptococcus pyogenes. The presence of the gram-positive cocci growing in chains is the evidence of Streptococcus pyogenes. To consider the condition to be caused by Clostridium perfringens or gangrene there would need to be gram-positive rod-shaped bacteria obtained from the wound. 2. The below the knee amputation was the best solution for this type of infection because necrotizing fasciitis progresses and spreads rapidly, delaying surgical intervention increases the risk of mortality. 3. This bacterium is generally transmitted through person-to-person contact and sometimes can be found in unpasteurized milk. In this case the transmission was most likely related to the

Osteomyelitis is a broad and debilitating disease typically triggered by a variety of conditions. Osteomyelitis starts off as inflammation seen within bone and bone marrow that can quickly progress into a large, subclassified infection. The length of time the infection has been present in the body and whether or not there is a pus formation or increased density among the infected bone is commonly used to classify severity. Pyrogenic bacteria or mycobacteria systematically attack the route and anatomic location of the infection evolving acute conditions into chronic ones. “Staphylococcus Aureus is a gram-positive, round shaped, non-mobile cocci typically found in clusters inside these wounds. Staphylococcus Aureus is one of the most common causes of infections after injury or surgery and affects nearly 500,000 patients in hospitals each year. Staphylococcus Aureus belongs to the family Staphylcoccaceae and survives by affecting all known mammalian species including humans” (www.news-medical.net). Osteomyelitis can start in one area of the body while spreading through the blood stream into other bone regions. Typical treatment options for Osteomyelitis includes antibiotics, removal of

Postoperative surgical site infections according to Nichol (2001) remain a major source of illness in surgical patients. Beaver, (2008) point out that surgical infection is one of the side effects that occur after a patient has gone for surgery.

They have diminished inflammatory response even when extreme soft tissue and bone infection are present. Identification of foot infections in the patient with diabetes mellitus requires vigilance because the signs of infection may not be present ( Baranoski and Ayello, 2003,p.327). The most common bacteria found in non-limb threatening infection are Staphylococcus and Streptococcus. These infections should be treated with oral antibiotics. If the limb is threatened with the infection, parenteral antibiotics and surgical debridement of necrotic tissue needs to be executed. Most limb threatening infections are polymicrobial. Staphylococcus aureus, group B atreptococci, Enterococcus, and facultative Gram-negative bacilli are the major pathogens involved in these types of