With increasing use of fluoroscopy in Orthopaedic theatres in recent years, the occupational radiation exposure to the surgeons and the theatre staff has increased significantly. Thyroid is one of the most radio-sensitive tissues in the body, but there is a clear lack of awareness among theatre staff of risks of radiation to thyroid. We prospectively reviewed the use of thyroid shield by the theatre staff in the orthopaedic theatre for two weeks period. We also recorded the number of fluoroscopic images taken and total radiation dosage for each case.Abstract
INTRODUCTION
METHODS
We reviewed the outcome of patients who had been
treated operatively for symptomatic peri-acetabular metastases and
present an algorithm to guide treatment. The records of 81 patients who had been treated operatively for
symptomatic peri-acetabular metastases between 1987 and 2010 were
identified. There were 27 men and 54 women with a mean age of 61
years (15 to 87). The diagnosis, size of lesion, degree of pelvic
continuity, type of reconstruction, World Health Organization performance
status, survival time, pain, mobility and complications including
implant failure were recorded in each case. The overall patient survivorship at five years was 5%. The longest
lived patient survived 16 years from the date of diagnosis. The
mean survival was 23 months (<
1 to 16 years) and the median
was 15 months. At follow-up 14 patients remained alive. Two cementoplasties
failed because of local disease progression. Three Harrington rods broke:
one patient needed a subsequent Girdlestone procedure. One ‘ice-cream
cone’ prosthesis dislocated and was subsequently revised without
further problems. We recommend the ‘ice-cream cone’ for pelvic discontinuity
and Harrington rod reconstruction for severe bone loss. Smaller
defects can be safely managed using standard revision hip techniques. Cite this article:
Reverse polarity shoulder replacements are indicated in cases of gleno-humeral arthritis with the presence of rotator cuff muscle dysfunction. Despite some studies demonstrating early improvement in function and pain, limited information still exists regarding the durability and longer term outcomes of these prostheses. The reported complication rates have been reported to range from 0–68%. Post-operative clinical complication rates of three commonly used reverse polarity total shoulder replacements (Delta, Verso and Equinoxe) were evaluated against those mentioned in the literature to predict satisfactory outcome. A retrospective review of 54 patients (3.5F:1M) and 64 operations (27L:37R) between 2004–2011 was carried out. Post-operative complications were searched for through medical records, the local hospital database (BLuespearIT) and the Picture Archiving and Imaging System (PACS). All operations were performed by two experienced consultant-grade orthopaedic shoulder surgeons. The mean age at time of operation was 75.9 years (range 64–94). 33 Delta, 19 Equinoxe and 12 Verso prostheses were inserted. Three patients were excluded from the study due to insufficient information from medical records and radiography. Total complications were seen in 25 % of operated cases:- dislocation (6), fracture (4), deep infection (2), significant post-operative pain (1) and deltoid muscle dysfunction (3). Complications categorised according to prosthesis type were:- Delta (24%), Equinoxe (32%) and Verso (8%). Short to medium term complication rates using reverse polarity total shoulder replacements are higher than the majority of the current literature suggests. The Verso is associated with the least number of complications which may correlate with its minimally invasive approach.
The aim of this prospective study was to assess the effectiveness of a single ultrasound-guided steroids injection in the treatment of Morton's neuromas and whether the response to injection correlates with the size of neuroma. Forty three patients with clinical features of Morton's neuroma underwent ultrasound scan assessment. Once the lesion was confirmed in the relevant web space, a single corticosteroids injection was given using 40 mg Methylprednisolone along with 1% Lidocaine. All scans and injections were performed by a single musculoskeletal radiologist. Patients were divided into two groups based on the size of the lesion measured on the scan. Group 1 included patients with Background
Methods
Unilateral musculoskeletal below knee injuries occur with great frequency. Patients who cannot bear weight on an injured limb usually mobilise with standard crutches. However when the patient also has an upper limb injury, mobilisation may be impossible and can result in a lengthy in-patient stay. We present its value in facilitating early discharge in patients with both upper and lower limb injuries. We show the cost benefit of the saving in in-patient stay that the hands free crutch provides. We present our experience in which this innovative crutch was used and discuss the potential of this device to be used more often in orthopaedic surgery.
