A comparison of risk profile for orthopaedic operations when utilizing individually wrapped screws (IWS) when compared with sterile screw caddies (screw racks).

INTRODUCTION: There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require re-sterilization. Individually wrapped screws (IWS) are purported to decrease infection rates and avoid the deleterious effects of repeated screw sterilizations, despite marginal evidence. This review aimed to evaluate the safety, effectiveness and economics of screw caddies with IWS. MATERIAL AND METHODS: The literature was surveyed in a systematic fashion between 1998 and 2017 and all relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-controlled studies and case series were sought. Any benefits or otherwise of IWS over screw caddies were then evaluated in the areas of safety, effectiveness and economics. RESULTS: Two level III-3 papers suggested the use of caddies at least as safe as individual screws. Four level III-2 papers demonstrated that screws from caddies were as effective as individual alternatives, while a level III-3 paper reported that individual screws were significantly more expensive than screw caddies. Cost increases to our regional health service from ankle open reduction and internal fixations alone of at least $50,112 (AUD) per annum were calculated. CONCLUSIONS: From the results obtained, the authors recommend the continued use of screw caddies for orthopaedic procedures.

Osteoporosis: A possible aetiological factor in the development of Scheuermann's disease.

The aim of this study was to test the hypothesis that spinal osteoporosis is an aetiological factor in the development of Scheuermann's disease in adolescents. Clinical and radiological data was collected on 12 individuals with Scheuermann's disease (SD). Lumbar spine bone mineral density (L2-4) was measured using dual energy X-ray absorptiometry. Age and sex-matched adolescents were used as controls. The number of standard deviations from the mean of age and sex-matched controls were calculated. In regards to results, SD patients demonstrated high bone densities of between 1 and 1.5 standard deviations above the mean of age-matched controls. These results suggest that osteoporosis is not an aetiological factor in Scheuermann's disease and that bone density measurements may indeed be higher than aged-matched controls in the general population.

Foot and ankle injuries occurring in inflatable rescue boats (IRB) during surf lifesaving activities.

Inflatable Rescue Boats (IRBs) are utilised by the Surf Life Saving Association (SLSA) in Australia to perform rescue operations and in regional competitions between surf clubs. These activities have resulted in a number of serious foot and ankle injuries which reflect the high impact of this activity in heavy and unpredictable surf. We have retrospectively reviewed 12 significant injuries relating to IRB usage presented to our regional hospital emergency department over a 3-year period. These include 6 Lisfranc fracture dislocations of the midfoot, 4 ankle fracture variants, one tibial shaft fracture, and one traumatic rupture of the peroneal retinaculum leading to peroneal tendon dislocation. Analysis of IRB footstraps in current usage shows they are directly related to the patterns of injury seen. We have recommended modifications to footstraps and handgrips currently in use with the aim of minimising or preventing these injuries.

Peroneal compartment syndrome of non-traumatic origin: A case report.

A patient with acute peroneal compartment syndrome is presented. This case is unusual because the pathology was localised to the peroneal compartment only and because trauma was not an aetiological factor. Acute and chronic compartment syndromes are discussed and differentiated, and the importance of a high index of suspicion in all cases is emphasised.

Prevention of heterotopic bone formation in high risk patients post-total hip arthroplasty.

A retrospective study was carried out to evaluate prophylaxis for heterotopic ossification (HO) about the hip joint post total hip arthroplasty (THA). Between 1990 and 1996, 20 patients with known risk for developing HO were treated prophylactically to prevent this complication. Patients at risk were divided into 3 groups based on risk factors for HO formation (previous ipsilateral hip HO formation, previous contralateral hip HO formation and bilateral hypertrophic osteoarthritis) Single fraction radiotherapy of 600, 700 or 800 cGy was administered postoperatively to all patients. The aim was to irradiate all patients within 72 hours of THA. 12 (60%) patients received in addition a short course of postoperative indomethacin for less than 13 days. Patients in this study were investigated for the following treatment variables: relative risk for forming HO, radiotherapy doses administered, time delays between surgery and irradiation, combined radiotherapy and indomethacin treatment versus radiotherapy alone, and surgical approach used for THA. Heterotopic ossification in patients was measured radiographically by use of the Brooker grading sytem, and was assessed clinically by use of the Harris Hip Score (HHS). A significant difference was found between relative risk groups (p = 0.02). Patients with previous HO formation in the ipsilateral hip joint were at greater risk of developing HO than those with previous contralateral HO formation. Moreover both of these groups were at greater risk than those with advanced bilateral hypertrophic osteoarthritis. Other variables studied showed differences that were not significant due to small sample numbers. This study, though limited by sample number, addresses questions regarding effective radiotherapy dosage, time delays acceptable before irradiation postoperatively, usefulness of short course postoperative indomethacin, and preferred operative approaches to minimise HO.