Cervical spine collars are applied in trauma situations to immobilise patients' cervical spines. Whilst movement of the cervical spine following the application of a collar has been well documented, the movement in the cervical spine during the application of a collar has not been. There is universal agreement that C-spine collars should be applied to patients involved in high speed trauma, but there is no consensus as to the best method of application.

The clinical authors have been shown two different techniques on how to apply the C-spine collars in their Advanced Life Support Training (ATLS). One technique is the same as that recommended by the Laerdal Company (Laerdal Medical Ltd, Kent) that manufactures the cervical spine collar that we looked at. The other technique was refined by a Neurosurgeon with an interest in pre-hospital care. In both techniques the subjects' head is immobilised by an assistant whilst the collar is applied.

We aimed to quantify which of these techniques caused the least movement to the cervical spine. There is no evidence in the literature quantifying how much movement in any plane in the unstable cervical spine is safe. Therefore, we worked on the principle: the less movement the better.

The Qualisys Motion Capture System (Qualisys AB, Gothenburg, Sweden) was used to create an environment that would measure movement on the neck during collar application. This system consisted of cameras that were pre-positioned in a set order determined by trial and error initially. These cameras captured reflected infra-red light from markers placed on anatomically defined points on the subject's body. As the position of the cameras was fixed then as the patients moved the markers through space, a software package could deduce the relative movement of the markers to each camera with 6 degrees of freedom (6DOF).

Six healthy volunteers (3 M, 3 F; age 21-29) with no prior neck injuries acted as subjects. The collar was always applied by the same person. Each technique was used 3 times on each subject. To replicate the clinical situation another volunteer would hold the head for each test.

The movements we measured were along the x, y, and z axes, thus acting as an approximation to flexion, extension and rotation occurring at the C-spine during collar application. The average movement in each axis (x, y and z) was 8 degrees, 8 degrees and 5 degrees respectively for both techniques. No further data analysis was attempted on this small data set.

However this pilot study shows that our method enables researchers to reproducibly collect data about cervical spine movement whilst applying a cervical collar.

Introduction: Studies have shown that the addition of adrenaline to the saline wash used in total knee replacements reduces blood losses. Our aim was to see if this held true for patients undergoing Total Hip Replacement (THR).

Materials and Methods: Between January 2007 and March 2008 we retrospectively looked at all total hip replacements performed by the senior author. The same standard peri-operative regimen was used throughout. All patients received Aspirin 150mg post operatively for six weeks as thrombo-embolic prophylaxis (unless specifically contra-indicated). All patients had a Bellovac A.B.T (Astra Tech) drain placed deep to the fascia lata at the end of each operation. Blood drained in the first 6 hours was re-infused. After six hours the drain continued to function as a ‘normal drain’. All drains were removed within 24 hours following surgery. Patients were assigned to two groups: one control group of 80 patients, in which a saline solution was used to wash the surgical field, and a second group of 59 patients, in which a saline solution containing a low dose of adrenaline (4mg of 1:1000 in a litre) was used to wash the surgical field.Haemoglobin was determined preoperatively and on the first postoperative day. The total blood loss was calculated. We also measured the decrease in haemoglobin for each patient. Statistical analysis was carried out using the SPSS statistical package.

Results: A total of 139 patients were reviewed. The patient characteristics in both groups were closely matched. No significant differences found in the drop in haemoglobin between both groups P = −0.426. The mean volume of blood lost intraoperatively was also similar. Study 299ml and Control 313ml respectively.

Discussion: Our study suggests that the use of adrenaline wash in patients undergoing THR is of minimal benefit in reducing blood losses. As there is no tourniquet used in THR perhaps this may be explained by the fact that as the circulation is not temporarily disrupted then the local effect of the adrenaline may be lost as it is being washed away at the time of application and local levels do not become sufficiently high to have the desired vaso-constrictor effect.