Nareshkumar Satyanarayan Dhaniwala

Abstract

Prophylactic systemic antibiotics is the standard practice to prevent surgical site infections in orthopedic surgery including arthroplasty. There is enough evidence showing its utility in preventing or reducing surgical site infection. Timing of administration, antibiotics to be used and duration of antibiotics are controversial points regarding this practice. The present study using Ceftriaxone 1 gram intravenously 3 doses during 24 hours peri-operative period (group 1 n =58) versus 3 days (group 2 n= 57) has been carried out on planned orthopedic surgeries with specific exclusion and followed up for 1 year. None of the cases of either group developed any infection. The study demonstrates the utility of antibiotics prophylaxis and is a step in deciding guidelines about antibiotics use in our country.   Keywords: Antibiotics, Prophylaxis, Infection, Orthopedic surgery.

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Abstract

Introduction: Anti-Retroviral Therapy (ART) in HIV+ patients is known to cause decrease in bone mineral density (BMD).1 HIV infection and ART are included as risk factors for Osteoporosis and fragility fractures by National Osteoporosis Foundation in US2. In our country, not many reports are available in this regard. The present article reports two HIV + patients of different age group, on ART for variable periods, who developed bilateral fracture neck femur without any trauma. The cases were managed suitably and are being reported due to its rarity and to stress the need of careful evaluation in HIV+ patients. Case Reports: Case 1: A HIV+ male patient of age 37 years on regular ART presented with pain in his both hips region for 1-year duration without any trauma or fall. X-ray pelvis with both hips showed transcervical minimally displaced fracture neck of both femora. The young patient was managed with multiple cancellous screw fixation in situ and is under regular follow up for 15 months. Case 2: A HIV+ male patient of 65 years under regular ART presented with the complaints of pain right hip with difficulty in walking for 1 month without any trauma. X-ray pelvis showed displaced fracture neck right femur and incomplete fracture of superior cortex of neck left femur. The patient was treated by Austin Moore prosthetic replacement of head femur on right side and observation for the left femur neck incomplete fracture. The case is under follow up and continuing ART also. Clinical Message: Spontaneous non- traumatic fracture should be suspected in HIV + patients having persistent localized pain in an area even without history of any trauma or classical features of fracture on physical examination. Radiological examination must be carried out before excluding fracture. Keywords: HIV, Anti Retro viral Therapy, Fracture Neck Femur.

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Abstract

Fibrodysplasia Ossificans Progressiva (FOP) also known as Myositis Ossificans Progressiva is a very rare and disabling genetic condition characterized by congenital malformation of the great toes with hallux valgus and progressive heterotopic ossification in specific anatomic pattern.1 It is a rare condition with worldwide prevalence of about 1 case in 2 million individuals2. No ethnic, racial, sex or geographical predisposition is noted. Myositis Ossificans Progressiva term is misnomer and not used now. The case report herein describes this rare condition in a child of one and half year age having the classical clinical presentation and radiological features. The child is under follow- up with measures to prevent fast progression of the condition. Keywords: Fibrodysplasia, Ossificans, Progressiva, Myositis.

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Abstract

Introduction: Ossifying fibroma is a rare tumor seen in children in diaphysis of tibia or fibula, maxilla, mandible or temporal bone. Its clinical and histological picture have variable and confusing features. The case report hereunder describes an atypical case of ossifying fibroma involving both radius and ulna in an adolescent girl. Benign on the basis of history, the case had features of aggressive tumor on clinical and radiological examination. Histopathology did not show any features of malignancy. The patient underwent excisional biopsy followed by below elbow amputation. The patient remains asymptomatic without any features of recurrence 24 months post-surgery. Keywords: Atypical, Ossifying fibroma, Radius, Ulna, Aggressive.

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