Introduction: Haematogenous pyogenic spinal infection encompasses spondylodiskitis, septic discitis, vertebral osteomyelitis and epidural abscess. Management of pyogenic spinal infection can involve conservative methods and surgical intervention. We carried out a retrospective review of 48 cases of pyogenic vertebral osteomyelitis presenting over a twelve-year period to the National Spinal Injuries Unit of the Republic Of Ireland. Our objective was to analyze the presentation, aetiology, management and outcome of 48 cases of non-tuberculous pyogenic spinal infection.

Methods: Both the Hospital Inpatient Enquiry (HIPE) System and the National Spinal Injuries Unit Database were used to identify our study cohort. The medical records, blood results, radiologic imaging and bacteriology results of all patients identified were reviewed.

Results: The average age of presentation was 59 years with an almost even distribution between males and females. Most patients took between three and six weeks to present to hospital. Diagnosis was confirmed by serological testing of inflammatory markers and radiological imaging. The most frequently isolated pathogen was Staph. aureus (75% of cases). 94% of cases were managed by conservative measures alone, including antibiotic therapy and spinal bracing. However, in 6% of cases surgical intervention was required due to neurological compromise or mechanical instability.

Conclusions: With this large cohort of non-tuberculous, pyogenic spinal infections from the NSIU, we conclude that Staph. aureus is the predominent pathogen. In the vast majority, conservative management with antibiotic therapy and spinal bracing is very successful. However in 6% of cases surgical intervention is warranted and referral to a specialist centre is appropriate.

Aims: Rugby is a popular sport in Ireland, with over 100,000 players registered with the Irish Rugby Football Union (IRFU) at all levels. We report a 10 year series of spinal injuries presenting to the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital.

Methods: A large series of spinal injuries in rugby players was isolated utilizing the NSIU database, HIPE and data from the IRFU. An extensive chart review and telephone interview was performed in all cases to determine age, mechanism of injury, possible aetiological factors, anatomic location of injury, American Spinal Injuries Association (ASIA) scores, current level of activity and response to rehabilitation.

Results: From 1994 to 2004, 22 rugby players with spinal injuries necessitated admission to the NSIU. Twelve patients (54%) presented with neurology. The average age at time of injury was 21.1 years (range 14 – 44 years) and all patients were male. The average length of hospital stay was 10.1 days (range 1 – 45 days). Twenty patients had cervical spine injuries. The most common mechanism of injury was hyperflexion of the cervical spine, with C5/C6 most commonly injured. Fifteen injuries occurred at adult level, the remainder at schoolboy level. Seventeen (77%) players were injured whilst playing First Team rugby. Eleven (50%) players were injured in the Backs, the remainder in the Forwards. 68% of injuries occurred in the tackle situation and 32% in the scrums, rucks and mauls. Winger, Full Back and Hooker were the playing positions at greatest risk.

Nine (41%) patients underwent surgery and 11 (50%) required rehabilitation in the National Rehabilitation Centre, Dun Laoghaire, with an average length of inpatient stay of 9.22 months (range 5 – 14 months). Eight (36%) patients felt that their injury was preventable. Of those patients without neurology, 60% have returned to playing rugby.

Conclusion: Rugby as a sporting pastime is not without risk. During the ten year period under review, 8 players suffered permanent disability as a direct result of participation in competitive rugby. Serious spinal injuries continue to occur and recent rule changes have had little effect in reducing their incidence.

Aims: Rugby is a popular sport in Ireland, with over 90,000 players registered with the Irish Rugby Football Union (IRFU) at all levels. We report a 10 year series of spinal injuries presenting to the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital.

Methods: A large series of spinal injuries in rugby players was isolated utilizing the NSIU database, HIPE and data from the IRFU. An extensive chart review and telephone interview was performed in all cases to determine age, mechanism of injury, possible aetiological factors, anatomic location of injury, American Spinal Injuries Association (ASIA) scores, current level of activity and response to rehabilitation.

Results: From 1994 to 2004, 22 rugby players with spinal injuries necessitated admission to the NSIU. Twelve patients (54%) presented with neurology. The average age at time of injury was 21.1 years (range 14 – 44 years) and all patients were male. The average length of hospital stay was 10.1 days (range 1 – 45 days). Twenty patients had cervical spine injuries. The most common mechanism of injury was hyperflexion of the cervical spine, with C5/C6 most commonly injured. Fifteen injuries occurred at adult level, the remainder at schoolboy level. Seventeen (77%) players were injured whilst playing First Team rugby. Eleven (50%) players were injured in the Backs, the remainder in the Forwards. 68% of injuries occurred in the tackle situation and 32% in the scrums, rucks and mauls. Winger, Full Back and Hooker were the playing positions at greatest risk.

