Introduction

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterised by bony pain and swelling which may be initially mistaken for bacterial osteomyelitis. The episodic course of the disease may confound the diagnosis and potentially be mistaken for a partial response to antimicrobial therapy. It is an orphan disease and consequently results in many unclear aspects of diagnosis, treatment and follow up for patients. The aim of this study is to evaluate a national tertiary centre's experience with the clinical condition and present one of the largest cohorts to date, emphasizing the vast array of clinical spectrum, course and response to treatment.

Introduction

There is little evidence surrounding the clinical implications of a diagnosis of IIa hip dysplasia with no consensus as to its efficacy as a predictor pathological dysplasia or treatment. Therefore, we evaluated the importance of categorising 2a hip dysplasia in to 2a- and 2a+ to better understand the clinical outcomes of each.

Introduction

Current undergraduate trauma and life-support training inadequately equips medical students with the knowledge, practical skills and confidence to manage trauma patients. Often first to the scene of medical emergencies, it is imperative junior doctors feel confident and competent from day one. No UK university currently includes advanced trauma and life support (ATLS) in their curriculum. This study piloted an ATLS course for Cardiff final-year medical students to improve confidence and knowledge in management of the trauma patient.

Complex congenital foot deformities pose a challenge to the surgeon due to poor results after extensive surgery. We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® (Universal mini-external fixator System) frames.

This is a prospective review of our experience in patients treated in this way, from 2004 to 2011. The indications for treatment included resistant/recurrent Congenital Talipes Equino Varus (CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. A total of 32 children (35 feet) have been treated, out of which 22 were male and 10 were female patients. Age at surgery ranged from 3 to 15 years (median age – 7 years). Three patients underwent bilateral procedures; the reminder (29 patients) underwent unilateral foot operations. Twenty-eight patients had undergone previous surgery including soft-tissue and/or bony corrective procedures.

The frames were removed at an average of 69 days after application, and the patients spent a further 6 weeks in a walking cast. Good functional outcomes were noted in 26 patients in the first postoperative year and in 19 patients in the fifth postoperative year. Further operations were needed in 10 patients. Complications occurred in 10 patients, predominantly pin-site infections and 1 case of bony overgrowth at pin-site and 1 of proximal tibio-fibular diastasis.

This is a simple fixator to use with a short learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates.

Total hip replacement (THR) is NICE recommended for a group of patients with neck of femur fracture (NOF) and guidance published in 2011. In our institution a Hip Fracture Program was established at this time to improve patient care.

An audit of the Hip Fracture Program, appropriateness of THR and management following THR was undertaken and compared to NICE standards, set at 100%, and National Hip Fracture Database (NHFD) results

The case-notes for 53 patients (38 female, 15 male) undergoing THR for NOF between 2011 and 2013 were reviewed: median age 70 yrs (34–87), follow-up 28 months (3–57).

All patients were initiated on a Hip Fracture Program. 92% were eligible for THR according to NICE guidance. Pre-operative pain management (67%), hourly assessment of pain in ED (4%), surgery with 48 hours (32%), pre-operative orthogeriatric review (58%) and intra-operative nerve block (38%) are areas for development, but most results are comparable to NHFD. Post-operative care is satisfactory with daily mobilisation (87%) and post-operative pain management (100%). No post-operative dislocation or infection was recorded. There was one case of post-operative DVT.

This study highlights areas for improvement in hip fracture management and emphasises the benefits in implementing a Hip Fracture Program in this vulnerable patient population.

We report the clinical outcomes of children with complex congenital foot deformities treated with UMEX® mini-external fixators. This is a prospective review of our experience in patients treated in this way, from 2004. The indications for treatment were resistant/recurrent Congenital Talus Equina Varus(CTEV), cavo-varus deformity secondary to Charcot-Marie-Tooth disease, arthrogryposis, fibular hemimelia and other congenital abnormalities. In addition, one patient underwent this treatment since he was allergic to casting material.

A total of 32 children (35 feet) have been treated, with a male to female ratio of 22:10 respectively. The patient-age at operation ranged between 3 and 15 years (median age −7 years). Three patients underwent bilateral procedures and 29 patients underwent unilateral foot operations. Twenty-eight patients underwent previous soft-tissue and bony corrective operations with serial casting. The frames were removed at an average of 69 days after application with a further 6 weeks in a walking cast. Seventy-nine percent of the patients had good functional outcome. Further operations were needed in 10 patients. Complications occurred in 10 patients, including pin-site infections, bony overgrowth at pin-site and proximal tibio-fibular diastasis.

In conclusion, this is a simple fixator to use with a small learning curve. In groups of patients with complex congenital abnormalities, we achieved good functional outcome with low-complication rates.