Introduction: There has been a constant rise in the incidence of extensive musculoskeletal trauma with soft-tissue loss due to high velocity trauma. Vacuum Assisted Closure (VAC) is a modality for managing soft tissue aspect of such injuries. However, conventional VAC therapy is very costly and is sometimes associated with complications like skin maceration, pain during dressing removal and sensitivity to adhesive dressings. Whenever frequent wound inspection is required these dressings have to be changed every time, hence, increasing cost. We developed a method wherein these complications can be dealt with by using ultrasound jelly as a sealant. Our aim is to compare the efficacy and complications of Jelly VAC with that of Conventional VAC therapy. Methods: A total of 86 patients were included and treated with both VAC therapies and the results were compared. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in either Jelly VAC or Conventional VAC groups randomly. Results: We observed a significant reduction of wound size, discharge and infection control in both groups. The efficacy of Jelly VAC is at par with conventional VAC. 3 patients in each group developed complications. Conclusion: Jelly VAC can be easily used in resource limited settings at 1/40th price of conventional VAC while minimising adhesive related complications. It is a potent and cost-effective method to control infection and managing severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

Introduction:Infected non-union of the tibia is difficult to manage due to problems like osteomyelitis, soft tissue distortion, draining sinuses, joint stiffness, and multidrug-resistant polybacterial infection. Material and methods:We report the outcome of 18 patients of infected non-union tibia treated with the LRS. The causes were open fracture in 15 cases and infection following internal fixation in 3 cases. We assessed the LRS in the management of infected non-union of the tibia in terms of, union rate, control of infection, and associated complications. The assessment parameters were based on the ASAMI criteria.Result:88% were male and 11% were female, mean age was 32 ±9. The mean bone gap was 3.1±1.0. Corticotomy and fibula osteotomy was performed in 14 (77.8%) of the patients. Bony union was seen in 17 (94.4%) of the patients. The mean time of union was found to be 9.7±1.7 months. The mean limb length discrepancy was 1.1±0.6 cm. Deformity angle of less than 7 degrees was present in 16 (88.9%).15 (83.3%) patients had excellent ASAMI bone scores and the remaining 02 (11.1%) had a good score. One patient in which the union was not observed had a poor score. For the functional component, 12 (66.7%) had an excellent score, 05 (27.8%) had a good score and 01 (5.6%) with non-union of the tibia bone was found to have a poor score.Conclusion:LRS is easy to perform, has predictable healing for infected non-union, has a short learning curve, ensures compliance in patients, and provides reliable results with lesser complications.

Introduction: The tibia is the most frequently fractured long bone due to its vulnerable location, often complicating with pseudarthrosis or infection. Given the need to remove material of osteosynthesis in a nonhealing fracture, which method offers stability and dynamism that allows for proper bone regeneration? Case Presentation: 25-year-old, female, observed two months after an ORIF of proximal left tibia fracture with plate and screws due to a motorcycle crash. The leg was swollen and painful, with exuberant inflammatory signs, purulent drainage and multifistulized. The X-ray showed no signs of fracture healing. She was submitted to material removal, extensive debridement, judet osteotomy and transosseous osteosynthesis with circular external fixator. The microbiology identified a Staphylococcus aureus and she performed an antibiotic treatment with ciprofloxacin and clindamycin during 6 weeks. After 4 months she was walking with full weight bearing, the control X-ray showed signs of bone consolidation and the external fixator was removed. After 1 year of follow-up, in view of the drop foot sequelae, she was submitted to a posterior tibial tendon transfer, resulting in a complete recovery of the ankle mobility. Discussion: Early conversion of an infected conventional osteosynthesis to transosseous osteosynthesis was essential for the successful outcomes, avoiding multiple additional interventions. It allows an early mobilization and full weight bearing, which is an advantage over other conventional osteosynthesis techniques. Conclusion: The need for an effective osteosynthesis when conventional methods fails often generates a doubt that traumatologists are faced to solve, emerging the transosseous osteosynthesis as the most credible answer.

Introduction: No study has investigated the risk factors and rates for complications following decompression fasciotomy in traumatic compartment syndrome (CS) patients. The purpose of this study is to assess and identify the rate of risk factors for postoperative complications. Methods: The NSQIP database was queried to identify traumatic CS surgical patients in 2008-2016. The identified pool of patients was further refined by selecting for patients who had orthopaedic fasciotomies. Binary logistic regression analysis was used to identify risk factors for adverse events including postoperative complications and readmissions. Significance was set to p<0.05. Results: 379 patients were identified. 109 (28.8%) had postoperative complications, 36 (9.5%) required reoperations, and 19 (5.0%) were readmitted. The most commonly performed fasciotomies were of the lower leg in the anterior and/or lateral and posterior compartment (121 patients, 31.9%), followed by the lower leg in the anterior and/or lateral compartments only (69 patients, 18.2%), and the forearm and/or wrist in the flexor or extensor compartment (30 patients, 7.9%). Binary logistic regression analysis revealed diabetes (OR=3.5 [1.9-6.5], p<0.001), active smoking (OR=2.2 [1.4-3.4], p=0.001), hypertension (OR=1.6 [1.0-2.5], p=0.032), dialysis (OR=4.7 [1.4-15.7], p=0.011), and renal failure (OR=22.0 [5.0-96.1], p<0.001) to be significant predictors for postoperative complications. Conclusion: The overall rate of complications within 30 days following decompression in traumatic CS patients (28.8%) is higher than what has been found for non-traumatic CS patients (4.5%), as well as for chronic exertional CS patients (15.7%). Diabetes, active smoking, hypertension, dialysis and renal failure were found to be risk factors for postoperative complication.

