The Not-So-Merry-Go-Round: Traumatic Inferior-Anterior Hip Dislocation in a 9-Year-Old.

Merry-go-rounds are not as innocuous as they may seem. Pediatric hip anterior-inferior dislocations are very rare and can be associated with low-energy trauma. Prompt recognition of pediatric hip dislocations is vital, and this should be treated as a time-sensitive orthopedic emergency. Closed reduction within 6 hours minimizes the risk of avascular necrosis (AVN). We present a case of a 9-year-old boy with an inferior-anterior hip dislocation following low energy trauma while playing on a merry-go-round. The patient was emergently brought to the theatre for closed reduction under general anesthesia within 6 hours. At his 12-month follow-up, he has a full range of motion without any pain.

A Curious Case of a Wooden Toothpick Inside a Child's Knee: A Case Report.

CASE: A 10-year-old boy presented with vague symptoms, a few days after a nondescript injury to his left knee. History, examination and blood tests, and imaging were unremarkable. Because of his severe pain, we proceeded to arthroscopy. On proceeding to arthroscopy, a wooden toothpick was found inside the knee joint. The wooden toothpick was removed arthroscopically. CONCLUSION: The physicians/surgeons have to be vigilant and should approach holistically toward history and examination of a child presenting with vague signs and symptoms.

Ten Inventions That Shaped Modern Orthopedics.

The current field of orthopedics is the result of many decades of minor and major advancements. The evolution of orthopedics has culminated into the modern field seen today. This article presents 10 inventions that played a key role in shaping modern orthopedics.

Corrosion and Heat Treatment Study of Electroless NiP-Ti Nanocomposite Coatings Deposited on HSLA Steel.

Corrosion and heat treatment studies are essential to predict the performance and sustainability of the coatings in harsh environments, such as the oil and gas industries. In this study, nickel phosphorus (NiP)-titanium (Ti) nanocomposite coatings (NiP-Ti nanoparticles (TNPs)), containing various concentrations of Ti nanoparticles (TNPs) were deposited on high strength low alloy (HSLA) steel through electroless deposition processing. The concentrations of 0.25, 0.50 and 1.0 g/L TNPs were dispersed in the electroless bath, to obtain NiP-TNPs nanocomposite coatings comprising different Ti contents. Further, the effect of TNPs on the structural, mechanical, corrosion, and heat treatment performance of NiP coatings was thoroughly studied to illustrate the role of TNPs into the NiP matrix. Field emission scanning electron microscope (FESEM) and energy dispersive spectroscopy (EDX) results confirm the successful incorporation of TNPs into the NiP matrix. A substantial improvement in the mechanical response of the NiP matrix was noticed with an increasing amount of TNPs, which reached to its ultimate values (hardness 675 Hv, modulus of elasticity 18.26 GPa, and stiffness 9.02 kN/m) at NiP-0.5TNPs coatings composition. Likewise, the electrochemical impedance spectroscopy measurements confirmed a tremendous increase in the corrosion inhibition efficiency of the NiP coatings with an increasing amount of TNPs, reaching ~96.4% at a composition of NiP-0.5TNPs. In addition, the NiP-TNPs nanocomposite coatings also unveiled better performance after heat treatment than NiP coatings, due to the presence of TNPs into the NiP matrix and the formation of more stable (heat resistant) phases, such as Ni3P, Ni3Ti, NiO, etc., during the subsequent processing.

A Novel Technique of Proximal Humerus Fixation.

Proximal humerus fractures account for 4%-6% of all the fracture presentations. There are many ways of treating different kinds of proximal humerus fractures. We describe the percutaneous fixation of proximal humerus which is not widely used but is a cost effective, less invasive and comparable to other techniques with regard to results.

A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.

An Incidental Discovery of Amyand's Hernia: A Case Study and Literature Review on Its Intraoperative Management.

