The aim of this investigation is to firstly quantify the burden of disease, and secondly qualify the organisms being cultured during debridement to establish their sensitivities to available antibiotics. This study will also look at the concomitant burden of Human Immunodeficiency Virus (HIV) and Diabetes Mellitus (DM) in cases of hand sepsis, to establish whether these two disease processes require special consideration and treatment tailoring.

The method employed to collect the data will be retrospective collection of patient information, using random sampling. Included patients will be adult patients who undergo debridement and have a sample registered on the National Health Laboratory System (NHLS). The daily intake sheet will be used to collect patients details and these details will then be used to collect results of intra-operative specimens using the NHLS. These patient details will also be used to check patients’ HIV results and HBA1c (Glycated Haemoglobin A1c) results.

Majority of the specimens revealed Methicillin Sensitive Staphylococcus Aureus (MSSA), with a reassuringly low rate of Methicillin Resistant Staphylococcus Aureus (MRSA) when compared to international data. The yield of patients tested for HIV or DM was lower than expected, despite this being the standard of care.

The projected impact of this study will be assessment of the current burden of disease and then clarification of our current management strategy, in order to assess if it would be possible to change to a more cost-effective antibiotic with a narrower spectrum of bacteria coverage. The potential exists to not only implement cost saving measures, but also promote antibiotic stewardship by decreasing the practice of empiric broad-spectrum antibiotic use.

Introduction:

Measurement of ankle brachial pressure index is an easy screening test to perform in patients presenting with an acute knee injury. According to Nicardi et al recognition of vascular injury is particularly challenging because vascular compromise may not be immediately associated with clinical signs of ischemia.

The aim of the study is to correlate the values of ABPI measurements to CT angiograms and clinical outcome in high energy knee trauma.

We reviewed eleven diaphyseal humerus fractures treated over an 18 month period, March 2004 to October 2005, using a single intramedullary Titanium Elastic Nail (TEN).

The mean age of 6 boys and 5 girls was 7.6 years. The longest follow up was twelve months. The mean period of implant insertion was 6 months. Diaphyseal fractures were most commonly the result of a fall (45%), and 3 (27%) were the result of motor vehicle accidents (MVA) with other associated injuries. Two (18%) were pathological fractures. All were closed fractures.

Nine of the eleven (81%) were treated by a closed reduction and a single retrograde TEN inserted percutaneously. Two required open reduction. There were no pre-operative or post-operative neurovascular complications. At mean follow up (6 months), there were ten satisfactory results (91%), with one complication of implant sepsis.

The use of TENs for diaphyseal humerus fractures in children has not been widely described in the literature as compared to their use for diaphyseal femoral fractures. Traditional teaching advocates conservative treatment for these fractures. We believe that in 4–12 year old patients, a single TEN is a viable option in the treatment of these fractures in that it gives over-all good results with minimal morbidity. It is easy, quick, allows early return to activities, and avoids some of the complications of conservative treatment such as those associated with prolonged immobilization and malunion.