The external fixator is an invaluable device when treating acute complex trauma and in limb reconstruction. It is therefore important to ensure its efficient and safe application to avoid complications. A lot of research has been done to evaluate the factors around external fixator stability, pin site infections and more is still being done to understand pin loosening. The purpose of this study was to evaluate other factors that may contribute in external fixator pin loosening. The aim was to evaluate if the different Schanz pin insertion techniques contribute to pin loosening.

Two tibia diaphyses from two cadavers were each divided into three sections. Three different drilling techniques were repeated in each of the sections. A total of 36 Schanz pins were inserted and a section cut out of the bone in front of the pins was done allowing visual inspection of the pin hole for features of thread stripping. These features were predefined as thread pattern disruption, smoothening and shallow imprint on the cortex.

Evidence of pin thread stripping was seen in all of the pin insertion techniques. The first method where the hole was pre-drilled and pin inserted with the drill showed 100% thread stripping. The second method of pre-drilling and hand insertion showed the least amount with 16.7% of pin stripping noted and 66.7% pin thread stripping was observed when inserting the pin with power without pre-drilling the pilot hole using the third method.

Different pin insertion techniques result in varying amounts of pin thread stripping. The most amount of thread stripping occurs when a Schanz pin is inserted with power after pre-drilling. This finding, although not measured scientifically, supports the current recommendation of pre-drilling and manual insertion of the pin. In future, more scientific measurement are necessary to quantify these findings and assess their clinical significance.

Background

Stratifying patients with Low Back Pain (LBP) using the STarT Back Tool and delivering targeted treatment has demonstrated efficacy in individual physiotherapy settings. Physiotherapy interventions for LBP patients are often delivered in groups. This study aimed to explore the sustainability and cost effectiveness of a group stratified intervention in primary care.

Background

Using digital X-rays to plan a hip replacement can cause problems with sizing and templating the prosthesis. Using an AP view of both hips is desirable as this allows the use of the sometimes unaffected contralateral hip for templating.

Background

Farming is regarded as a high-risk work sector for LBP.

Background: The UK guidelines for the management of low back pain (LBP) in the workplace were published in 2000 but studies exploring their implementation are limited. As part of a larger implementation strategy which combined changes in organisational structures with a health promotion campaign, managers at a major Dublin teaching hospital were surveyed.

The aim of this study was to establish the efficacy of a health promotion campaign in changing managers’ attitudes towards the guidelines.

Methods: A questionnaire survey of hospital managers was conducted in 2004. As part of this survey, managers were asked to indicate their level of agreement with a series of guideline based statements. The results of this survey were used to guide the development of a health promotion campaign which included a series of workshops combined with provision of written materials.

In 2006 a repeat survey of the managers (n=92) was conducted to measure the efficacy of the health promotion campaign. Survey data were entered onto SPSS (V.11) for analysis using descriptive statistics and chi square tests.

Results: A 63% (n=58) response rate was achieved. Positive changes occurred in relation to all the guidelines including a 28% increase (p< 0.05) in the proportion of managers who believe that most LBP is self limiting and a 38% increase (p< 0.05) in the proportion of managers who believe that remaining active and returning to work even if there is some pain is appropriate.

Conclusion: A health promotion campaign targeting hospital managers was successful in changing managers’ attitudes towards the occupational LBP guidelines.

Background: Most research regarding low back pain (LBP) amongst health service workers has tended to focus on single occupational groups rather than conducting occupational group comparisons.

Purpose: This study aims to compare the prevalence of LBP, associated sick leave and the proportion of LBP attributed to a work incident between various subgroups of workers in the Irish health service.

Methods: Hospital employees (n=2237) were stratified according to the five Department of Health and Children occupational clusters (Administration, Medical, General Support, Nursing and Professionals). A disproportional stratified sample (n=400) of employees was taken. Postal questionnaires and subsequent reminders were administered.

Data were analysed using descriptive statistics. Subgroup comparisons were made using chi square tests.

Results: A response rate of 61.5% (n=246) was achieved of whom 52% (n=128) had experienced LBP. There was no significant difference in lifetime prevalence between groups (χ² = 3.874, p= 0.423). However, the difference, between groups, in the proportion of staff with LBP who had taken sick leave in the previous year was significant (χ² =12.070, p=0.017) with the highest level of sick leave among nursing staff ( 57%) and the lowest level among medical staff (14%). The proportion of staff attributing LBP onset to a work incident was no different between groups (χ² = 6.551, p= 0.586).

Conclusions: While no difference in LBP prevalence or attribution of LBP onset to work was found between the occupational groups, the variance in LBP related sick leave suggests that occupation specific factors influence back related work loss.

Background: Current evidence emphasises the need for workplace managers to become more involved in the case management of the worker with low back pain (UK Guidelines , 2000).

Purpose: To establish health service managers’ needs in relation to the management of the worker with low back pain (LBP).

Methods: A self administered questionnaire was distributed to all departmental managers (n =63) at a major Irish teaching hospital. The questionnaire comprised of a series of quantitative and qualitative questions relating to aspects of management of the worker with LBP including facilitation of return to work and organisational support for managers.

Quantitative data were summarised using descriptive statistics. Qualitative data were transcribed, coded and analysed using the qualitative data analysis approach of Miles and Huberman (1994).

Results: A response rate of 76% (n =48) was achieved. Of these 63%(n=30) had experience of managing LBP related sick leave among staff. Common themes which emerged from the qualitative data included lack of staff resources to accommodate return to work of a worker at less than full physical work capacity, lack of specific guidance from the occupational health department regarding expected work capacity of the worker with LBP and difficulty dealing with attitudes of colleagues towards the worker with LBP.

Conclusion: Strategies aimed at improving the management of the worker with LBP and facilitating earlier return to work need to give consideration to improving staff resources, provision of clear guidelines from occupational health departments and guidance for managers regarding ways of supporting both the worker with LBP and his/her colleagues.