Amyand's hernia (AH) is a rare form of an inguinal hernia where the vermiform appendix is found within the hernia sac. Diagnosis is usually based on incidental finding intraoperatively. The AH makes up a small proportion of all inguinal hernia cases, and concurrent acute ischemic complication makes up an even smaller subset. We present an 85-year-old male who was referred to general surgery services for a growing mass on his right lower quadrant in the inguinal region. This was non-tender on palpation, and therefore there was no suspicion of ischaemic complications. An open hernioplasty was performed with resection of the appendix. The AH in this patient would be conventionally classified as type 1 AH, which would be managed with hernial reduction and mesh repair. The anatomical variance in our patient's AH increased the risk for hernial incarceration; hence an appendectomy was also performed despite the absence of acute appendicitis. This approach was also deemed necessary to avoid the recurrence of hernia due to its large size and adhesions within the hernial sac. This study reports a novel management approach for an incidentally discovered type 1 AH. It highlights that there is a lack of management guidance for the AH anatomical variants. The classification and management for AH under the conventional Losanoff and Basson's AH classification model have limitations that can be amended by incorporating the physical dimensions of the AH. This approach will enable surgeons to recognize and manage more variations of AH while mitigating downstream complications.

Does Google™ Have the Answers? The Internet-based Information on Pelvic and Acetabular Fractures.

Introduction The aim of this study is to assess the readability and reliability of internet-based information on pelvic and acetabular fractures. Methods The three most popular English-based internet search engines are Google, Yahoo, and Bing. Quality was assessed using the DISCERN tool, the Journal of the American Medical Association tool, and the presence of the Health on the Net Code (HONcode) seal. Readability was assessed using a combination of the Flesch Reading Ease Score and the Flesch-Kincaid grade level. Inclusion criteria included English language websites with the relevant search terms. We excluded videos, YouTube links, or sponsored advertisements. Search terms included acetabular fracture/fractured acetabulum and pelvic fracture/fractured pelvis. The top 25 websites in each search engine were reviewed. The searches for acetabular fractures and pelvic fractures generated 75 websites in total. Duplicates were excluded. Results The search for acetabular fracture revealed 36 discrete websites among the three search engines, and the search for pelvic fractures revealed 45 websites. Overall, the average reading grade was 9.7 for acetabular websites and 13.6 for pelvis websites. The quality of the websites was poor across all key performance indicators studied. Conclusion Physicians should be aware of the quality of medical information available to patients via internet searches because physicians should play a central role in the navigation of poor quality information to help direct patient-centered care.

Negative Predictors of Outcomes of Flexor Tendon Repairs.

The current trend in hand surgery has streamlined the treatment of acute hand trauma to the modern-day surgery unit. As the volume of hand trauma caseloads continues to increase, it is becoming increasingly difficult to schedule patients for theater on the day of injury. It, therefore, becomes paramount to adequately triage patients in accordance with best clinical evidence and predictors of poor clinical outcomes. Animal models suggest that the earlier flexor tendons are repaired, the better the patient functional outcome. The largest study to date examining the timing of injury to functional post-operative outcome also recognizes that the faster these injuries are repaired, the better the patient outcome. Age-related changes to tendon biomechanics and structure are well-documented. However, no conclusive evidence exists specific to the degenerative changes and mechanical properties of flexor tendons in humans. The animal model strongly suggests that increasing age is associated with local architectural and biological changes that directly affect the tendon repair functional outcome. Although retrospective analyses to date suggest that smoking is a negative outcome predictor for functional tendon outcome, no prospective large-scale studies exist. A large, single-center prospective study specifically examining the positive and negative outcome predictors of flexor tendon repairs and functional post-operative outcome is warranted. The negative predictive model of patient care may enable us to further council patients preoperatively and stratify patients according to clinical need.

Preoperative Patient Preparation Audit: Completed Loop Cycle.

Introduction Nurses usually check patients scheduled for surgery while the patients are still in the ward. A lack of complete preoperative patient preparation can cause delayed care and disastrous outcomes. The objective of this study was to assess the number of patients en route to surgery who had been fully preoperatively prepared and evaluate any change in that number once a proforma was introduced as part of the preparation protocol. Methods We conducted a two-part audit of preoperative preparedness to assess factors such as up-to-date blood work, group and save, cross-match, and surgical site marking, among others. We then devised a proforma to be signed and checked by the ward doctor (e.g., intern or senior house officer). We compared the number of patients marked completely ready for surgery in the six weeks prior to use of the proforma with the number of patients marked completely ready for surgery for six weeks after implementation of the proforma. Results The study included the preoperative audit of 35 patients prior to the use of the proforma and 30 patients after the implementation of the proforma. Use of the proforma improved preoperative patient preparation by 50% compared to the level of preparedness when no proforma was used. Conclusion Health care facilities may benefit from a similar proforma for supplementing standardized, widely accepted preoperative protocols as an additional safety measure.

