Background and Purpose

Serum lactate has been shown to be an indicator of adverse clinical outcomes in patients admitted secondary to general trauma or sepsis. We retrospectively investigated whether admission serum venous lactate can predict in-hospital mortality in patients with hip fractures.

Background

Cauda equina syndrome (CES) is a physical process. There is compression of the cauda equina resulting in arrest of the electrochemical signal from the central nervous system. Previous studies have demonstrated that anthropomorphic features influence nerve conduction properties.

Background

Fractures of the odontoid peg are one of the commonest cervical spinal injuries in the elderly population. In this population there is a higher risk of morbidity and mortality as a result of the injury. The magnitude of the mortality risk has not been quantified in the literature.

Background

The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined.

Background

The National Institute of Clinical Excellence (NICE) published clinical guidelines in 2006 defining urgent referral criteria for soft tissue sarcoma to help improve the diagnostic accuracy and overall outcome. Despite these guidelines inadvertent excisions of soft tissue sarcomas continue to occur with alarming frequency potentially compromising patient outcomes.

Background

Thoracolumbar fractures are the most common spinal injuries resulting from blunt trauma. Missed spinal injuries can have serious consequences.

Background

Minimally invasive surgery is an alternative therapeutic option for treating unstable spinal pathologies to reduce approach-related morbidity inherent to conventional open surgery.

Background

Rotatory subluxation of the atlantoaxial joint has been thoroughly documented in children. However, pure traumatic atlantoaxial rotatory subluxation (TAARS) is a rare injury in adults with only a few cases reported in the English literature.

Background

Wallis implant was developed in 1986 to stiffen unstable operated degenerate lumbar segments while preserving some intervertebral mobility. The long-term results of first-generation Wallis implant from developers were promising. However, documentation pertaining to safety and efficacy of second generation Wallis implant is sparse in literature.

Background

The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined.

Background

Fractures of the odontoid peg are one of the commonest spinal injuries in the elderly population. In this population there is a higher risk of morbidity and mortality as a result of the injury. The magnitude of this risk has not been quantified in the literature.

Background: Non-rigid fixation clearly appears to be a useful technique in the management of degenerative intervertebral lumbar disc disease. A mobile, dynamic stabilization restricting segmental motion is possible to be advantageous in various indications, allowing greater physiological function and reducing the inherent disadvantages of rigid instrumentation and fusion.

Aim: This study is a prospective analysis of the early results of second generation Wallis implant for degenerative disc disease.

Methods and Materials: Twenty-five patients with leg and back pain that was not responsive to conservative treatment underwent discectomy and implantation of second generation device. There were 22 one-level and 3 two-level cases. The preoperative radiological work-up included conventional X-rays, computed tomography and magnetic resonance imaging (MRI). All patients underwent neurological examination, assessment of pain on a visual analog scale, and a functional evaluation using the Revised Oswestry disability index before surgery, 3 months after surgery and at follow- up.

Results: A total of 25 patients (13 men, 12 women) with a mean age of 51.9 years (range, 34 to 69 years) were evaluated with a mean follow-up of 1.4 year after the intervention. Mean pain and function scores improved significantly from baseline to follow up as follows: – back pain scale from 7.2 to 2.9, leg pain scale from 6.8 to 2.5 and Oswestry Disability Index from 59.1% to 22.6%. No cases of infection or worsening of neurological deficit occurred. One patient had revision surgery for persistent pain as a result of granulation tissue underneath the implant. No mechanical failure of the implants or loosening was observed and the process retained motion.

Conclusion: Clinical results are satisfactory and compare well with those obtained by conventional procedures in addition to which mobile stabilisation are less invasive then fusion. Wallis neutralisation proves to be a safe and effective in the treatment of unstable lumbar condition.

Aim: To determine the effectiveness of therapeutic lumbar facet joint injections in patients with chronic low back pain.

Methods: Eighty-six patients with refractory chronic low back pain were randomly assigned to receive facet joint injection using local anaesthetic and corticosteroid suspension under fluoroscopic guidance after clinical and radiological assessment. The main parameter for the success or failure of this treatment was the relief of the pain. Pain intensity was assessed with a visual analog scale (VAS) and changes in function and quality of life were assessed by the revised Oswestry Disability Questionnaire (ODQ) at baseline and during follow-up after injection.

Results: Patients reported lasting pain relief, better function, and improved quality of life following injection. Cumulative significant relief following injection was 91.9% up to 1 to 3 months, 81% for 4 to 6 months, 34% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/− 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. No complications were noted following injection.

Conclusion: The results of this study demonstrate that intra-articular facet joint injection appear to have a beneficial medium-term effect in patients with chronic lower back pain and may therefore be a reasonable adjunct to non-operative treatment.

