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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_6 | Pages 15 - 15
1 Feb 2013
Mullan C Thompson L Cosgrove A
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Northern Ireland has previously demonstrated high incidence of Perthes' disease (11.6 per 100,000). The aim of this study is to confirm a declining incidence in this diagnosis in Northern Ireland.

Methods

A reduction in new Perthes' patients had been noted by the senior author. A retrospective study was designed to identify patients with a new diagnosis of this disease over a 7 year period (2004–10). Clinical notes were interrogated using word searches. Further cross referencing with x-ray system reports were utilised to capture all new patients presenting with subsequently proven Perthes'. Patients not resident in Northern Ireland at the time of diagnosis were excluded. Patients with epiphyseal dysplasia or avascular necrosis secondary to treatment of developmental dysplasia of the hip were also excluded.

A previous study from this unit had demonstrated 313 new cases over the 7 year period 1992–1998, with average incidence of approximately 45/year for the population.

Results

All years in our study (2004–10) have had less than 30 for the entire population (<8.3 per 100,000). Significant variation between years with some years much less detected, so further searches are been undertaken to ensure completeness if data capture.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 107 - 107
1 Apr 2012
Allan C Gibson L Rice L Thompson L
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MRI scanning of spinal patients at the Primary Care Triage stage is pivotal in reducing inappropriate referrals into Secondary Care.

A retrospective study was undertaken. Details of patients from spinal triage clinics referred for MRI scan were collated together with a provisional diagnosis. Following imaging the results and management plan were documented.

2191 Patients referred via GP's to Physiotherapy Specialist- lead spinal triage clinics from April to September 2009 inclusive.

Referred to a spinal consultant routine/urgent, Managed conservatively, Failed to attend for MRI scanning or MRI cancelled, Sent for scanning for reassurance and discharged.

Of 2191 patients seen in a 6-month period 194 (9%) were referred for MRI of which 81 (41%) were referred on to spinal consultant. This equates to 3.7% of the total number of patients triaged.

Specialist physiotherapy diagnosticians with access to MRI scanning, allows simultaneous treatment and seamless transfer to spinal consultants for surgical intervention if appropriate1. This process is used effectively to manage large numbers of spinal referrals and minimises the number of patients seen unnecessarily in secondary care1. This is only possible with close multidisciplinary team working2.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 457 - 457
1 Aug 2008
Buchanan E Mukherjee K Freeman R Thompson L
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Background: Guidelines for the management of Low Back Pain (LBP) consistently recommend that initial assessment should focus on the detection of serious spinal pathologies. In 1994 the UK Clinical Standards Advisory Group introduced the concept of “red flags”. One flag is the presentation of back pain in people under the age of 20. LBP in children is common, with an annual and lifetime prevalence of around 30%. Because many cases of benign and malignant spinal tumours and spinal infection have been documented in this age group, young people with LBP who are referred to secondary care are investigated by MRI.

Purpose: The purpose of this study is to review the incidence of tumour and infection in subjects under age 20, who present to secondary care with LBP, but do not have concerning objective findings such as neurology, fever, acute deformity or scoliosis.

Method/Results: A retrospective analysis of the MRI database, at a specialist orthopaedic hospital, from 1994 until 2005 identified 403 limited MRI’s taken in LBP patients under the age of 20. Analysis revealed 2 radiological reports of spinal tumour, 1 ependymoma and 1 osteoid osteoma and no cases of spinal infection. Histology confirmed pathology in the ependymoma but excluded serious pathology in the osteoid oste-oma. Other MRI findings, included minor degenerative change (17%), pars defect (9%) and disc prolapse (4%). Therefore, over an 11 year period only 0.25% of young people with LBP who underwent limited MRI were found to have serious pathology.

Conclusion: In conclusion, LBP is relatively common in people under the age of 20 and can be severe enough to warrant secondary care referral. However, in the absence of other objective findings, serious pathologies such as cancer and infection remain rare. These results support the use of limited MRI for screening. However, further research into the clinical value of “under 20” as an independent red flag is recommended.