Slipped Upper Femoral Epiphysis: Are We Missing the Point?

Slipped upper femoral epiphysis (SUFE) is one of the most common orthopaedic conditions in adolescents. SUFE typically presents as hip pain and limping, but it may present deceptively as knee pain or contralateral hip pain. We discuss a case of a child with a deceptive presentation of SUFE resulting in delayed diagnosis.

Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management.

Femoral head osteonecrosis is a condition caused by a compromise of the blood supply of the femoral head. The precarious blood supply of the head and its role as a major weight-bearing joint makes it one of the most common bones to be affected by osteonecrosis. We describe the etiology, clinical presentation, investigations and common management options used nowadays to treat it.

Erythema Ab Igne and Its Relation to Spinal Pathology.

Erythema ab igne is a skin condition usually caused by abnormal exposure to heat in a variety of forms. While common in the past, its incidence has declined significantly to become a rare occurrence today. Today, we still see an odd case once in a while, although they have become a rarity. We describe a case of a young man who presented with erythema ab igne with a unique cause.

Challenges in Hip Replacement in Hip Dysplasia Cases and the "Happy Elephant Sign.

Hip dysplasia is an abnormal development of the hip that consists of a spectrum of different abnormalities featuring an abnormal relation of the femoral head to the acetabulum. It can be treated in early childhood when it is diagnosed. Later in adult life, it is more challenging. We present a case of a 50-year-old woman who presented to us with adult hip dysplastic changes; we undertook the care of her left hip and treated her surgically.

Signs of Nature in Spine Radiology.

As medical science developed over time, we have relied on natural imagery to help us recognise and remember things. In this review article, we will be discussing some radiological signs named because of their resemblance to the occurrences in the natural world.

Intriguing Periprosthetic Fracture of Hip Stem and Proximal Femoral Replacement.

Lateral femoral prosthesis perforation is an uncommon periprosthetic fracture. Periprosthetic fractures may be fixed with open reduction and internal fixation, or with revision arthroplasty, depending on the type of fracture, the condition of the host bone in the proximal femur, the stability of the implant, and occasionally the medical co-morbidities of the patient. Proximal femoral replacement is a complex and challenging procedure but provides a better chance of early mobilisation. We describe a case of treating a 71-year-old woman who presented with an unusual type of periprosthetic fracture, treated with a revision arthroplasty procedure using a proximal femur replacement.

Epidemiology and Characteristics of Cervical Spine Injury in Patients Presenting to a Regional Emergency Department.

Purpose This study aims to establish the demographics and characteristics of patients with cervical spine injury (CSI) in an Irish cohort presenting to a regional emergency department. Methods We performed a retrospective analysis of the medical records of patients who underwent cervical spine computed tomography (CT) scans following trauma from January 2013 to July 2016. We looked at the mechanism of injury, mode of arrival to the emergency department, triage category, correlation between examination, and site of CSI and neurological status. Results Over the study period, 808 patients underwent CT scans of the cervical spine for potential CSI. The incidence of CSI in our cohort was 9.4% (n = 76). Approximately 70% (n = 53) were men. Falls (53%) and motor vehicle accidents (29%) were noted to be the more common mechanisms of injury in this cohort. The C2 region was the most common location for CSI. Only 7% (n = 5) of patients had documented neurology. Conclusion This study demonstrates the epidemiology and characteristics of CSI presenting in an Irish cohort. The incidence of CSI was found to be 9.4% with a male preponderance and falls being the most common cause of trauma.

Hip Fracture in a Patient with Primary Hyperparathyroidism: Medical and Surgical Lessons.

Hyperparathyroidism is a condition which can be primary, secondary or tertiary and is characterized by increased calcium levels, low phosphate levels, and elevated parathyroid hormone (PTH) levels. Primary hyperthyroidism can cause severe bone resorption leading to bone pains and pathological fracture. We present the case of a patient with severe primary hyperparathyroidism with an atraumatic fracture at the neck of the femur and multiple medical comorbidities presenting a surgical challenge. While primary hyperparathyroidism is rare, it should be considered during differential diagnoses.