Background. The incidence of
This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering pharmacological interventions for the prevention of
Introduction and Objective. Tranexamic acid (TXA) is used across surgical specialties to reduce perioperative
In-office surgeries have the potential to offer high quality medical care in a more efficient, cost-effective setting than outpatient surgical centers for certain procedures. The primary concerns with operating on patients in the office setting are insufficient sterility and lack of appropriate resources in case of excessive
Abstract. Background. Ultrasonic cutting of bone boasts many advantages over alternatively powered surgical instruments, including but not limited to: elimination of swarf, reduced reaction forces, increased precision in cutting and reduced adjacent soft tissue damage, reduced post-operative complications such as
Abstract. Objectives. Our study evaluates financial impact to the Best Practice Tariff (BPT) of hip fracture patients on Novel Oral Anti-Coagulant (NOAC) medication. Since their approval by NICE for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, the incidence of hip fracture patients admitted to hospitals on NOAC medication (e.g. rivaroxiban, apixaban) has been increasing. BPT for hip fractures has two components: a base tariff and a conditional top-up tariff of £1,335 per patient (applied to patients of 60 years of age). For the top-up tariff, six criteria must be met, of which time-to-surgery within 36 hours is one. Our department currently recommends withholding NOAC medication and delaying surgery for at least 48 hours as per our Trust's haematology guidelines to reduce intra-operative
The use of antifibrinolytic drugs and many other agents have a critical importance in
Introduction and Objective. In multiple trauma patients, as well as in the healing of isolated fractures (Fx) with heavy
An ex vivo biomechanical test model for evaluating a novel bone adhesive has been developed. However, at day 1 in the in vivo pilot, high blood flow forced the study to halt until the solution presented here was developed. The profuse
Tourniquet is widely used in orthopedic surgery to reduce intraoperative
Blood management protocols attempt to reduce blood loss by strategies including autologous blood donation, red cell salvage, normovolaemic haemodilution and haemostatic agents such as tranexamic acid (TXA). TXA usage in particular has become increasingly commonplace with numerous studies demonstrating a significant reduction in peri-operative blood loss and proportion of patients requiring transfusion, without increasing the risk of venous thromboembolism. Tourniquet usage has now become ubiquitous in TKA operations with reported benefits of improved visualization, shorter operative time and decreased intra-operative
Objectives. Intra-articular injections of local anaesthetics (LA), glucocorticoids (GC), or hyaluronic acid (HA) are used to treat osteoarthritis (OA). Contrast agents (CA) are needed to prove successful intra-articular injection or aspiration, or to visualize articular structures dynamically during fluoroscopy. Tranexamic acid (TA) is used to control haemostasis and prevent excessive intra-articular
Adductor strain is a common injury among football players. The adductor muscle group contains the three adductor muscles. (adductor longus, magnus and brevis) Adductor longus muscle is a triangular-shaped long muscle. This muscle originates from the superior ramus of the pubic bone and inserted into the middle part of the linea aspera. Adductor longus muscle is the most commonly injured muscle of adductors. Sudden acceleration, jumping, stretching, and kicking the ball are common causes of an adductor injury. Adductor muscle strains can result in missed playing time for football players. We present a 26-year-old man soccer player with pain in the left groin and proximal thigh. The symptoms had started during training and after kicking the ball with left foot (dominant side), he felt an acute pain in the groin region and proximal thigh. Despite the injury, he managed to finish the training. The team physician examined the patient immediately after training. The range of motion of both hip joints was in normal ranges and mild pain with adduction. There was a palpable mass at the inner proximal thigh during contraction of adductor muscles. There was no history of groin pain or adductor problems before this injury. Conventional radiographs showed no osseous abnormalities. 36 hours after the injury, MRI revealed acute grade IIB strain in the left adductor longus muscle, including both superior and inferior parts of the muscle. A hematoma was observed in the superior part of the left adductor muscle, with a craniocaudal length of 42 millimeters. There was an adductor muscle strain with hyperintensity extending for a craniocaudal length of approximately 12 centimeters involving more than 50% crosses sectional diameter of the muscle belly. Conservative treatment started immediately, consisting of cold therapy and soft tissue massage. Compression of the injured tissue using a 15-cm elastic bandage roll is done to limit
Venous Thromboembolism (VTE) prophylaxis is an essential part of orthopaedic surgeries in preventing life-threatening thromboembolic events such as Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). Orthopaedic surgery has the highest incidence rate of thromboembolic events as compared to any other surgical specialities, making it an essential component in managing any orthopaedic case. At Queen's Medical Centre (QMC), a major trauma centre in the United Kingdom (UK), sees up to 750 NOF fracture cases annually, making it one of the busiest trauma and orthopaedic centres in the UK. Our study aims to evaluate how VTE Prophylaxis is conducted in a UK Major Trauma Centre for NOF and pelvic fragility fractures and how human factors can improve its efficacy. The Nottingham University Hospitals (NUH) Trust has implemented new guidelines from August 2019 that patients with fragility fractures such as NOF and pelvic fractures are prescribed with 28 days VTE prophylaxis with Enoxaparin, or their own anti-coagulants if risk of thrombosis exceed the risk of
Background and Aims. Many orthopaedic patients admitted to hospital who require urgent surgery are also on Warfarin. Patients with an INR>2 have an increased risk of
The Cochrane Collaboration has produced five new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner These reviews are relevant to a wide range of musculoskeletal specialists, and include reviews in Morton’s neuroma, scoliosis, vertebral fractures, carpal tunnel syndrome, and lower limb arthroplasty.
The purpose of this study is to evaluate accuracy of tibia cutting and tibia implantation in UKA which used navigation system for tibia cutting and tibia component implantation, and to evaluate clinical results. We performed 72 UKAs using navigation system from November, 2012. This study of 72 knees included 56 females and 16 males with an average operation age of 74.2 years and an average body mass index (BMI) of 24.8 kg/m2. The diagnosis was osteoarthritis (OA) in 67 knees and osteonecrosis (ON) in 5 knees. The UKA (Oxford partial knee microplasty, Biomet, Warsaw, IN) was used all cases. We evaluated patients clinically using the Japanese orthopaedic association (JOA) score, range of motion (ROM), operation time, the amount of
Summary. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienböck's Disease. Introduction. The purpose of this study was to investigate the outcomes of patients suffering from avascular necrosis of the lunate, or Kienböck's Disease, who received arthroscopic decompression to treat the ischemic lunate. Previous studies have demonstrated an elevated intraosseus pressure in the ischemic lunate, and it has been hypothesised that ischemia in the lunate is secondary to this elevated pressure and subsequent venous congestion, as opposed to diminished arterial supply. Based on this work we have used decompression of the lunate to prevent progression of the disease. Patients and Methods. 21 patients, (22 wrists), reported to a single surgeon with a chief complaint of unremitting wrist pain and the subsequent diagnosis was Kienböck's disease, stages I, II, IIIA or IIIB. Range of motion measurement and grip strength, as well as self-reported outcome measures such as Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo, were obtained preoperatively and post operatively at 2, 7 and 12 months. The patients were treated operatively with arthroscopic decompression of the lunate. The lunate was approached dorsally at the interosseous lunotriquetral and the scapholunate ligament areas with an arthroscopic shaver until brisk