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?

Mortality after hip fractures in the elderly is one of the most important patient outcome measures. Sub-clinical thyroid dysfunction is common in the elderly population. This is a prospective study of 131 elderly patients with a mean (SD) age of 82.0 (8.9) years (range: 61–94) admitted consecutively to our trauma unit. The aim of the study was to determine the prevalence of sub-clinical thyroid dysfunction in an elderly cohort of patients with hip fracture and to determine if this affects the one year mortality.

There were three times more women (n=100) than men (n=31) in this cohort. All patients underwent surgical treatment for the hip fracture. The prevalence of sub-clinical hypothyroidism (TSH > 5.5 mU/L) was15% (n=20) and of sub-clinical hyperthyroidism (TSH < 0.35 mU/L) was 3% (n=4). Overall 18% (n=24) of patients had a subclinical thyroid dysfunction. The twelve month mortality was 27% (n=36).

Age, gender, heart rate at admission, pre-existing Coronary Heart Disease, ASA grade and presence of overt or subclinical thyroid dysfunction were analysed for association with twelve month mortality using a forward stepwise logistic regression analysis. Only ASA grade was found to significantly affect mortality at twelve months (c2 = 3.98, df = 1, p =.046). The presence of sub-clinical hypo or hyper – thyroidism was not associated with a higher mortality (p = 0.278).

We conclude that sub-clinical thyroid dysfunction does not affect the one year mortality in elderly patients treated surgically for hip fracture.

Clinical decision-making could be difficult when Magnetic resonance imaging (MRI) is used for the diagnosis of knee injuries. We retrospectively studied 565 knee arthroscopies done between 2002 and 2005, 110 of which had suspected ligamentous injuries, evaluated clinically, with MRI and subsequently by arthroscopy.

The aim of the study was to know the extent of correlation of clinical, MRI features with arthroscopy and whether MRI could be justifiably used to deny an arthroscopy. All patients with a strongly suggestive history were examined in the clinic by experienced orthopaedic surgeons and MRI was requested. Clinical examination was repeated under anaesthesia by the operating surgeon who not necessarily had examined the patient initially. The clinical and arthroscopy findings were recorded systematically. 3 Radiology consultants of varying musculoskeletal experience reported the MRI films. The clinical and MRI findings were compared with arthroscopy for the extent of correlation.

We observed that overall Sensitivity of MRI for meniscal injuries was 73%, being more for medial than lateral and 86% for cruciate ligament injuries. Clinical examination had a sensitivity of 33% and a specificity of 93% for meniscal injuries, sensitivity of 86% and specificity of 100% for cruciate injuries. MRI was not able to demonstrate synovial plicae in 13 knees and chondral defects in 3 knees. 96 Knees, which were normal clinically, were found to have meniscal tears on MRI in 65 and subsequently confirmed by arthroscopy in 39.

We conclude that an accurately performed clinical examination with positive signs alone, will be justified for arthroscopy and a negative MRI will not be a sufficient evidence to deny an arthroscopy. Also the reporting will largely depend on the quality of information provided by the clinician, technical factors and the musculoskeletal experience of the person reporting the films.

Proximal femoral fractures, whether it is due to meta-static destruction or periprosthetic fractures with loose femoral component with secondary osteolysis of the proximal femur in the elderly patient is a major task. We find the Cannulock hip system quite useful in tackling this issue. It offers various options for the management of this complex pathology.

We present the results of 11 Cannulock Hip Arthroplasty performed in 10 patients (Age Range 55–92). 6 out of 11 patients was noted to have metastatic destruction of proximal femur including the head and neck down to lesser trochanter. Ca of Bronchus and Breast with multiple bony metastsis were responsible for these cases. 4/11 had loose femoral component with type 2 periprosthetic fractures. 1 out of 11 had failed DCS fixation for Reverse oblique fracture. The procedures were done in a district general Hospital in the UK between August 2001–Jan 2006. The patients were mostly ASA 4.

The Cannulock Hip system offered the simplicity of a Hemiarthroplasty with an advantage of Intramedullary nailing option. This has the option of fitting standard Bipolar Head or 22 mm metallic head in case of Peri Prosthetic fracture where the acetabular component is intact. Long stem with HA coating and standard options for cemented stem insertion. The long stem with a bow enables easy insertion with distal locking facility.

In our study all the patients were excellent with both clinical and readilogical out come, however sadly 1 patient died with in 3 months of surgery. 5/6 patients with metastatic bone tumour were discharged at the mean of 8 weeks with no clinical concerns. 4 patients with femoral stem revisions and 1 patient with failed DCS were discharged at a mean of 4 months. We find the Cannulock hip arthroplasty system quite versatile in the management of these complex injuries.

Leucocytes are white blood cells that help the body fight against bacteria, viruses and tumour cells. However, the activity of leucocytes has been implicated in other clinically important inflammatory conditions such as ischaemic heart disease, stroke, and during cardio-aortic and orthopaedic surgery.

The main objectives of this study was to optimise methods for the isolation of leucocyte subpopulations (neutrophils and monocytes), and to assess in vitro the effects of PMA and fMLP on markers of leucocyte adhesion (CD11b, CD62L) and activation (intracellular hydrogen peroxide) (n=10). Leucocyte subpopulations were labelled by incubation with fluorescein isothiocya-nate (FITC) conjugated anti-human CD11b and CD62L antibodies. The cell surface expression of these labelled adhesion molecules were measured by flow cytometry. Intracellular production of hydrogen peroxide by neutrophils and monocytes was measured by flow cytometry, using the fluorochrome dichloroflurorescin diacetate (DCFH-DA). These were visualised by Immunofluorescence microscopy.

During this study, methods of isolating leucocyte subpopulations from whole blood were optimised. This ensured that these cells were isolated with consistently high yields, purity and with no changes in cellular function. Following incubation with PMA and fMLP, neutrophils and monocytes displayed an increase in CD11b cell surface expression; a decrease in CD62L cell surface expression; and increased leucocyte activation. Leucocyte activation was represented by the intracellular production of hydrogen peroxide.

In conclusion this study confirms that both PMA and fMLP have an intrinsic effect on markers of leucocyte function. These findings are in agreement with previous studies performed.