Background: Surgical site infctions is one of the frequently seen complication following instrumented spinal surgeries. Although numerous prophylactic measures have been tried out to prevent surgical site infections, it still remains a concern. Local use of powdered vancomycin is one of the newer method which is being tried all over the world to reduce the rates of infection. Materials and methods: The study was conducted in our Institute in a prospective manner from January 2012 to June 2017. A total of 80 patients who underwent spinal instrumentation for various indications were included in the study. Patients were divided into two groups, first group a Control Group(CG) and second group-Vancomycin Group (VG). Both the groups comprised of 40 patients each. One gram of powdered vancomycin was impregnated below the fascial layer after completion of surgery in patients who belonged to Vancomycin Group. Results: There found to be no statistical significant difference between the groups for the following variables: age, sex, operating time and blood loss. Infection rates in the two groups were compared. There were total 6 cases of infection. 5 out of 40 (12.5%) patients in the control group had either superficial or deep infections. While only one patient (2.5%) belonged to vancomycin group had infection, that too it was a superficial infection. Threre was a statistically significant reduction in the rate of infection in the vancomycin group on comparing with the control group when 'p' value was calculated, with a value of < 0.001. Conclusion: Use of local powdered form of vancomycin following spinal instrumentation surgeries is an effective prophylactic method in reducing the rates of infection. However, further randomized double blind studies with larger sample size is needed.

Background: Distal femoral fractures historically have been difficult to treat. Because of the proximity to the knee joint, regaining full knee motion and function is difficult. Controversy remains regarding the optimum device among various fixation devices available for distal femoral fixation. Retrograde nailing has shown to be the optimal device for this fracture. Hence this study was conducted to analyze the functional outcome Muller's type A and C distal femoral fractures treated with retrograde intramedullary nailing. Materials and methods:The study was conducted in a tertiary referral institute between January 2010 to December 2015. This study was conducted in a retrospective and prospective manner. Retrograde nailing was performed on a total of 43 patients presenting with supracondylar and intra condylar fractures of distal femur. Cases were followed up till December 2016. 3 of our patient lost to follow up. Outcome was assessed by using Neer's scoring system. Results: All patients were followed up for an average of 15 months. There were 30 type A and 10 type C AO fractures. All the fractures eventually healed with an average time to union of 15 weeks. Using Neer's scoring system there were 22(55%) excellent, 12(30%) good, 4(10%) fair and 2(5%) poor results. Conclusion: Retrograde nailing makes biological osteosynthesis of distal femoral fractures with less Periosteal stripping, less blood loss, lesser need for none grafting, decreased operative time and very low late varus collapse rates.

Introduction: Deep Vein Thrombosis (DVT) is one of the common and dreaded complication of joint replacements, hip and spine surgeries. The incidence of deep vein thrombosis among these cases is significant in spite of the various prophylactic measure such as physiotherapy and pharmacological measures. Materials and Methods:The study was conducted in our Institute between January 2014 to June 2017. The study included patients who underwent total hip and total knee replacements for various cases and spinal surgeries during the same year. We had a total of 195 patients in the study. Among these, 65 patients were given DVT prophylaxis by physiotherapeutic measure such as foot pump and pneumatic compression device and 130 were given combined physiotherapeutic and pharmacological prophylaxis by giving Low molecular weight heparin postoperatively. Post operatively patients were assessed for DVT both clinically and by Doppler Study Results: A total of 8 patients out of 65 among the physiotherapeutic alone group developed thrombosis [12%]. Among 130 patients who were given prophylaxis by combined measures 9 patients developed thrombosis [07%]. So the results of our study have shown that combined physiotherapeutic and pharmacological measure have an edge over the physiotherapeutic measure alone. Conclusion: Researches which have been done previously have shown that there is no difference in the incidence of DVT among patients treated by other physiotherapeutic and pharmacological measures alone. In our study the result of combined methods was found to be better than physiotherapy measure alone. Hence, the incidence of DVT among the replacement and spine surgeries can be reduced by combined modalities of prophylaxis.

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