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1.
J Arthroplasty ; 35(6S): S313-S318, 2020 06.
Article in English | MEDLINE | ID: mdl-32139192

ABSTRACT

BACKGROUND: Both body mass index (BMI) and local measures of adiposity at the surgical site have been identified as independent risk factors for periprosthetic joint infection (PJI) (periprosthetic joint infection) after total knee arthroplasty (TKA). We aimed to 1) evaluate previously used measures of assessing knee adiposity and 2) determine the best measure for predicting both surgical duration and PJI after TKA. METHODS: We performed a multicentre retrospective review of 4745 patients who underwent primary TKA between January 2013 and December 2016. Patient demographic information, surgical duration and postoperative infection status within one year were obtained. Preoperative weight-bearing AP and lateral x-rays were analyzed to determine prepatellar adipose thickness, bony width of the tibial plateau, and total soft tissue knee width. The knee adipose index (KAI) was calculated from the ratio of bone to total knee width. RESULTS: We observed substantial variability in both local measures of adiposity compared with BMI. Neither measure of local knee adipose showed a significant correlation with PJI risk. By contrast, there was a strong correlation between PJI risk and BMI >35 (odds ratio 2.9, 95% CI 1.4-6.1). Surgical duration increased with both BMI and measures of local adipose tissue (KAI and prepatellar fat thickness). CONCLUSION: Local adipose deposition varies greatly for any given BMI. In this study, BMI was a better predictor of PJI after TKA than local measures of knee adipose tissue.


Subject(s)
Arthroplasty, Replacement, Knee , Prosthesis-Related Infections , Adipose Tissue/diagnostic imaging , Arthroplasty, Replacement, Knee/adverse effects , Body Mass Index , Humans , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/etiology , Retrospective Studies
2.
Ir J Med Sci ; 189(4): 1317-1322, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32067189

ABSTRACT

BACKGROUND: The dynamic hip screw (DHS) is a common device used in the fixation of hip fractures. Traditionally, this involves the use of a four-hole side plate. Reducing the length of the side plate would theoretically reduce the amount of surgical exposure required, decrease surgery duration, and decrease perioperative morbidity and mortality. Our study aims to review the current evidence regarding the use of two-hole side plates, their use and potential complications. METHODS: Using PRISMA guidelines, two independent reviewers performed a search to collate the available literature from medical databases PubMed, EMBASE, Web of Science, and the Cochrane library. Only clinical and biochemical studies were included. The reference lists of articles included for full text review were searched for any additional primary or review publications. RESULTS: Four online libraries were searched, with a combined total of 5344 titles reviewed. Following title, abstract, and full text review, 8 articles were considered suitable for inclusion in qualitative analysis. There was a trend towards equal efficiency between two- and four-hole plates when used in stable fractures in terms of blood loss, failure/revision rates, operative and hospital stay durations, collapse loading testing, maximum stress, and fragment migration. CONCLUSION: The results of this study show that DHS constructs with two- or four-hole side plates have comparable outcomes when used in patients with stable fracture patterns. However, the majority of the clinical data regarding the use of two-hole DHS plates come from retrospective case series; further prospective, randomised control trials would be of significant benefit. LEVEL OF EVIDENCE: Level II; systematic review of all levels of evidence.


Subject(s)
Bone Screws/standards , Fracture Fixation, Internal/methods , Hip Fractures/surgery , Plastic Surgery Procedures/methods , Female , Humans , Male , Middle Aged , Retrospective Studies
3.
Cureus ; 12(1): e6794, 2020 Jan 28.
Article in English | MEDLINE | ID: mdl-32025448

