Closed traumatic dislocation of multiple metatarsophalangeal joints is a rare injury. Until now only one case of simultaneous dislocation of all five metatarsophalangeal joints has been reported in peer-reviewed studies. The complex anatomy of the metatarsophalangeal joints prevents the relocation of the joints in a closed manner in maximum cases. We are reporting a case of dorsal dislocation of the second to fifth metatarsophalangeal joints in the left foot after road traffic accident. Bony prominence over the plantar aspect and increased web space between toes on presentation, then incongruity of metatarsophalangeal joints has to be thoroughly checked on radiograph. Since closed reduction attempts failed open reduction was done through dorsal approach using two incisions. Button holing of the capsule with interposition of capsule and plantar plate was noted. Dorsal approach avoids damage to the plantar plate and surrounding soft tissues.

ABSTRACT-Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in terms of prolonged hospital stay and lost work days. Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the common organism isolated and its antibiotic sensitivity and resistance. Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity. Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07% of all the SSI's and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that could promote a more rational use of antibiotics.