Nine (41%) patients underwent surgery and 11 (50%) required rehabilitation in the National Rehabilitation Centre, Dun Laoghaire, with an average length of inpatient stay of 9.22 months (range 5 – 14 months). Eight (36%) patients felt that their injury was preventable. Of those patients without neurology, 60% have returned to playing rugby.

Conclusion: Rugby as a sporting pastime is not without risk. During the ten year period under review, 8 players suffered permanent disability as a direct result of participation in competitive rugby. Serious spinal injuries continue to occur and recent rule changes have had little effect in reducing their incidence.

Introduction: Patients with multiple skeletal injuries are susceptible to Systemic Inflammatory Response Syndrome (SIRS) and consequently Acute Respiratory Distress Syndrome (ARDS). Fracture haematoma contains pro-inflammatory mediators. The aim of our study was to show in vitro that fracture haematoma is implicated in neutrophil mediated injury, SIRS, ARDS and MOF.

Methods: Fracture haematoma was isolated from 10 patients at the time of surgery. Neutrophils (PMN) were isolated from 10 healthy volunteers. PMN were exposed to the fracture haematoma supernatant and PMN activation in both primed and unprimed neutrophils were examined (CD11b and CD18 adhesion receptor expression and respiratory burst). PMN phagocytosis and apoptosis were also assessed using flow cytometry. Transmigration across an endothelial barrier was also measured following exposure to fracture haematoma.

Results: Fracture haematoma had a marked effect on respiratory burst in primed PMNs (control = 100% vs 20% fracture haematoma = 1044% ± 405, p=0.04). CD11b and CD18 adhesion receptor expression were not upregulated in the fracture haematoma group. PMN phagocytosis of E coli was increased following treatment with fracture haematoma (control = 100% vs fracture haematoma = 171% ± 6SE, p=0.0001). Transendothelial migration of treated neutrophils was unaffected. Treatment of endothelial monolayers with fracture haematoma did not result in upregulated ICAM1 expression but was observed to induce significant endothelial cell death. PMN apoptosis was significantly delayed following exposure to fracture haematoma (control = 46% ± 5 vs fracture haematoma = 8% ±2, p=0.0005).

Discussion: We have shown that fracture haematoma activates neutrophils, increases phagocytosis and respiratory burst whilst delaying apoptosis. These effects, whilst beneficial at the site of injury, may cause neutrophil mediated tissue injury systemically.

Introduction: Since the introduction of joint arthroplasty major advances including the introduction of laminar airflow, have been made in reducing infection to current rates of 1 to 2%. Nonetheless infection remains a devastating complication, with major implications in terms of patient suffering, duration of hospital stay and financial burden. We undertook a study to examine the incidence of bacterial wound contamination occurring in the intra-operative period.

Materials and Methods: All patients admitted to our unit for elective hip and knee arthroplasty were entered into the study. On arrival in theatre a skin swab was taken. The patient was then prepared and draped in the anaesthetic room before final draping by the surgical team in the operating theatre. All procedures were performed in theatres equipped with laminar airflow, and all surgical personnel wore isolator suits. During the course of the procedure swabs were taken from the anterior aspect of the femur at 30-minute intervals. In addition the skin and inside blades and the suction tip were harvested at the end of the procedure. All samples were then sent for culture. Patient data including age, comorbid conditions and history of previous surgery were noted on a standardised pro forma. In addition, operative data including duration of the procedure, operating surgeon and type of drape and skin preparation used were noted.

Results: 65 patients have been examined to date. An incidence of contamination of 14% has been noted (9 patients) with the skin blade and suction tip being the most common source of contaminating organisms. Staphylococcus epidermis was cultured in 5 cases, with Gram negative organisms being cultured in the remaining samples. In all 9 cases only small numbers of organisms were identified. None of the patients with positive cultures developed clinical signs of deep or superficial wound sepsis, and all had an uncomplicated postoperative course.

Conclusions: While low levels of contamination are unavoidable in theatre, it is important that strict discipline be maintained in order to minimise this risk. In particular, careful attention to patient skin preparation, the use of prophylactic antibiotics and minimising use of the suction tubing help decrease contamination rates.