Introduction: Surgical site infections (SSI) are common healthcare associated infections (HAI) that is associated with increased morbidity and cost. Antimicrobial prophylaxis is effective when used appropriately. This study assesses the prophylactic antimicrobial prescribing and practice in the orthopaedic wards based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline on antibiotic prophylaxis in surgery. Materials and Methods: Patients admitted to the Orthopaedics wards over a four-week period were studied (n = 68). Criterions 1 to 4; appropriateness, choice of antimicrobial and route of administration (1- given when indicated, 2- not given when not indicated, 3- appropriate choice and 4- given intravenously), criterions 5 to 7; allergy status and documentation (5: documentation, 6- details and 7- definite or possible history reaction immediately after penicillin therapy should not receive prophylaxis with a beta-lactam antimicrobial), criterions 8 to 10; documentation of antimicrobial given (8- name, dose and route of administration, 9- documentation in the appropriate 'one-off' section of the drug chart and 10- documentation of time of administration and surgical incision) and criterion 11 to 14; time and doses required (11- prophylaxis should be given 30 minutes before surgery, 12- additional intra-operative dose not required, 13- post-operative doses of prophylaxis not given and 14- a 24 hours regimen of prophylactic antimicrobial is given for primary arthroplasty procedures). A simple scoring system was used to allocate level of appropriateness. The rate was considered 'very good' for above 85%, 'good' for 70%-85%, 'moderate' for 50%-69%, 'poor' for 30%-49% and 'very poor' for below 30%. Results: The overall conformation to criteria and standards was 66.4% (95% CI 61.7-70.7). The rates were rated as 'very good' for criterion 1, 3, 4, 5b, 6, 8 and 9, 'good' for criterion 5a and 'poor' for criterions 2 and 5c. The adherence rates were 'very poor' to criterion 10a, 10b, 13 and 14. Intravenous cefuroxime was used as the first choice for antimicrobial prophylaxis. Conclusions: The overall practice was moderate and the choice of drug was considered appropriate. However, certain areas such as documentation need improvement. A local guideline may be useful.
Antimicrobial ; Orthopaedic Surgery ; Surgical Site Infection

Pagets disease is common in Western countries but is very rare in Chinese populations. Although bisphosphonate has been widely used to treat symptomatic Pagets disease, prolonged use may be associated with insufficiency fracture. We highlight this rare case of Pagets disease in a Chinese lady who presented with an insufficiency fracture following long term use of bisphosphonate.
Orthopaedic

Objective: The aim of this study was to evaluate the role of polymerase chain reaction (PCR) in the diagnosis of spinal tuberculosis after 2 weeks of preoperative anti tuberculosis treatment and to compare PCR to the Lwenstein Jensen Culture (LJC) and histopathological examination (HPE) methods. Methods: Twenty five patients were included in this study. Sixteen patients were diagnosed and treated for spinal tuberculosis based on clinical and radiological evidence. Nine patients were controls. The LJC me
Orthopaedic

Objective: To review the presentation and outcome of developmental dysplasia of the hip (DDH) cases in the last 6 years. Methodology: We retrospectively reviewed the presentation as well as short and mid term outcome of 17 children (18 hips) with DDH seen and treated from 2004 to 2010. Treatment was either splinting with Pavlik harness, closed or open reduction depending on age at presentation and the individual needs of each patient. Results: The average age at presentation was 31.1 months, and the male t
Orthopaedic

Intertrochanteric fracture of the femur is one of the commonfractures in the elderly. Dynamic Hip Screw (DHS) fixation is the gold standard for treatment of intertrochanteric femoral fracture. Conventional methods of achieving reduction prior to instrumentation require utilization of a traction table. A manual traction technique applied in the supine position using only a translucent table was devised to do away with the use of traction table. The rationale for this technique includes enhanced ease of set
Orthopaedic

Talar neck fractures (TNFs) are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type I, 7 type II, 4 type III, and 1 type IV. Five patients with type I and 2 with type II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized
Orthopaedic

Background: The modified Stoppa approach was first described in 1993 by Hirvensalo as an alternative to the ilioinguinal approach for treatment of pelvic ring fracture. Methods: This is a retrospective study of 5 patients with unstable pelvic fracture treated with internal fixation using the modified Stoppa approach. Residual displacement of the pelvic ring was measured and graded using the methods described by Matta and Lindahl. Functional outcomes were assessed using the modified Merle D Aubigne and Pos
Orthopaedic

This retrospective study was undertaken to evaluate the outcome of primary total knee arthroplasty (TKA) performed from January 1986 to December 1997 at this institution. Case review included Knee Society scores and functional knee score. The records of 94 patients (128 knees) were available for analysis with the sample comprised of 76 females (80.9%) and 18 males (19.1%) and a mean age was 61.4 years. TKA was performed for osteoarthritis (OA) in 96 knees (75%) and rheumatoid arthritis (RA) in 32 knees (25
Orthopaedic

Ankle fractures are commonly seen in orthopaedic practice. This retrospective study of patients with ankle fractures who underwent surgical treatment in our institution from January 2000 to December 2003 was undertaken to analyze the common causes and patterns of ankle fractures; and the functional outcome of operative treatment for these fractures. Eighty patients were identified and reviewed. There were 65 male (81.3%) and 15 female patients (18.7%) with age ranging from 13 to 71 years old (mean, 32.3y).
Orthopaedic

We report a case of end stage renal failure in a patient who presented with acute cord compression and extensive brown tumour involving the spine, distal femur and patella. Brown tumours of the long bone, spine and pelvis have been documented previously. However, the occurrence of brown tumour in sesamoid bones such as the patella is extremely rare and is indicative of widespread lesions and severe secondary hyperparathyroidism. These tumours typically respond poorly to medical treatment alone. The acute c
Orthopaedic