Introduction: Incidence of infection after internal fixation of closed fractures is generally lower (1−2%). Aim of this study is to find out risk factors and identify the organism and their sensitivity to commonly used antibiotics in post-operative infected cases following internally fixed closed fractures. Material & Methods: 211 patients of all ages and both sexes underwent elective surgery for internal fixation of closed fractures by a single surgical team at our institute from September 2016 to September 2017. 18 of them developed post-operative infection and were retrospectively analysed. Presence of post-operative infection was diagnosed on basis of history, clinical examination, blood parameters and radiographs. Surgical site infection, superficial or deep, florid or low grade, early or delayed or late onset infection were defined as per existing literature. Microscopy, culture and sensitivity test was done on swabs obtained from discharge through surgical site or sinus tract or from deep tissues during surgical exploration under anaesthesia. Results: The post-operative infection rate in our study was 8.53% (18 cases out of 211). Males (n=14), age > 40 years (n=11), femur (n=9, 50%) especially proximal end (n=7), pre-operative hospital stay for > one week and increased duration of surgery of more than 60 minutes were most commonly affected. 5 out of 40 cases (12.5%) of closed reduction and 13 out of 171 cases (7.6%) of open reduction developed post-operative infection. The percentage of post-operative infection with plate, intramedullary nail, screw and bipolar prosthesis implantation are almost similar. Late onset (50%), superficial (61.11%) and low grade infection (77.78%) were more common than their counterparts. Staphylococcus aureus was the most common organism followed by Klebsiella pneumonae. Imipenem, ciprofloxacin& vancomycin were most common sensitive antibiotics. Imipenem showed sensitivity to gram negative organisms but Vancomycin, Co-trimoxazole, Cefoxitim and Linezolid were sensitive to Staphylococcus species including MRSA (Methicillin resistant Staphylococcus aureus). Ciprofloxacin was sensitive to both Staph species & gram negative organisms. 15 patients had at least one comorbidity and 8 patients had more than 2 comorbidities, anaemia being the most common. Conclusion: Knowledge of patient related clinical factors and commonly isolated organisms and their antimicrobial sensitivity patterns within a given hospital assists in prophylaxis and treatment of postoperative infection.

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures in children are treated by different conservative and operative methods. Patient’s age may be the single most important factor deciding treatment. Several studies have documented superior results with internal fixation compared to non-operative treatment. The aim of the study is to evaluate the outcome of proximal humerus locking plate fixation of subtrochanteric femoral fractures in children.</p><p class="abstract"><strong>Methods:</strong> Between October 2015 and December 2017, 13 children with closed subtrochanteric femoral fractures including 3 pathological fractures were treated in our tertiary care teaching institute and the results were retrospectively analysed. Children of both sexes within 5–12½ years of age with isolated subtrochanteric fractures were included. There was no open fracture and fracture associated with neuromuscular disease or any systemic injury. In all cases, ORIF with proximal humerus locking plate was done using lateral approach.<strong></strong></p><p class="abstract"><strong>Results:</strong> Average age at the time of injury was 9.35 years (range 5–12 ½ years). There were four (30.77%) short oblique, four (30.77%) long oblique, three (23.08%) transverse fractures and two (15.38%) comminuted fractures. Average operative time was 88.76 minutes and average intra operative blood loss was 86.23 ml. Average follow-up was 13 months. All fractures showed radiological union at an average of 8 weeks. One case had superficial infection which was controlled by antibiotics. Two patients had limb lengthening (average 0.75 cm) but required no intervention.</p><p class="abstract"><strong>Conclusions:</strong> Internal fixation with adult proximal humerus locking plate appears as a good treatment option for paediatric subtrochanteric femoral fractures.</p>

Chondromyxoid fibroma is a benign bone tumour accounting for less than 1% of all primary bone tumours. It usually affects the metaphyseal region of long bones in the first or second decade of life. It rarely occurs in scapula. We present a case of 29 year old female with biopsy proven Chondromyxoid fibroma of left scapula. She underwent wide marginal excision by partial scapulectomy with preservation of glenoid. Post operatively she has stable shoulder joint with normal range of movement & no recurrence on regular follow up.

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