Introduction: Non-unions often arise because of high strain at fracture sites. Treatment for long bone fracture non-union can be expensive, protracted and invasive. Percutaneous strain reduction screws (PSRS) can be inserted as a day-case surgical procedure to supplement primary fixation at a fraction of the cost of traditional treatments. A multi-centre retrospective study was undertaken to confirm the efficacy of this technique, ascertain whether this technique can be adopted outside of the developing institution and assess the financial impact of this technique.

Methods: Retrospective analysis was performed for PSRS cases used to treat long bone non-union in four level 1 trauma centres from 2016 to 2020. All patients were followed up until union was achieved or further management was required. Demographic data was collected on patients, as were data about their injuries, initial management and timings of all treatments received. A comparative cost analysis was performed comparing patients treated with PSRS and with traditional non-union surgery methods.

Results: 51 patients were treated with the PSRS technique. 45 (88%) patients achieved union at a median time of 5.2 months (range 1.0 – 24.7). Comparable results were seen between the developing institution and independent units. No patients experienced adverse events beyond failure to achieve union. PSRS appears to offer savings of between £3,177 to £11,352 per case compared with traditional methods of non-union surgery.

Conclusions: PSRS is a safe, cost-effective treatment for long bone non-union. The promising initial results of this technique have now been replicated outside of the developing institution.

Background: Chronic post-traumatic osteomyelitis(OM) is one of the most common refractory conditions resulting in significant morbidity. Vancomycin-loaded calcium sulfate(VCS) is used to control infection by local delivery of antibiotics but there is limited evidence proving its efficacy. Our aim was to compare the efficacy of the use of VCS in osteomyelitis when compared to the control group without the use of VCS.

Methods: This randomized controlled study involved 212 patients suffering from chronic post-traumatic OM of the lower extremities who were among which 82 were treated with VCS and rest without them. Using the stratified random sampling method, 50 patients from either group were selected using computer software for evaluation. All patients had thorough surgical debridement and the same antibiotic regimen based on cultures. Hematological parameters, eradication of infection, rate of infection recurrence, and reoperation rate were evaluated during the follow-up.

Results: The average follow-up after first-stage surgery was 18.3 months (range, 10–48 months). In the study group, all the patients revealed complete calcium sulfate resorption at an average of 7.2±2.8 weeks (range, 30–80 days). Infection was primarily eradicated in 88 (44 of 50) of patients in the study group compared to 32 of 50 in the control group (p<0.001) and re-operation rate of 12% (6 of 50) after the first-stage surgery in the study group compared to 36%(18 of 50)(p<0.001). All patients requiring reoperation were subsequently treated with VTCS and 14 out of 24 had eradication after second-stage surgery.
Level of Evidence: Level 1, Randomised Controlled study

This is a retrospective study to compare the acute admissions in our department for the same period of time 24/03-12/05 in 2019 and 2020(without lockdown/during lockdown) and to see if and how Covid 19 pandemic changed our practice.Material-for the same period in 2019 there were admitted 235 patients and 134 in 2020 .We compared this admissions from point of view of diagnosis, group of age , length of stay, treatment, discharge destination ,source of referral to our department. Results -For the same period of time (7 weeks) it was obvious that in 2019 we treated more patients -235 comparing with 2020 lockdown-134 patients.Regarding sex distribution -in both years there were more females treated than males-59.14% in 2019/69.4% in 2020.Comparing distribution on group of age in 2019 predominantly was group of age < 60 years old 40.42%-the active population group,in 2020 predominantly was group of age 60-80 y 38.05%.In both years majority of referrals for trauma came from Emergency Department .Comparing the main group of diagnosis if in 2020 the leader was neck of femur fractures -32.08% in 2019 on the first place were soft tissue injuries .In 2020 50% of patients received surgical treatment comparing with 2019 when 65% did not required surgery.Conclusions-More patients were treated in 2019 comparing with 2020.More sport injuries work accident and RTC were treated in 2019.During lockdown only if it was strictly necessary patients came to ED. Covid 19 changed our practice with less admissions and related to injury unable to treat at home.

Introduction: Spontaneous bone regeneration of long bone gaps can occur in patients with open injuries without head injury. Patients Methods: Our institution 5 year fracture registry data indicated that 702 open injuries with bone loss (29.7%) were treated between 2009 and 2014. Among these open injuries, 5 patients had shown spontaneous bone regeneration in the bone gaps. Femoral bone loss was seen in 4 patients and one patient had bone loss in tibia. All of them had bone loss at the time of injury. The mean bone defect was 9 cm (range, 6 to 11cm). There were 3 males and one female patient. The mean age was 17.2 years (range, 10years to 26 years). None of the patients had associated head injury at the time of the accident. All the 5 patients were waiting to undergo secondary procedures for bone loss during which the follow-up x-rays showed new bone formation in the bone gaps. Results: Initial thin bone streak was noticed in x-ray of all patients with bone gap during regular follow-up visits, the earliest being at 6 weeks period. The mean time for progression and complete consolidation of the new bone was 10 months (range, 8 to 12 months). In one patient, spontaneous bone formation was incomplete and failed to consolidate. Bone grafting was performed. Conclusion: Spontaneous bone regeneration can occur very rarely in patients without head injury by a chance in very few selected patients.