The anterior-posterior (AP) pelvis radiograph is crucial for diagnosis of neck of femur (NOF) fractures, especially as this is one of the commonest fractures in the elderly population. Anecdotally we found that initial AP pelvis radiographs for these suspected fractures did not always exhibit the bones sufficiently. Repeat radiographs were needed, leading to delays in diagnosis, treatment, and repeated radiation exposure. Missed diagnoses can have significant consequences for this patient group. We assessed how many initial AP pelvis radiographs taken for suspected NOF fracture fitted criteria for adequate diagnostic imaging. A retrospective study was carried out assessing the initial AP pelvis radiograph done for each patient presenting to our dedicated NOF unit with suspected NOF fracture for 1st June – 31st July 2014. European Guidelines for Diagnostic Imaging were used as the benchmark. Each radiograph was scored out of six, one for each criteria fulfilled. Guidelines deemed images scoring ≤3 as inadequate.Background
Methods
A modified Kessel trans-acromial approach has been utilised in our Unit for decompression and repair of associated rotator cuff tear for all advanced impingement syndrome (Stage III). This preliminary report aims to review our results, and to assess the complications of this approach. From 1996 to 1999, 22 consecutive patients who were treated surgically using a Trans-acromial approach for advanced impingement syndrome, were reviewed. The diagnosis of impingement syndrome was based on history, physical examination and Lignocaine impingement test, with either an ultrasound scan, arthrogram, or MRI. The modified trans-acromial approach was used involving splitting and raising a periosteal soft tissue flap over the acromion, followed by splitting the acromion in the coronal plane just behind the acromioclavicular joint, this allowed an extensive exposure of the rotator cuff and easy undercutting of the acromion. 20 patients were interviewed and examined specifically for this study, for an average follow up of 17 months. The other two patients were interviewed by telephone. The following parameters were studied: 1) functional assessment:[Constant’s Scoring system, and the UCLA Shoulder rating Scale. 2) Pain relief. 3) Patient satisfaction. 5) Return to preoperative activity. 6) Complication. The results were satisfactory in 17 patients (77%), and unsatisfactory in 5 pt (23%), one of which had cervical spondolysis, and two had new bony formation in the subacromial space. Pain relief was achieved in 78%. All patients returned to their preoperative occupation apart from one. Two patients had persisting impingement and had undergone revision subacromial decompression with satisfactory results. The modified trans-acromial approach is an acceptable alternative to open anterior acromioplasty. It offers adequate decompression of the sub-acromial space, allowing a wide exposure and excellent visualisation of the rotator cuff. This facilitates cuff repair and mobilisation, while maintaining the integrity of the deltoid muscle, which accelerates postoperative rehabilitation.
