The United States and Canada are in the midst
of an
Purpose: Operative site infections can have catastrophic consequences after orthopaedic surgery. Prevention is particularly difficult due to the large number of factors involved. We describe here an exceptional
Aim: Since obesity is thought to be an aetiological factor for SCFE we have looked to see if the ‘Obesity
Background The non-motorised microscooter has become the urban transport of choice for children in Ireland. Recently, Josefson highlighted the rising trend of scooter-related injury in the US and predicted possible significant impacts in human and socioeconomic terms. Materials and Methods. A prospective study was undertaken of all referrals with scooter injuries to accident and emergency departments and fracture clinics in the first three months of the year. These cases were then reviewed at 6 months post injury Results: There were 151 microscooter injuries seen in the first 3 months of the year, Forming over 4% of all trauma seen over this period. Eighty nine of the patients (59%) were female, and the mean age at presentation was 8.5 years (range 3–15 years). The peak referral rates for January, February and March measured 48%, 29% and 23% respectively. A survey of attending paediatric outpatients over this period revealed that 75% of households possessed at least 1 scooter, and in those households with children aged between 4 and 14 years, the rate of micoscooter possession increased to 83%. Eighty four children suffered fractures and dislocations, 59 suffered soft tissue injuries, 8 had isolated head injuries. Upper limb fractures and dislocations were the most common injury (75 of 84 bone and joint injuries). Fracture of distal third of radius and ulna, was the most common single injury. upper limb fractures wer seen frequently. A high proportion of these had apex dorsal angulation with or without displacement (Smith deformity). Lower limb fractures were relatively rare. The pattern of soft tissue injuries and lacerations mostly affected the head and neck 25 (17%), the lower limb was involved in 19 (13%) and upper limb in 15 (10%) of patients. No major head injuries occurred. Only 5 patients had any adult supervision at the time of their injury. No children wore any formal protective clothing or apparatus. In the 84 patients who had suffered bony injury, at 6 months, 110 patients (73%) had
Of the 11 patients who had an arthroscopy, 4 were told that they had an ACL injury. None of the 15 who had an MRI scan were told that they had an ACL injury.
The senior author has treated a series of patients with subtrochanteric and diaphyseal femoral stress fractures associated with long-term alendronate or other bisphosphonate usage. Several patients completely fractured their femurs prior to referral. Most patients had consulted other physicians and were referred for presumed neoplasms. All patients had been diagnosed with osteoporosis and had been treated with bisphosphonates. Their plane radiographs revealed abnormalities that are pathognomonic of bisphosphonate-associated stress fractures. However, due to the subtle nature of these new unfamiliar abnormalities, most were unrecognized as such by clinicians (including experienced ISTA member hip surgeons) and radiologists. This series is presented to illustrate this pattern of impending fracture. The authors have reviewed and will present a series (n=17) of femoral stress fractures in bisphosphonate-treated patients to illustrate the clinical and radiographic pattern of these stress fractures, and review their treatment. The most common lesion is a subtrochanteric lateral cortical thickening that in actuality is a horizontal plane “dreaded black line” of a stress fracture with surrounding proximal and distal cortical thickening of the endosteal and periosteal bone. The stress fracture line is obscured unless a near-perfect radiographic projection is obtained. The lesion is best seen with CT scans. MRI scans reveal the stress fracture lines with surrounding edema (Fig 1), which may be misinterpreted as a tumor. Without treatment, a low-impact completed fracture will likely occur. Many bisphosphonate-associated impending subtrochanteric femoral stress fractures are misdiagnosed as trochanteric bursitis, leading to subsequent displaced subtrochanteric fractures [Fig. 2 - Note subtle impending fracture lesion on right, completed fracture on left]. The clinical and subtle radiographic findings must be recognized by orthopaedic surgeons, particularly hip surgeons, to prevent these complete fractures. These fractures are preventable with internal fixation. Long-term administration of bisphosphonates can have adverse effects, and alternatives to long-term continuous dosing must be investigated to determine optimal administration regimens.
Radiation exposure is a hazard to orthopaedic surgeons, theatre staff and patients intra-operatively. Obesity is becoming a more prevalent problem worldwide and there is little evidence how a patient's body habitus correlates with the radiation doses required to penetrate the soft tissues for adequate imaging. We aimed to identify if there was a correlation between Body Mass Index (BMI) and radiation exposure intra-operatively. We performed a retrospective review of 75 patients who underwent sliding hip screw fixation for femoral neck fractures in one year. We recorded Body Mass Index (BMI), screening time, dose area product (DAP), American Society of Anesthesiologists (ASA) grade, seniority of surgeon and complexity of the fracture configuration. We analysed the data using statistical tests. We found that there was a statistically significant correlation between dose area product and patient's BMI. There was no statistically significant relationship between screening time and BMI. There was no statistical difference between ASA grade, seniority of surgeon, or complexity of fracture configuration and dose area product. Obese patients are exposed to increased doses of radiation regardless of length of screening time. Surgeons and theatre staff should be aware of the increased radiation exposure during fixation of fractures in obese patients and, along with radiographers, ensure steps are taken to minimise these risks.
