CASE STUDIES
CASE STUDY Courtesy of Dr Parihar Consultant Orthopaedic Surgeon, Center for Limb Lengthening & Reconstruction, Mangal Anand Hospital, Mumbai, India Clinical particulars 42-year-old female presented with a recent history involving a closed fracture of the radius and ulna. Open reduction and internal fixation had been carried out but by the second day an infection was present. Subsequent procedures at the referring hospital to change the fixation, and to alter the antibiotic regimen, failed to clear the infection. Treatment The patient was referred to hospital 3 months after the initial procedure. The wound was debrided, packed with STIMULAN mixed with vancomycin and colistin and stabilised with an intramedullary flexible nail fixation.* Outcome I.V. antibiotics were continued for 3 weeks only. The STIMULAN beads were absorbed within 3 months and the infection was cleared. The patient subsequently underwent reconstructive surgery and has bony union and full healing at 1 year. *The treating physician is responsible for deciding the type and quantity of antibiotic used
Presentation Post-operative 2 months 3 months 1 year
CASE STUDY Courtesy of Mr Jogia Consultant Podiatric Surgeon, University Hospitals of Leicester, UK Clinical particulars 67-year-old male with type 2 diabetes and BMI of 37 presented with osteomyelitis and interphalangeal joint destruction to his left hallux. This failed to resolve with conservative treatment regime of oral antibiotics and off-loading. Surgical management was to amputate the left hallux, however there was a risk of re-ulceration as he was already receiving treatment for Charcot arthropathy to his right foot. Treatment As a last effort to prevent amputation, surgical debridement was carried out, the bone was fenestrated and STIMULAN mixed with vancomycin and gentamicin used to fill the cavities.* Surgery was carried out as a day case under local anaesthetic. Outcome 2 weeks post-operatively the toe reduced in size. At the 16-month X-ray STIMULAN was seen to be completely absorbed, the patient was infection-free and amputation had been avoided. *The treating physician is responsible for deciding the type and quantity of antibiotic used
Presentation Post-operative 2 weeks 16 months
CASE STUDY Courtesy of Dr D Nayar Consultant Microbiologist, Mr S Thomas, Orthopaedic Specialist Registrar, Mr P Duffy, Consultant Orthopaedic Surgeon, University Hospital of North Durham, UK Clinical particulars 78-year-old male presented with unilateral right thigh collection, which was incised and drained. Past medical history included bilateral THRs 8 years prior, CABG, type 1 diabetes mellitus and recurrent urinary tract infections. The pus grew Salmonella typhimurium. Detailed history-taking revealed that he had suffered from S. typhimurium gastroenteritis in September 2011. The thigh infection was treated with a 4-week course of piperacillin-tazobactam. Re-presented 5 months later with discharging sinus from the bottom of right thigh wound and persistent ache in the groin radiating to the anterior thigh. Aspirate from the hip grew S. typhimurium. Sinus tissue also grew an MRSA.
CASE STUDY Courtesy of Dr D Nayar Consultant Microbiologist, Mr S Thomas, Orthopaedic Specialist Registrar, Mr P Duffy, Consultant Orthopaedic Surgeon, University Hospital of North Durham, UK Treatment Following extensive investigations the patient underwent revision arthroplasty. First stage radical debridement, implant removal and insertion of antibiotic loaded cement spacer and STIMULAN beads mixed with vancomycin and gentamicin.* Multiple samples at first stage grew the S. typhimurium as well as MRSA. Patient treated with I.V. teicoplanin and ciprofloxacin in the interval period for 6 weeks. Second stage STIMULAN beads mixed with gentamicin and meropenem were implanted alongside a cemented revision prosthesis and in the tissue surrounding the sinus.* All samples at second stage were negative on extended incubation. Patient treated post-operatively with I.V. teicoplanin and ciprofloxacin for 4 weeks. Outcome At 1 year follow-up the patient remains well and symptom-free with a well-functioning prosthesis. *The treating physician is responsible for deciding the type and quantity of antibiotic used
Intra-operative Post-operative
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