Introduction

Given the rising incidence of obesity in the adult population, it is more than likely that orthopaedic surgeons will be treating more obese patients with lumbar disc pathologies. The relationship between obesity and recurrent herniated nucleus pulposus (HNP) following microdiscectomy remains unclear.

Historically human and animal bites to the hand have resulted in significant morbidity in relation to the high risk of contamination and subsequent infection. Our study aimed to assess the outcomes following such injuries in terms of infection requiring further intervention through specialist referral to the hand surgery team at our hospital.

124 consecutive patients attending the A&E department over a three month period in 2011 were included in this retrospective study which provided 126 separate cases due to bilateral injuries (110 animal: 16 human). Data was obtained from the electronic patient management system. The demographics of each patient were recorded followed by type of bite sustained including number and size of lacerations.

79% of patients presented within 24 hours and the majority before 6 hours from injury. The majority of the forearm bites were documented as superficial abrasions and none of these went on to develop problems with infection, so the study concentrated on bite injuries to the hand of which there were 99 cases. Most hand injuries were a single puncture or laceration (64%) but in 9 cases there were greater than 3 separate wounds.

5 cases were directly referred to the Hand surgery team with 4 requiring admission and of these 3 required washout and debdridement in theatres. The remaining 94 cases were managed solely by A&E. Of these 94 cases 87 pts received Abx and 78 pts had a lavage. Overall 68% received both Abx and lavage. Subsequent to discharge from A&E only 3 developed problems with infection later (2 requiring specialist input) they were all dog bites and in keeping with the ‘typical’ bite pattern seen in other pts.

The study concluded that bites not involving joint, tendon or bone have only a small chance of causing infection provided good initial treatment.

To assess whether Patients who are clinically Obese are more likely to require further or revision Surgery following One-Level simple Microdiscectomy compared to Non-obese Patients.

Retrospective, single centre and single Surgeon review of Patients' Clinical notes of consecutive Patients who underwent primary One-Level Microdiscectomy between December 2007 and July 2009.

Background: Obesity in Surgery has become a topical subject given the increasing proportion of Surgical Patients being Obese. This study provides the largest single centre and single Surgeon comparative cohort.

All Patients had undergone One-level simple Primary Microdiscectomy Surgery. Data from the Clinical notes included Patient Demographics, level and side of operation, Length of stay and Re-Operation details. A total number of 71 Patients were eligible for inclusion of which 38 were Female and 33 Male with an average age of 41 years. 25 Patients were Clinically Obese (35%). Average LOS was 1.1 days. 8% of the clinically Obese Patients required further Surgery compared to 8.7% in the Non-obese group.

Revision surgery for recurrent discs and Surgery for dural tear repair were the main reasons for return to theatre. Revision rates were comparable between the two Patient groups. LOS was no different for Obese Patients. This study concludes that Obese Patients undergoing One-Level simple Microdiscectomy do not face a significantly higher risk of requiring Revision Surgery in the future.