We reproduced a frequently cited study performed at our University Hospital that was published in the British Medical Journal in 1981 assessing the extent of “snow and ice” fractures during the winter period. As per the original study, four days of snow and ice were identified as well as two control periods when snow and ice wasn't recorded; four days within the same year, with a similar amount of sunshine hours, and four days one calendar year later. The distribution of fractures according to age and sex in addition to the anatomical location were examined in relation to the presence of snow and ice as well as comparisons with the index study 33 years ago.Background
Methods
Firearm injury is a potentially increasing public health problem worldwide. It is increasingly the subject of media and public attention. We aim to analyze the epidemiology, pattern and outcome as experienced. Data such as age, sex, race, scene and nature of injury, firearm used, alcohol and drug factors, anatomy involved, surgical requirements, transfusion details, ICU/HDU stay, complications, deaths, and outcome were collected from medical notes, WYMAS and Coroners office of all patients who presented with firearm injuries from January 1995 to December 2001. Seventy-eight cases presented to our institution. There were 19 fatalities at the scene of injury. 69 were male. 51 sustained injuries in public places, 20 at their homes and 7 in outdoor areas. Low velocity firearms were involved in 49 cases. 50 were crime related. Alcohol was identified in 34 patients and illicit drugs in 6 cases. 19 cases had bony injury with associated vascular injury in one case. Primary neurological injury was diagnosed in 5 cases. Lower extremities and upper limb injuries accounted for 59% and 26%. 3 had head and neck wounds. 4 patients had thoracic trauma and 5 had abdominal injury. 86% required surgical intervention. 11 patients had a total of 16 complications, the most common being secondary infection. 6% of patients died at the emergency department and 3 after. Chest injuries caused 5 deaths and head wounds caused 3 deaths illustrating criminal intention to cause fatal body harm.
Arthrogryposis multiplex congenita is believed to be a specific clinical entity which is aetiologically unrelated to the "arthrogryposis-like" deformities of known neurological diseases such as myelomeningocele and myelodysplasia. The observation that the condition appeared to be three times as common in Melbourne, Australia, as in four centres in the United Kingdom (Wynne-Davies and Lloyd-Roberts 1976), prompted this survey of 132 patients: 73 from the United Kingdom, 34 from Australia and 25 from Wilmington, Delaware, USA. The survey aimed to established the same criteria for diagnosis in the three countries and to search for prenatal and genetic aetiological factors. It was shown that all centers treated more newborn children with this disorder during the 1960s than either before or after that period. All cases were sporadic and there was no family association with talipes equinovarus, congenital dislocation of the hip or hereditary neuromuscular disease. "Environmental" findings from all three centers were similar and it was concluded that arthrogryposis multiplex cogenita is a non-genetic disease of early pregnancy, associated with a variety of unfavourable intra-uterine factors. In addition, an unknown but possibly viral environmental agent may have been present to a significant extent only during recent decades and is now declining.
Revision hip surgery is reportedly rising inexorably yet not all units report this phenomenon. The outcome of 1143 consecutive Corin TaperFit primary hip arthroplasties (957 patients) performed between 1995 and 2010 is presented. The implants were cemented under pressurisation and combined the TaperFit stem with Ogee flanged cups. Data was gathered from local arthroplasty database and case note review of revised joints. 13 hips have been revised (1.1%). Cumulative prosthesis survival is 0.99 +/− 0.0. Two femoral stems were revised (0.2%); one at 6 months for sepsis, one at 14 days after dislodgment during reduction of dislocation. No revisions were undertaken for aseptic loosening of the stem or cup, nor for thigh pain. 32 patients (32 hips) ≥15 year follow up, 13 survive today and none have been revised (0%). Of the 471 with ≥10 year follow up, 38 were aged ≤50 at time of surgery and 1/38 has been revised to date (PLAD for dislocation). The strong population stability in this region, supported by independent investigation by Scottish Arthroplasty Project, endorses the accuracy of the data quoted. The low incidence of revision in this cohort, and absence of revision for aseptic loosening (mean follow up 8.03 years +/− SD 3.94; range 18 months to 16yrs 2 months), substantially supports the longevity and use of cemented, double-taper, polished, collarless femoral stems in combination with cemented polyethylene cups in primary hip arthroplasty in all patient age groups.
Aims. To investigate factors that contribute to patient decisions regarding attendance for arthroplasty during the COVID-19 pandemic. Methods. A postal questionnaire was distributed to patients on the waiting list for hip or knee arthroplasty in a single tertiary centre within the UK. Patient factors that may have influenced the decision to attend for arthroplasty, global quality of life (QoL) (EuroQol five-dimension three-level (EQ-5D-3L)), and joint-specific QoL (Oxford Hip or Knee Score) were assessed. Patients were asked at which ‘COVID-alert’ level they would be willing to attend an NHS and a “COVID-light” hospital for arthroplasty. Independent predictors were assessed using multivariate logistic regression. Results. Of 540 distributed questionnaires, 400 (74.1%; 236 awaiting hip arthroplasty, 164 awaiting knee arthroplasty) complete responses were received and included. Less than half (48.2%) were willing to attend for hip or knee arthroplasty while a UK COVID-19
Aims. Due to the opioid
The coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&O) departments worldwide. To manage the peak of the
Introduction. Due to the opioid
Obesity is a global
Despite the widespread success of total hip arthroplasty (THA), postoperative pain management remains a concern. Opioids have classically been administered for pain relief after THA, but their side effect profile, in addition to the cognizance of the growing opioid
HIV and musculoskeletal trauma have reached
Osteoarthritis (OA) is one of the most common causes of knee pain in the aging population and presents with higher odds with increased BMI. Total knee arthroplasty (TKA) has become the standard of care for the treatment of OA. Over “719,000 TKA's were performed in 2010 in the USA alone, with dramatic economic burden- costing 16,000 USD per TKA” (CDC 2012). Over the past two decades, this cost was compounded by the unknown increasing rate of primary TKA and cannot be explained by the expanding population or worldwide obesity
The August 2013 Hip &
Pelvis Roundup. 360 . looks at: are we getting it right first time?; tantalum augments in revision hip surgery; lower wear in dual mobility?; changing faces changes outcomes; synovial fluid aspiration in MOM hips; taper disease: the new