Bone bruising of the scaphoid is a common term reported, when MRI imaging is carried out for continued pain, within the anatomical snuff box. Is this significant? Our aim was to ascertain if bone bruising lead to continued symptoms, and resulted in delayed fracture detection- an occult fracture. This was a prospective study looking at 170 patients with scaphoid injuries. Of the 170 scaphoid injuries identified there were 120 scaphoid fractures seen on scaphoid view radiographs. The remaining 50 had no fracture on radiographs, however were clinically symptomatic and had MRI scaphoid imaging which demonstrated various grades of bone bruising. All were treated in a scaphoid plaster and re-examined at 8 weeks. There 4 were patients that remained symptomatic, MRI scan were performed which revealed 3 with resolving scaphoid bone bruising and 1 with a scaphoid fracture (p-value=0.05). Two further weeks of immobilisation resolved the symptoms of those 4 patients. Therefore occult scaphoid fractures demonstrating only bone bruising may take up to 8 weeks to declare itself as a fracture. Immobilisation in a scaphoid cast should be the mainstay of treatment for a minimum period of 8 weeks.
The purpose of our study was to see what the microbiological epidemiology of our discitis biopsy specimens were. In doing this we could identify if biopsy served a strategic and necessary purpose in the management of this potentially serious pathology. At our institution the Combined Orthopaedic and Medical Microbiology Service (COMMS) reviews all patients on antibiotic treatment on a weekly basis and records data prospectively. We present a review of discitis patient data from a 28 month period (August 2008-December 2010). Inclusion criteria included a first diagnosis of discitis, based on a history of pain, raised inflammatory markers (erythrocyte sedimentation rate, C reactive protein), MRI confirmation, radiological biopsy of disc, patients that had spinal procedures and patients that had no spinal procedures. Exclusion criteria included patients who did not have a disc biopsy or MRI scan diagnosis. The outcome measure was discitis biopsy micro-organism.Aim
Methods
MRI imaging is carried out to identify levels of degenerative disc disease, and in some cases to identify a definite surgical target at which decompression should take place. We wanted to see if repeat MRI scans due to a prolonged time between the initial diagnostic MRI scan of the lumbar sacral spine, and the MRI scan immediately pre-operatively, due for the desire for a ‘fresh’ MRI scan pre-operatively, altered the level or type of procedure that they would have. This was a retrospective observational cohort study. Inclusion criteria- all patients with more than one MRI scan before their surgical procedure on the lumbar sacral spine, these were limited to patients that had either, discectomy, microdiscectomy, laminotomy decompression, laminectomy decompression and fusion, and posterior lumbar interbody fusion. Exclusion criteria- all patients with anterior approaches, all patients without decompression and all non lumbar sacral patients. Outcome measures were if there was a change between the pre-operative MRI scans, which would have changed the operative level of decompression, added other levels of decompression or type of surgery than primarily decided.Introduction
Methods
Coccygectomy, surgical excision of the coccyx, may be used to treat coccydynia, a chronic and disabling condition of the lowest part of the spine. It is a controversial and infrequently performed operation that many surgeons are reluctant to perform due to the risks of rectal perforation and infection. The criteria for patient selection for coccygectomy remain ill-defined. We present a single surgeon case series of 17 patients who underwent coccygectomy for chronic coccydynia. This was a retrospective observarional case series analysis. Case notes of 17 patients who underwent coccygectomy from 1999 -2009 were obtained and analysed. We then carried out telephone survey for which only 15 patients were contactable. We used the Milton Keynes Orthopaedic Patient Satisfaction survey and the modified Oswestry low back pain disability questionnaire. All patients had a two to three year history of coccydynia; 15 following trauma, one following a caudal injection and one following birth delivery. All patients had received between one and five lignocaine/methylprednisolone injections prior to coccygectomy, with documented initial symptom relief. All 17 patients had documented hypermobile sacro-coccygeal joints. Post-operative symptom relief varied between 60% and 100%, with all patients reporting that they would have their surgery again. Complications included three post-operative wound infections. There were no cases of rectal perforation. Coccygectomy for intractable coccydynia is sometimes the only option available. With good patient selection, including identification of a hypermobile joint with initial symptom relief following local injection, coccygectomy is a successful and safe treatment.