ABSTRACT

Introduction The British Orthopaedic Association and British Geriatric Association Blue Book guidelines for patients presenting acutely with a hip fracture stipulate that the patient should be admitted to an acute orthopedic ward within four hours of presentation to the emergency department (ED).  Materials and methods A retrospective review of all patients who presented to the ED with a hip fracture diagnosed on plain film X-Ray over an eight-week period by a single auditor. Time of arrival, time to X-ray, time of blood draw, time to orthopedic referral, time to orthopedic review, and time to arrival at the orthopedic ward were documented. A policy change stipulating that orthopedics on call would prospectively review potential hip fracture patients prior to definitive workup was initiated. The same parameters were re-audited following this intervention over a six-week period. Results Pre-intervention, the mean time to orthopedic review was 83 minutes with a mean time to ward of 417 minutes. Post-intervention, the mean time to orthopedic review was 76 minutes with a mean time to ward of 333 minutes. When orthopedic trainees were on call, the mean time to review was 37.5 minutes with a mean time to ward of 294 minutes. Conclusions While we were able to demonstrate an improvement in orthopedic response times, this did not significantly improve time to ward transfer. This highlights a number of other areas that need to be optimized to improve compliance with best practice guidelines.

4.
Ir J Med Sci ; 188(3): 879-883, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30569374

ABSTRACT

AIM: To establish the mode of failure of primary total hip replacement in patients under 50 years old. METHODS: A total of 1062 revision total hip arthroplasties were performed over a 5-year period, with 146 on patients under 50 years old. These were subdivided into early (< 5 years) and late (> 5 years) failures from the index procedure. RESULTS: The commonest mechanism of failure was aseptic loosening (42.3%) followed by metal-on-metal failure (15.8%), infection (14.4%) and instability (9.6%). The commonest cause of early revision surgery was due to metal-on-metal failure (27.8%) followed by aseptic loosening (19.7%) and infection (18.4%). In the late revision group, the main cause of failure was aseptic loosening (64%) and infection (10.7%). CONCLUSION: The changing trend of early revision due to metal-on-metal failure is important to recognise. Continuous review of the mechanism of primary total hip replacement failure is necessary to ensure the best patient outcome and maximise implant survivorship.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Prosthesis Failure/trends , Adolescent , Adult , Arthroplasty, Replacement, Hip/methods , Female , Humans , Male , Middle Aged , Young Adult
6.
BMJ Case Rep ; 20142014 Aug 21.
Article in English | MEDLINE | ID: mdl-25188931

ABSTRACT

Stress fractures occurring within the lower limbs are relatively common in athletes and military personnel. The specific bones affected are often predictable when the patient's activities are considered. We present an unusual case of bilateral distal tibial stress fractures sustained while playing as a goalkeeper in field hockey, in an otherwise healthy 46-year-old woman.


Subject(s)
Fractures, Stress/diagnostic imaging , Hockey/injuries , Tibial Fractures/diagnostic imaging , Female , Fractures, Stress/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , Prognosis , Radiography , Tibial Fractures/pathology
7.
J Orthop Surg (Hong Kong) ; 22(2): 190-4, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25163953

ABSTRACT

PURPOSE. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. METHODS. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. RESULTS. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p<0.01) and increased the load to failure (1452 N vs. 1159 N, p<0.001), compared to fixation without inferomedial screws. CONCLUSION. Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.


Subject(s)
Bone Plates , Bone Screws , Fracture Fixation, Internal/instrumentation , Shoulder Fractures/surgery , Compressive Strength , Equipment Failure Analysis , Humans , Models, Biological , Weight-Bearing
8.
BMJ Case Rep ; 20142014 Mar 31.
Article in English | MEDLINE | ID: mdl-24686808

ABSTRACT

Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.


