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Skeletal Tuberculosis Following Fracture FixationA Report of Five Cases
Sudhir Kumar, MCh(Ortho)1; Anil Agarwal, MS(Ortho)1; Anil Arora, MS(Ortho)1
1 Department of Orthopaedics, University College of Medical Sciences, Shahdara, Delhi-110095, India. E-mail address for A. Agarwal: rachna_anila@yahoo.co.in
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1101-1106. doi: 10.2106/JBJS.E.00718
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Instances of prosthetic joint infection due to Mycobacterium tuberculosis have been reported in the literature1-5; however, it is extremely rare to find tuberculosis causing deep infection around fracture-fixation implants. We report the clinical presentations and outcomes of five such cases that were treated at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, between 1992 and 2004. There was no history of clinical manifestations of tuberculosis and no evidence of a pulmonary primary focus of the infection in these patients at the time of initial fracture treatment. The patients were informed that data concerning these cases would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Praveen K. Sharda
    Posted on June 05, 2006
    Skeletal Tuberculosis as a Nosocomial Infection?
    University Hospital of North Tees, UK

    To The Editor:

    Having trained initially in India, I know by experience, and the authors would probably agree, that there is higher prevalence of tuberculosis in hospitals than in the community. This is more so where tuberculosis patients are treated in the same wards with other non-infected patients.

    Since all the patients were apparently immunocompetent with no other identifiable source of tuberculosis, I am inclined to believe that it may have been hospital acquired infection, more likely acquired in the operating theatres.

    M Tuberculosis usually spreads by airborne dissemination(1,2), and the best way to ensure clean theatre suites is laminar air flow. Also, since the tubercle bacillus has greater resistance to chemical disinfectants, longer contact times are needed for sterilization(3). Proper ventilation and meticulous cleaning and sterilization of instruments may help to bring down the incidence of such complication. I am not sure if doing a PCR test would help in earlier diagnosis of such infections. Would the authors agree?


    1.van Rie A, Warren R, Richardson M. Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med 1999 Oct 14; 341(16): 1174-9

    2. Thomas Herchline, MD; emedicine - http://www.emedicine.com/MED/topic2324.htm

    3. Friedman LN, ed. Tuberculosis: Current Concepts and Treatment. Boca Raton, Fla: CRC Press; 1994: 1-366.

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