Aims

This phase II safety study aimed to investigate the bleeding side effect profile in patients treated with Rivaroxaban as a new agent for venous thromboembolism (VTE) prophylaxis following hip or knee arthroplasty.

Purpose of study

A recent audit in our institution showed that 40% of Lumbar spine X-rays ordered by General Practitioners were outside the Royal College of Radiology guidelines. Little in 1998 had commented that GPs requested Lumber Spine X-rays for psychosocial reasons.

Purpose of study

NICE recommends 8-9 sessions of non operative therapy for back pain that has lasted for 6 weeks but less than 12 months. NICE recommended exercises, manual therapy, acupuncture and suggested that Lumbar supports, TENS, Ultrasound and Traction should not be offered. Since multiple methods and disciplines were available a survey was conducted among the local General Practitioners to determine what non operative methods they preferred and how it matched with NICE's recommendation.

Purpose of study

The Royal College of Radiology (RCR) provides guideline criteria to order lumbar spine X-rays for back pain. An audit was undertaken in our hospital to see compliance with this guideline.

Introduction: The large number of procedures designed for patients presenting osteoarthritis of the trapezio-metacarpal (TMC) joint indicates that none of them are completely satisfactory. The new generation of non cemented hidroxyapatite coated (HAC) prosthesis made us reconsider the use of this type of implants in patients who require total arthroplasty of the thumb TMC joint.

Objective: To show the results obtained in a series of selected patients presenting TMC joint osteoarthritis who were managed by implantation of a non cemented HAC prosthesis.

Material and methods: We performed a retrospective study over 34 patients (38 prosthesis) presenting TMC joint osteoarthritis with a follow-up period ranging between 6 months and 8 years. The mean age was 60 years of age. All patients were managed by implantation of a HAC total arthroplasty (Roseland).

Postoperatively, the first column was immobilized in a neoprene splint for one month. Physical therapy was started one week after surgery. Clinical evaluation focused on the first web opening, thumb opposition, pinch and grasp strength, pain, patient satisfaction and return to work/leisure time activities.

Results: Almost all patients had satisfactory clinical results. Bone integration was confirmed by CT. Six patients (15.79%) showed radiological images of loosening located in all cases at the MC stem but with no clinical significance at the latest follow-up. 7 patients (18.42%) showed some type of complication: 1 case (2.63%) of infection (which underwent arthrodesis), 1 case (2.63%) of painful scar and 5 cases (13.16%) of reflex sympathetyc dystrophy (RSD) (3 of them related to length of the first column greater than 2 mm compared to the contralateral side).

Discussion/Conclusion: In almost all patients, when joint disease is limited to the TMC joint, there is enough bone stock and there are not too many osteophytes so a total non cemented arthroplasty can be considered in selected patients and satisfactory results can be expected. In addition, insertion of a non cemented HAC prosthesis gives the possibility to reconvert this procedure to any other type of technique in case of failure. The authors would like to remark the importance of patient selection as well as the importance of the postoperative length of the first column due to its association with the possible appearance of RSD postoperatively.

Fractures of the proximal forearm in young children may be unstable with the elbow flexed but stable with it in extension. Fifteen such fractures were managed by immobilisation in long-arm casts with the elbow extended. Only one patient had more than 15 degrees angulation at the time of bony union. All obtained normal elbow movement at two weeks and full forearm rotation at follow-up. No casts fell off. The extended elbow cast is awkward but it provides an alternative to internal fixation for some unstable fractures.