Subject(s)
Capitate Bone/injuries , Fractures, Bone/surgery , Scaphoid Bone/injuries , Adult , Fracture Fixation, Internal , Fractures, Bone/diagnostic imaging , Humans , Male , Radiography
9.
Surgeon ; 12(2): 73-7, 2014 Apr.
Article in English | MEDLINE | ID: mdl-23932670

ABSTRACT

Cadaveric dissection remains an important part of undergraduate medical education in anatomy. In a concerted effort to rise the number of doctors in practice in Ireland the amount of medical school placements has been increased steadily since 1995. This poses a problem as the number of cadavers has remained unchanged despite an overall increase in the population Ireland over the last twenty years. The medical profession plays a central part in raising public awareness of living and post-mortem organ donation. Previous studies have examined the attitudes of medical students to whole body donation, however to our knowledge this is the first study that evaluates the attitudes of medical professionals. We assess the opinions of junior and senior doctors at the time of their dissection experience and in their current practice. We show that their attitudes have changed as their clinical experience grows.


Subject(s)
Attitude of Health Personnel , Education, Medical, Undergraduate/methods , Health Knowledge, Attitudes, Practice , Schools, Medical/supply & distribution , Students, Medical/psychology , Teaching/ethics , Tissue and Organ Procurement , Anatomy/education , Attitude to Death , Cadaver , Female , Humans , Ireland , Male , Surveys and Questionnaires
10.
J Orthop Surg (Hong Kong) ; 21(2): 173-7, 2013 Aug.
Article in English | MEDLINE | ID: mdl-24014778

ABSTRACT

PURPOSE. To evaluate the effect of filling a central humeral bone void with calcium triphosphate cement on the strength and stability of an osteosynthesis in elderly cadavers. METHODS. 14 fresh cadaveric shoulder specimens obtained from 11 donors (mean age, 91.5 years; mean body weight, 61 kg) were divided into 2 age- and sex-matched groups. A standardised 3-part proximal humeral fracture with a central bone void was created in each specimen. Each specimen was reduced and fixed with a locking plate. In half the specimens the central bone void was packed with calcium triphosphate cement. The intra-fragmentary motion and the load and mode of failure were recorded. RESULTS. Respectively in the test group and controls, the intra-fragmentary motion was 1.0 and 6.4 mm, and the peak displacement at the 500 N load was 1.8 and 9.1 mm. The Cohen's d was 1.6 to 2.7 for all load steps, indicating a large effect of the calcium triphosphate cement on strength and stability. The mean difference in the failure load was 300 N (p<0.05). CONCLUSION. Construct stability and failure load improved significantly when the central humeral bone void was filled with calcium triphosphate cement.


Subject(s)
Bone Cements/therapeutic use , Fracture Fixation, Internal/methods , Shoulder Fractures/surgery , Aged, 80 and over , Biomechanical Phenomena , Bone Plates , Bone Screws , Cadaver , Calcium/therapeutic use , Female , Humans , Male , Polyphosphates/therapeutic use , Shoulder Fractures/physiopathology
12.
Acta Orthop Belg ; 78(3): 409-13, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22822586

ABSTRACT

Although the vast majority of injuries suffered while cycling are minor, acute spinal injuries have been reported. We describe three cases of acute spinal injury occurring while cycling. All three patients reported being thrown over the handlebars, while travelling downhill at speed. Two of the cases resulted in profound neurological deficit. These cases show that there is a spectrum of spinal injury due to bicycle accidents, ranging from no neurological deficit to profound insult, and from high cervical injury to mid-thoracic spinal injury. In cases of bicycle accidents, increased awareness of the possibility of such spinal injury is advisable.


Subject(s)
Bicycling/injuries , Spinal Cord Injuries/etiology , Spinal Fractures/etiology , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/injuries , Humans , Male , Middle Aged , Radiography , Spinal Fractures/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/injuries
13.
J Tissue Viability ; 21(3): 84-7, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22658450

ABSTRACT

AIM OF THE STUDY: It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing. METHOD: 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient. RESULTS: The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups. CONCLUSION: The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate.


