The purpose of this study was to determine the accuracy of MRI scan for the detection of meniscal pathology in our unit. There are published data which show that both sensitivity and specificity can approach 90% when compared to arthroscopic findings.

We retrospectively analysed a single surgeon series of 240 scopes for all indications The arthroscopic reports included an outline diagram of the meniscus upon which the surgeon recorded operative findings. 112 of these patients had also had recent MRI.

We looked at whether the MRI report showed a tear, and this was graded Y/N. The arthroscopic report was graded for tear: Y/N. 66 patients had a positive scan. 64 of these were found to have a tear at surgery. 37 scans were reported as “no tear”, of which 4 were found to have a tear at surgery. Nine scans were not easy to classify as they were descriptive.

In our series of 112 knees, MRI was 90.5% sensitive, 89.5% specific and 90.1% accurate.

When a definite diagnosis of “tear”, or “no tear” was made at scan, there were two false positives and four false negatives. False positives may be unnecessarily exposed to the risks of surgery. Patients with negative scans had a mean delay to surgery of 33 weeks compared to 18 weeks for patients with positive scans. False negatives may wait longer for their surgery. Two of the false negative scans clearly showed meniscus tears which were missed by the reporting radiographer. In our series the scan itself was more accurate than the reporting. It is important to have an experienced musculoskeletal radiologist to minimise the number of missed tears. It is also important for surgeon to check the scan as well as the report.

Introduction

Tranexamic acid (TXA) reduces total knee replacement (TKR) & total hip replacement (THR) blood loss. We launched a ‘fast track’ protocol to reduce inpatient stay including a single 15mg/kg dose of TXA. We conducted a retrospective cohort analysis on haemoglobin balance and transfusion requirement before and after the protocol, which aimed to reduce blood loss during lower limb arthroplasty.

Introduction: Limp in a child is a common presentation to the emergency department. Most patients have no serious pathology. However, it is important not to miss specific problems and delay treatment. We therefore established a limping child protocol in conjunction with the emergency department, which was implemented in 2003. We aimed to assess our performance against agreed standards; 100% investigated as per protocol, and 100% admitted or seen in the next fracture clinic.

Methods: We examined all emergency department case notes of children aged less than 14 years old who presented with a lower limb problem over a 1 year period. Patients diagnosed as having soft tissue injuries or fractures were excluded. We were left with 58 patients. Information concerning investigations and disposal from the emergency department was sought from the case notes and the hospital computer system.

Results: Average age was 5.1 years. The protocol was followed correctly in only 21% of cases. 33% were followed-up incorrectly, and 22% received no documented follow-up.

Discussion: There was poor compliance in the emergency department. Incomplete investigations, follow-up and documentation were the main problems. Up to one quarter of serious pathology may have been missed. We attribute these problems to high staff turn over and poor awareness of the protocol. We have introduced changes to improve our performance.

Introduction Infection is a disastrous complication of arthroplasty surgery, requiring multidisciplinary treatment and debilitating revision surgery. As between 80–90% of bacterial wound contaminants originate from colony forming units (CFU’s) present in operating room air tending to originate from bacteria shed by personnel present within the operating environment, any steps that can reduce this bacterial shedding should reduce the chances of wound contamination. These steps have included the use of unidirectional downward laminar airflow theatre systems, and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit has introduced the use of the Stryker T4 Personal Protection System helmet in conjunction with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood & mask attire.

Method 12 simulated hip arthroplasty operations were performed, six using disposable sterile impermeable gown, hood and mask, with a further 6 using the T4 helmet & hood. Each 20 minute operation consisted of a series of arm and head movements simulating movements performed during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37oc & the CFU’s grown were counted.

Results The mean number of CFU’s for the helmet was 9.33 with hood and mask attire yielding 49.16 CFU’s (S.Ds 6.34 & 26.17; p value 0.0126). In all cases, the organism isolated was a coagulase negative staphylococcus

Conclusion Although the sample size was small, we demonstrated a fivefold increase in the number of CFU’s shed when using hood and mask attire compared to personal helmet and sterile hood. We conclude that the helmet system is superior to non-sterile hood & mask at reducing bacterial shedding by theatre personnel.