Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial.

Knee osteoarthritis is a leading cause of chronic disability and economic burden. In many patients who are not surgical candidates, existing treatment options are insufficient. Clinical evidence for a new treatment approach, genicular artery embolisation (GAE), is currently limited to single arm cohort, or small population randomised studies. This trial will investigate the use of a permanent embolic agent for embolisation of abnormal genicular arterial vasculature to reduce pain in patients with mild to moderate knee osteoarthritis. Up to 110 participants, 45 years or older, with knee pain for ≥ 3 months resistant to conservative treatment will be randomised (1:1) to GAE or a sham procedure. The treatment group will receive embolisation using 100-micron Embozene™ microspheres (Varian, a Siemens Healthineers Company) (investigational use for this indication in the UK), and the sham group will receive 0.9% saline in an otherwise identical procedure. Patients will be followed for 24 months. At 6 months, sham participants will be offered crossover to GAE. The primary endpoint is change of 4 Knee Injury and OA Outcome Score subscales (KOOS4) at 6 months post-randomisation. The study will also evaluate quality of life, health economics, imaging findings, and psychosocial pain outcomes. The primary manuscript will be submitted for publication after all participants complete 6 months of follow-up. The trial is expected to run for 3.5 years. Trial Registration: ClinicalTrials.gov, Identifier: NCT05423587.

Hybrid Fixation in Pediatric Forearm Fractures, does it Predispose to Non-union? A Case Report and Literature Review.

INTRODUCTION: Pediatric fracture non-union is rare, with limited published evidence available. Whilst there have been certain predisposing factors identified throughout case reports/series, we present a case, hypothesizing a previously undocumented risk factor for non-union. CASE REPORT: A 9-year-old boy sustained closed, diaphyseal both bone forearm fractures. He underwent a hybrid fixation (plate fixation of the ulnar and elastic stable intramedullary nail of the radius). Whilst the ulnar fracture healed well, the radial fracture went on to non-union before a second procedure was performed, metalwork removed, and a compression plate utilized. At 2-month post-radial compression plate, there was a union at this site. CONCLUSIONS: There are numerous risk factors for non-union in pediatric fractures which have previously been highlighted throughout literature. We present a case hypothesizing a new risk factor, of hybrid fixation, for pediatric non-union.

Bilateral simultaneous traumatic upper arm compartment syndromes associated with anabolic steroids.

BACKGROUND: Acute compartment syndrome, a surgical emergency, is defined as increased pressure in an osseofascial space. The resulting reduction of capillary perfusion to that compartment requires prompt fasciotomy. Treatment delay has a poor prognosis, and is associated with muscle and nerve ischemia, resultant infarction, and late-onset contractures. OBJECTIVES: We report a case of traumatic bilateral upper limb acute compartment syndrome associated with anabolic steroids, requiring bilateral emergency fasciotomies. CASE REPORT: A 25-year-old male bodybuilder taking anabolic steroids, with no past medical history, presented to the Emergency Department 25 min after a road traffic accident. Secondary survey confirmed injuries to both upper limbs with no distal neurovascular deficit. Plain radiographs demonstrated bilateral metaphyseal fractures of the distal humeri. Within 2 h of the accident, the patient developed clinical features that were consistent with bilateral upper arm compartment syndrome. Bilateral fasciotomies of both anterior and posterior compartments were performed, confirming clinical suspicion. CONCLUSION: We suggest consideration of a history of anabolic steroid use when evaluating patients with extremity trauma.

Deep venous thrombosis in a child: an unusual presentation of an osteochondroma.

Deep vein thrombosis is very uncommon in the pediatric population. We describe an unusual case of deep vein thrombosis caused by a femoral osteochondroma in a 13-year-old adolescent girl with known multiple hereditary exostoses. We discuss the optimum investigations to determine the site of venous obstruction, which is crucial when there are several osteochondromata in the affected limb, which could be implicated in causing the obstruction to venous flow.