Subject(s)
Arthroplasty, Replacement, Hip/nursing , Arthroplasty, Replacement, Knee/nursing , Bandages/standards , Perioperative Nursing/methods , Surgical Wound Infection/prevention & control , Aged , Female , Humans , Male , Middle Aged , Perioperative Nursing/standards , Prospective Studies , Surgical Wound Infection/nursing
14.
Orthopedics ; 35(2): e250-4, 2012 Feb 17.
Article in English | MEDLINE | ID: mdl-22310414

ABSTRACT

Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.


Subject(s)
Bone Plates/statistics & numerical data , Evidence-Based Medicine , Fracture Fixation, Internal/statistics & numerical data , Shoulder Fractures/epidemiology , Shoulder Fractures/surgery , Humans , Prevalence , Treatment Outcome
15.
Emerg Med J ; 29(10): 846-7, 2012 Oct.
Article in English | MEDLINE | ID: mdl-21856703

ABSTRACT

This short report presents the case of a 32-year-old man with a knee injury sustained while playing football. A plain radiograph revealed a Segond fracture and a subsequent MRI confirmed a complete anterior cruciate ligament rupture. While the Segond fracture, and its associated intra-articular pathology, is well recognised among orthopaedic surgeons, it is less well recognised among staff in the emergency department. The report aims to emphasise the importance of plain radiographs in patients with a history of knee injury and to highlight that this seemingly innocuous avulsion fracture may reveal more severe underlying pathology.


Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries/diagnosis , Soccer/injuries , Tibial Fractures/diagnosis , Adult , Humans , Magnetic Resonance Imaging , Male
16.
J Orthop Surg (Hong Kong) ; 19(3): 350-3, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22184169

ABSTRACT

PURPOSE: To evaluate the efficacy of a musculoskeletal oncology training module during residency. METHODS: 24 orthopaedic residents with differing years of experience were recruited. 12 of them received musculoskeletal oncology training for 6 months. The remaining 12 were controls who did not attend the training and had no clinical experience in a musculoskeletal oncology unit but had at least 3 years of postgraduate surgical training. Upon completion, residents in both groups were assessed by a knowledge test and then an objective structured clinical examination (OSCE). RESULTS: Residents who attended the training module had better mean knowledge test scores (48 vs 25 out of 58, p<0.0001) and OSCE scores (32 vs 22 out of 42, p<0.004), compared to those who did not attend. No residents who attended the training module marked an inappropriate biopsy site that would have compromised definitive surgery, compared to 5 (42%) of the untrained residents who marked an inappropriate biopsy site that may have resulted in an unnecessary amputation. All residents who attended the training module agreed that such a module should be included in the orthopaedic residency programme. CONCLUSION: Residents who attended the training module were more aware of the biopsy principles and risks. A training module for musculoskeletal oncology should be included in the orthopaedic residency programme.


Subject(s)
Bone Neoplasms/surgery , Internship and Residency , Orthopedics/education , Soft Tissue Neoplasms/surgery , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/pathology , Clinical Competence , Humans , Radiography , Soft Tissue Neoplasms/diagnostic imaging , Soft Tissue Neoplasms/pathology
19.
Acta Orthop Belg ; 77(1): 33-40, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21473443

ABSTRACT

Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d'Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p < 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p < 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p < 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p < 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p < 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging.


Subject(s)
Acetabulum/abnormalities , Acetabulum/surgery , Hip Dislocation, Congenital/surgery , Osteotomy/methods , Acetabulum/diagnostic imaging , Adolescent , Adult , Female , Hip Dislocation, Congenital/diagnostic imaging , Humans , Male , Radiography , Treatment Outcome
20.
J Orthop Surg (Hong Kong) ; 18(3): 382-4, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21187558

ABSTRACT

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.


Subject(s)
Femoral Neuropathy/diagnosis , Femoral Neuropathy/physiopathology , Gait/physiology , Paralysis/diagnosis , Paralysis/physiopathology , Adult , Biomechanical Phenomena , Femoral Neuropathy/complications , Humans , Male , Paralysis/complications , Weight-Bearing/physiology
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