Open tibial fractures result in high rates of complications. This study aims to elucidate the risk factors causing these complications, and suggest antimicrobial regimens based on the organisms grown in post-operative infections. Over a period of five years, 173 patients had sustained open tibial fractures and undergone operative treatment at a single institution. All surgical data was gathered retrospectively through online medical records. Thirty-one patients (17.9%) had sustained post-operative bony complications, while infective complications were reported in 37 patients (21.4%). Patients with Gustilo type III fractures were found to be more than three times as likely to sustain post-operative infective (p=0.007) or bony (p=0.015) complications, compared to Gustilo type I or II fractures. The fracture location and time taken to fixation did not significantly affect the complication rate, but results were trending towards significance. The commonest cause of infective complications were hospital-acquired organisms, such as Methicillin-resistant staphylococcus aureus (40.5%). Closer monitoring of patients sustaining high grade Gustilo open fractures, as well as antimicrobial prophylaxis for both hospital-acquired organisms and environmental contaminants, will result in the best outcome for patients. Further studies with larger sample sizes are warranted, to determine the significance of fracture location and time taken to fixation on complication rates.
Tibial Fractures

Te djenkol bean (Archidendron pauciforum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). Te pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. Te patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.