Background

Dynamic Hip Screw (DHS) is the most frequently used implant in management of intertrochanteric femoral fractures. There is a known statistical relationship between a tip-apex distance (TAD) >25mm and higher rate of implant failure. Our aim was to analyse all DHS procedures performed in our trust from seventeen months and compare their TAD values to the acceptable standard of ≤25mm.

Background

A cautious outlook towards neck injuries is the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce the unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries.

Background

One of the basic principles in the primary survey of a trauma patient is immobilisation of the cervical spine till cleared of any injury. Lateral cervical spine radiograph is the gold standard initial radiographic assessment. More than often additional radiographs like the Swimmer's view are necessary for adequate visualisation of the cervical spine. How good is the Swimmer's view in visualisation of the cervical spine after an inadequate lateral cervical spine radiograph?

There is a high incidence of ipsilateral knee injuries with the Floating knee, which makes these fractures even more challenging to manage. We present the impact knee injuries have on the final outcome of the floating knee. We propose a protocol for assessment & management of knee injuries with the Floating knee.

This prospective study included 29 patients with floating knee injuries. Knee injuries encountered were divided into bony, ligamentous and soft tissue. Bony injuries were assessed with radiographs and managed surgically along with the floating knee injury. Patients were assessed clinically for knee ligament injuries after fixation of the fractures intra-operatively and managed surgically. Soft tissue injuries around the knee were managed conservatively. Final outcome was assessed using the Karlstrom criteria.

Ten of the 29 patients had knee injuries: 3 patella fractures, 2 anterior cruciate ligament injuries, 1 posterior cruciate ligament injury, 1 medial meniscus injury and 3 extensive soft tissue injuries. The complications were knee stiffness and superficial infection. The end results according to the Karlstrom criteria were Good – 6, Acceptable – 1 and Poor – 3.

The associated knee injury in the floating knee is an important prognostic indicator. Soft tissue injury seems to have a very poor prognosis. We propose clinical evaluation of the knee after fixation of the fractures, surgical management of ligament & bony injuries and a proper rehabilitation programme to improve outcomes.

Background: Knee prosthesis design is being constantly altered in a bid to imitate kinematics of the normal knee. It is hoped that this will improve the wear characteristics and performance of the implant. The ‘Medial Pivot’ knee has a characteristic geometry and is expected to lower contact stresses on the tibial surface and ease rehabilitation while providing greater stability.

We conducted a study comparing the midterm outcome of the Medial Pivot knee (MP) to the Posterior Stabilised (PS) knee.

Materials and Methods: Over a 3 year period, 312 knee replacements were carried out of which 124 were MP and 188 were PS. 100 patients from each of the 2 groups were called for review. Demographic data, age at operation, time since surgery and ASA grading were noted. Postoperative knee function was assessed using the American Knee Society (AKS) and Oxford Knee (OK) scores and the scores were compared between the 2 groups. Individual functional parameters were also compared.

Results: 38 patients with 42 replaced knees in the MP group and 43 patients with 52 replaced knees in the PS group were reviewed. The 2 groups were comparable in terms of gender of patients and age at operation and were followed up to a mean 31 months. For the MP group the mean AKS knee assessment score was 77/100, AKS function score was 75/100 and OK Score was 23/60. For the PS group the corresponding values were 81/100, 77/100 and 22/60. The differences in scores between the groups were not statistically significant. Only active and passive knee extension was better following MP Arthroplasty than PS arthroplasty (p< 0.05). Although the mean flexion was better following the PS arthroplasty, this was not statistically significant.

Conclusion: Our study has shown that the midterm outcome for the Medial Pivot knee system did not show any distinct advantage over the Posterior Stabilised knee system in terms of knee pain & function.

Background: A cautious outlook towards neck injuries has been the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce the unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries.

Methods: This was a retrospective study conducted in 2 hospitals. 114 alert and stable patients who had cervical spine radiographs done for suspected neck injuries were included in the study. Data on patient demographics, Canadian Cervical Spine rule, cervical spine radiography results and further visits after discharge were recorded.

