Metastatic spinal cord compression: the Spinal Instability Neoplastic Score and early surgical intervention.

OBJECTIVES: To evaluate the value of Spinal Instability Neoplastic Score (SINS) in patients with spine metastasis who subsequently developed or did not develop metastatic spinal cord compression (MSCC). METHODS: In this single institutional retrospective descriptive observational study, of 589 patients with MSCC who were referred for radiotherapy, 34 patients (with 41 compression sites) met the inclusion criteria: availability of diagnostic MRI spine pre-development of MSCC (MRI-1) and at the time of MSCC development (MRI-2) (CordGroup).For comparison, NoCordGroup consisted of 152 patients (160 sites) treated with radiotherapy to spinal metastases. SINS was compared between the two groups. RESULTS: In CordGroup, the median interval between MRI-1 and MRI-2 was 11 weeks. The median SINS was 8 (range: 4-14) and 9 (range: 7-14) on MRI-1 and MRI-2, respectively. In NoCordGroup, the median SINS was 6 (range: 4-10). CONCLUSIONS: Our study showed a trend in difference in SINS value between the two groups. This difference should be a subject of future prospective research in this patient population with poor survival.

A rare case report of high-grade primary B-cell intestinal lymphoma in young adult, with a focus on radiological role in the diagnosis and management.

In contrast to the common extra-nodal intestinal lymphoma, intestinal lymphoma of primary origin is rare. We present an interesting case of 35-year-old male patient presented with abdominal pain, then deteriorated rapidly and developed small bowel perforation. Initial diagnosis was made by computed tomography, and subsequently the diagnosis was confirmed by ultrasound-guided biopsy and histopathological assessment. This case report emphasizes on the importance of the radiological role in the diagnosis and management of such case to avoid catastrophic sequalae and complications such as intestinal obstruction, perforation, and intra-abdominal sepsis.

A prediction model for treatment decisions in distal radial physeal injuries: A multicenter retrospective study.

Background: There are no clearly defined guidelines for the management of distal radial physeal injuries. We aimed to identify the risk factors for patients with distal radial physeal trauma for the risk of deformity, physeal closure, and revision procedure and develop a predictive model. Methods: The retrospective study included patients less than 16 years old with displaced distal radial physeal injuries treated between 2011 and 2018 across five centers in the United Kingdom. Deformity was defined as a volar angulation of >11°, dorsal angulation of >15°, a radial inclination of <15° or >23°, or positive ulnar variance. Presence of a bony bar spanning the physis was considered physeal closure. Results: This study comprised of 479 patients. In that, 32 (6.6%) patients had a second procedure. Also, 49 (10.2%) patients had closure of physis, and 28 (6%) patients had deformity at the end of follow-up. The occurrence of deformity had a strong correlation with age (p = 0.04) and immobilization duration (p = 0.003). Receiver operating characteristic analysis showed that age >12.5 years (p = 0.006) and sagittal angulation of >21.7° (p = 0.002) had a higher odd of deformity. Immobilization for <4.5 weeks (p = 0.01) had a higher revision rate. The nomograms showed good calibration, with a sensitivity of 70% and specificity of 75%. Interpretation: The nomograms provide accurate, pragmatic multivariate predictive models. Anatomical reduction is recommended in patients >12.5 years of age with >22° of dorsal angulation with cast immobilization for no less than 4.5 weeks. Any revision procedure should be performed within 11 days from the date of injury to reduce the risk of physeal damage.

Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic.

Objectives: Achieving the hip fracture best practice tariff is associated with decreased mortality rates. The aim of this study is to evaluate the impact of Covid-19 pandemic on achieving Best Practice Tariff. Methods: We retrospectively reviewed all adult hip fractures admitted to our unit between March and June 2020. Patient's characteristics, place of residence, delirium assessment, and mobility status were recorded. All the Best practice Tariff criteria have been analysed. Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction. Results: 178 patients with a mean age of 82.8 years presented with hip fractures during the study period. 18 patients (10.1%) tested positive for COVID-19. 44.4% failed to achieve the BPT from the COVID-19 positive group and 22.5% from the negative group. Conclusion: Based on this study, hip fractures associated with Covid-19 infection are more likely to fail the BPT and have higher 30-day mortality rates compare to the COVID-19 negative patients.

The impact of COVID-19 infection on hip fracture 30-day mortality.

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65-98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0-22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community, and 70% (n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

The impact of COVID-19 infection on hip fractures 30-day mortality.

Introduction: A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.

The use of Tranexamic Acid in Total Elbow Replacement to Reduce Post-Operative Wound Infection.

Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER. Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed. All patients had 2 grams of TXA and antibiotics intra-operatively. All were reviewed at two weeks following surgery for wound check and removal of surgical clips. Results: Seven females and three males with a mean age of 81.5 had TER and TXA. The mean level of pre-operative haemoglobin was 134.40 g/l and the mean post-operative level was 122.70g/l. No patient in this series required blood transfusion. At two weeks and six weeks follow-up, all wound healed up with no signs of infection. Conclusion: TXA has been proven to be safe an effective way of reducing peri-operative bleeding. TXA maintains haemostasis after releasing the tourniquet and therefore reduces the swelling and wound complications post-operatively.

Survivorship Analysis of Eighty Revised Hip Arthroplasties With the Impaction Grafting Technique Using Whole Femoral Head Allografts With the Articular Cartilage.

BACKGROUND: Acetabular impaction bone grafting aims to restore anatomy in hip revision surgery. This is an effective but expensive and time-consuming technique. Usually, the articular cartilage is removed from the femoral head allograft. We aimed to reproduce the same results retaining the cartilage of the allograft. METHODS: Eighty acetabular revisions using impacted morselized bone graft retaining the articular cartilage and a cemented cup were studied retrospectively. Six were lost during follow-up. The mean follow-up was 6.5 years (range 1-13). Clinical and radiological assessment was made using the Oxford Hip Score, Hodgkinson's criteria for socket loosening, and the Gie classification for evaluation of allograft incorporation. RESULTS: Sixty-three sockets (85.1%) were considered radiologically stable (type 0, 1, and 2 demarcations), 8 (10.8%) were radiologically loose (type 3), and 3 (4.1%) presented with migration. Fifty-one (68.9%) cases showed good trabecular remodeling (grade 3), 20 (27%) showed trabecular incorporation (grade 2), and 3 (4.1%) showed poor allograft incorporation. Mean preoperative hip score was 43 and postoperative score was 28. Six (8.1%) cases presented heterotopic ossification around the revised implants, 2 patients (2.7%) had periprosthetic fractures, and 4 (5.4%) had dislocations. The Kaplan-Meier survivorship at a mean of 6.5 years with revision of the cup for any reason was 95.9% (95% confidence interval 5.6-7.5). CONCLUSION: The mid-term results of our technique are promising. Particularly when the supply of fresh-frozen allografts and surgical time is limited, using whole femoral head with articular cartilage is both safe and effective.