Background: Patients suffering from hip osteoarthritis (OA) are frequently symptomatic, and the disease can result in significant limitation of patients’ activity and high social costs. Viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid, is a well-accepted therapeutic option in knee OA patients, but limited data exist in the literature about its potential benefit for the treatment of hip OA.

Aim: To evaluate the efficacy and safety of viscosupplementation (VS) with hyaluronic acid (Hylan GF 20) under fluoroscopic guidance in patients with symptomatic hip OA

Methods: Forty six patients (26 men, 20 women, mean age 56.4 years) with symptomatic hip OA were treated with one injection of 2 ml of hylan G-F 20(Synvisc) under fluoroscopic guidance which could be repeated after at least 3 months. Treatment efficacy was assessed by functional index oxford hip score, pain evaluation on a visual analogue scale and NSAID consumption. All such parameters were recorded at baseline as well as 2, 6 and 12 months after the beginning of the treatment.

Results: We observed a statistically significant reduction of all considered parameters at the timepoints 2 and 6 months, when compared to baseline. At 12 months the changes were still statistically significant for all parameters for about 50% of the patients. Three patients reported self-limited mild, local pain post-injection otherwise no systemic adverse events were observed.

Conclusion: Viscosupplementation with hylan G-F20 is feasible, easy to perform as well as safely relieves osteoarthritis hip pain, facilitates an improved activity level, decreases the need for pain medication, physiotherapy, and assistive devices.

Introduction: Infection following TKR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before TKR. Despite the fact that some of the centers in UK now routinely perform preoperative screening for TKR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for TKR patients in the year 2004 at our center. According to the new admission policy all TKR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according toNINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following TKR

Introduction: Infection following THR is a catastrophic complication. Few authors have highlighted the need for screening of patients (nose, axilla and groin) before THR. Despite the fact that some of the centres in UK now routinely perform preoperative screening for THR patients the overall incidence of surgical site infection in the year 2004 was 2.9%.

Methods and Materials: We introduced a new admission policy and SSI surveillance protocol for THR patients in the year 2004 at our centre. According to the new admission policy all THR patients who were preoperatively screened were admitted into a clean elective ward. Care was taken not to admit anybody with positive infection screening in that ward, irrespective of the diagnosis. Further we also introduced a new policy of SSI surveillance according to NINSS protocol carried out by dedicated trained nurses.

Results and conclusions: Following the introduction of these policies our surgical site infection has come down to 0% in the year 2004–5 in contrast to 1.7% in the year 2002–3. These results showed that simple measures like having dedicated infection free clean wards and dedicated trained surveillance nurses can significantly reduce the infection rate following THR.

Introduction: Surgeries in elderly individuals should be less invasive and less time consuming to reduce immediate postoperative morbidity and mortality. Nevertheless it should also give optimal long-term outcome thereby avoiding subsequent procedures in these high risk individuals. Bipolar hemiarthroplasty is a commonly performed orthopaedic surgery in elderly patients with fracture neck of femur. It is commonly believed that the type of implant and the nature of fixation (cemented or uncemented) influences both the short term and the long term outcome of this procedure. In this retrospective study we compared uncemented and cemented JRI furlong prosthesis.

Method and materials: We had cohort of 60 patients who underwent cemented JRI bipolar hemiarthroplasty in the year of 2003 and 2004. We compared this cohort with the matched sample of 60 patients who underwent uncemented JRI bipolar hemiarthroplasty. We matched variables like age, ASA grade and the experience of surgeon.

Results and Discussion: The perioperative variables like duration of surgery, amount of blood loss, length of hospital stay and postoperative complications (DVT, chest infection, mortality) were found to be less in the uncemented JRI group. However there are concerns about the long-term outcome of uncemented JRI hemi-arthroplasty in the form of peri prosthetic fractures. Out of 60 patients of uncemented JRI group 3 had peri prosthetic fracture as compared to none in the cemented JRI group. We believe this complication more likely could be due to excessive canal preparation and the press fit necessary for the primary stability of the implant. This warrants further prospective controlled trials to provide more evidence on this finding.

Introduction: Outcome reporting following THR constitute a significant proportion of orthopaedic publications. Publication bias in the form of underreporting of studies showing non satisfactory or negative results is a well recognised problem in other specialities. We tried to find out the magnitude of this problem in orthopaedics publications dealing with THR.

Method and materials: We reviewed all publications on THR in the year 2004 in three general orthopaedic journals namely JBJS (BR), JBJS (Am), CORR. Of the 1034 original articles published in these three journals more than 400 articles were concerned with total hip replacement.

Results and Discussion: In this study we found only 6% of the published articles were showing non significant or negative results. This raises concerns about evidence based approach in THR and the need for preventive measures like registering all clinical trials and change in the attitude of editorial board.