Results: 14 patients were included in the high risk category according to the Canadian Cervical Spine rule. 100 patients were assessed according to the low risk category. If the Canadian Cervical Spine rule was applied, there was a significant reduction in cervical spine radiographs (p< 0.001) as 86/100 patients (86%) in the low risk category would not have needed cervical spine radiograph. 2/100 patients who had significant cervical spine injuries would have been identified when the Canadian Cervical Spine rule was applied.

Conclusion: Applying the Canadian Cervical Spine rule for neck injuries in alert and stable patients reduced the use of cervical spine radiographs without missing out significant cervical spine injuries. This relates to reduction in radiation exposure to patients and cost benefits.

Floating knee injuries are usually associated with other significant injuries. These injuries have major implications on the management of the floating knee and the final outcome of patients. Our study highlights the implications of associated injuries in the management of floating knee.

29 patients with 30 floating knees were assessed in our institution. A retrospective analysis of medical records and radiographs were done and all associated injuries were identified.

38 associated injuries were noted. 7 were associated with ipsilateral knee ligament injuries.

The associated injuries in our study had implications on the duration on surgery, anaesthetic exposure and delay in surgical management, post-operative rehabilitation, diagnosis and management of knee ligament injuries. The importance of these associated injuries cannot be overemphasized.

The Mini C-arm has been heralded as a safer means of fluoroscopy. No clinical data on the use of the mini C-arm is available in the literature. The purpose of this study is to compare the exposure in clinical practice between the conventional C-arm and the mini C-arm, and to scrutinize the patterns of radiation exposure.

All operations using the mini C-arm were reviewed. A control group of patients undergoing the identical surgical procedure using the conventional C-arm was used. The Sign test was used to detect the number of exposures taken and the radiation exposure documented.

There were 16 surgical procedures where a valid control was available. The number of exposures performed with the mini C-arm was significantly greater than the conventional C-arm (p=0.05), but the emitted dose of radiation was significantly smaller for the mini C-arm (p 0.001).

The authors conclude that the mini C-arm is a safer device for use in extremity surgery, but that the Surgeon should still be careful to avoid repeated excessive exposures.

Introduction: The mini C arm is a surgeon operated fluoroscopic device for use in the operating theatre for extremity orthopaedic surgery. There have been no studies comparing the radiation dose of the mini C arm and the conventional C arm.

The aim of this study was to determine if the exposure to patient and surgeon was decreased with use of the mini C arm.

Methods: This was a case-control study. Operations performed with the mini C arm were matched for type, complexity and operator with cases performed with the conventional C arm. The number of exposures and the total time of exposure were measured, and the skin dose and scatter calculated.

Results: There were 16 case-control pairs. There was a significantly greater number of exposures taken by the surgeon operated mini C arm (p=0.02), but there was still a significantly lower exposure to the surgeon with the mini C arm (p=0.004). There was no significant difference in the patient skin dose (p=0.21).

Conclusions: The surgeon operated mini C arm results in a greater exposure time and number of exposures. Despite this, the mini C arm exposes the surgeon to less radiation compared to the conventional C arm in extremity orthopaedics. The radiation exposure with the mini C arm is approximately half that of the conventional C arm. The increased number of exposures may occur because surgeons are more trigger happy with the mini C arm, or because there are technical problems with achieving a useful image. The mini C arm should be used for extremity orthopaedics whenever possible to decrease the radiation exposure.

Background: The Mini C-arm has been heralded as a safer means of fluoroscopy. No clinical data on the use of mini C-arm is available in the literature.

Aim: The purpose of this study was to compare the exposure in clinical practice from the conventional C-arm and the Mini C-arm and scrutinize patterns of exposure.

Materials/methods: Case-Control design. All operations using the mini C-arm were reviewed. Control cases were identical operations using the conventional C-arm. The Sign test was used to detect the number of exposures taken and the dose of radiation.

Results: There were 16 operations with valid case-control pairs. The number of exposures performed was significantly greater for the mini C-arm (p=0.05), but the emitted dose of radiation was significantly smaller (p< 0.001) for the mini C-arm.

Conclusions: The mini C-arm is a safer device for extremity surgery, but the surgeon should be careful to avoid excessive exposures.