“No routine post-operative follow up appointments” policy has been implemented in NHS hospitals in different specialties for uncomplicated surgical procedures. In trauma and orthopaedics few studies to date reviewed this practice and reflected on the patients' opinions. A total of 121 patients were recruited over 2 years, each patient had post operative follow up by the hand therapist for 3 months. 50 patients post Trapeziectomy and 71 patients post single digit Dupuytren's fasciectomy were prospectively surveyed for their opinion on their post operative care and whether they would have liked to be reviewed by the surgeon in a routine post operative follow up appointment or not. All operations were done by one surgeon in one hospital. All patients were reviewed by a hand therapist within 2 weeks post operatively and treatment protocols were followed with all the patients. During their final appointment with the hand therapist all patients completed a questionnaire.Introduction
Methods
Seventy-two percent of patients (47/65) were graded Frankel D pre-operatively and 65% (42/65) remained so after surgery. SF36 data were obtained for 17 patients. Pre-operatively, patients with ISCT had significantly lower SF36 physical domain scores when compared with normative data from age-matched population controls (p=0.0096). There was no difference between post-operative scores and those of normal controls. Matched pairs analysis on the patients with complete SF36 data sets (n=12) demonstrated a significant improvement in physical function post-operatively. Eleven of these 12 did not show an improvement in their Frankel grade, remaining Grade D pre- and post-operatively.
To determine whether the Dynamic Condylar Screw, DCS, is suitable in treating pathological subtrochanteric fractures of the femur and the incidence of failure with this device. Nineteen sequential and unselected patients with twenty femurs with pathological subtrochanteric fractures, or impending fractures, were identified, which had been treated with DCS. Mean age was seventy. Follow up was until functional union (minimum follow up 18 months) or until death. Primary tumour was identified in seventeen of the nineteen cases. Grade of surgeon was recorded as was the use of adjunctive measures at the time of surgery (PMMA). Subsequent failure, cause and need for revision was noted. Operative morbidity was low and initial pain relief good in all cases. Two fractures went on to unite. Eight original implants survived until the patient died (mean survival time 24 days). Ten implants failed (50%). Failure resulted from fracture through the DCS plate in eight cases and cut out of the screw in the other two. Of these, five patients (6 femurs) went on to further operative procedures. The others were either deemed unfit (3 cases) or refused further surgery (1 case). In the light of newer intramedullary techniques we feel the DCS should be used with caution in this type of fracture. DCS in this fracture is associated with a high degree of failure.
In the reconstruction of the exstrophy/epispadias complex pelvic osteotomy has a role in helping the urologist close the anterior defect thereby improving appearance and helping to achieve continence. In the neonate and infant, we have traditionally used an oblique osteotomy coupled with plastering of the legs until the osteotomy shows signs of healing. Plastering has significant disadvantages in respect of nursing care. We have therefore looked to external fixation in this age group. In the past year we have used the A.O. wrist fixator to stabilise the osteotomised pelvis of ten babies with bladder exstrophy ranging in age from neonates to two years. All have achieved soft tissue closure with improved appearance. However, because of the foreshortened anterior pelvis in the exstrophy patients, it is not possible to reconstruct to normality. The results to date are promising and the patients remain under follow up.
We report on four cases in which the diagnosis of compartment syndrome was delayed by the administration of patient controlled opiate analgesia ( PCA ) following intramedullary nailing of tibial shaft fractures. We believe that this poses a diagnostic problem and can lead to lasting sequelae as decompression is delayed. We present the 4 cases and a review of the literature. We recommend that the use of PCA in patients with intramedullary nailing following tibial shaft fractures be discontinued or used in conjunction with continuous intracompartmental pressure monitoring.
The effects of splintage, suture and excision of the tendon sheath on the healing of incompletely transected flexor tendons in the rabbit have been evaluated separately and in various combinations. When all procedures were done together, repair was accompanied by dense adhesion formation with little evidence of any healing activity by the tendon cells. The experiments indicated that the adhesions were the result not of any one single factor studied but of all three contributing in varying degrees. Suturing produced the most adhesions but synovial sheath excision and immobilisation also contributed. It is suggested that these factors are also responsible for the adhesions which occur after flexor tendon repair in clinical practice.
1. Tendon possesses an active potential for repair and remodelling. 2. Large defects made in the flexor tendons of rabbits showed tenoblastic activity and repair without the formation of adhesions. 3. The failure to show this intrinsic ability for repair in previous studies may have been influenced by adverse factors introduced in order to hold the cut tendon ends together.
