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.

Tranexamic acid in hip fracture surgery: A systematic review and meta-analysis.

AIMS: The primary objective of this review was to determine whether tranexamic acid (TXA) reduces transfusion rates in patients undergoing surgery for hip fractures. The secondary objective was to assess the effects of TXA on mortality and thromboembolic events in the same cohort. METHODS: A systematic review of electronic databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials comparing perioperative TXA in patients treated surgically for hip/proximal femoral fractures against placebo. The primary outcome was the proportion of patients requiring blood transfusion. Secondary outcomes were blood loss, mortality, and complications. Meta-analysis was performed using inverse variance and random effects model. RESULTS: The pooled data from 10 studies involving 842 patients showed that the proportion of patients requiring blood transfusion was significantly less in the TXA group (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.59-0.88). There was no difference between TXA and control groups when comparing mortality (RR 1.17, 95% CI 0.65-2.10), deep venous thrombosis (RR 1.14, 95% CI 0.43-3.06), pulmonary embolism (RR 0.53, CI 0.09-3.02), acute coronary syndrome (RR 1.52, CI 0.18-12.98), cerebrovascular events (RR 0.78, CI 0.16-3.68), or wound complications (RR 1.61, CI 0.51-5.13). CONCLUSION: There is evidence that TXA reduces the proportion of patients requiring blood transfusions when undergoing hip fracture surgery. However, the small sample size and low event rates for adverse effects preclude any definitive conclusions from being established regarding adverse effects. Future trials should be powered to further assess potential complications and determine the ideal dosage and regime.

The change in position of the axillary nerve with rotation of the arm.

The axillary nerve is the most commonly injured nerve around the arm. In the deltopectoral approach, classical teaching states that lateral rotation of the humerus increases the distance between the subscapularis and the axillary nerve. This is the first anatomical study to quantify the distance change between the axillary nerve and subscapularis produced by arm rotation. Eight arms were placed in the supine position and a classical deltopectoral approach was performed. With digital calipers, measurements were made from the closest identifiable margin of the nerve to the inferior extent of the tenotomy. All measurements were made with the arm in 0° abduction and elbow in 90° of flexion, and repeated with the arm in 45° of medial rotation, 0° lateral rotation and 45° of lateral rotation. The mean d Axillary Nerve to subscapularis was recorded as 30.9 mm (95% CI:25.3-36.3), 39.4 mm(95% CI:34.1-44.8), and 46.1 mm (95% CI:41.1-51.2) for 45° MR, 0°, and 45° LR, respectively. Using paired-samples T-testing, the mean change in distance when moving from 45° MR to 0° was +8.5 mm (P < 0.0001), and from 0° to LR 45°, +6.7 mm (P < 0.0001). There is a significant difference in the distance between the subscapularis tenotomy and the axillary nerve with medial and lateral rotation. Laterally rotating the arm increased the distance by 6.7 mm, reaffirming that positioning the glenohumeral joint in a position of LR during subscapular tenotomy is protective against iatrogenic injury of the axillary nerve. Clin. Anat. 32:268-271, 2019. © 2018 Wiley Periodicals, Inc.

The prevalence of overuse injuries in Australian non-elite netballers.

PURPOSE: The aim of this study was to investigate the prevalence of overuse injuries in non-elite netballers and whether these increase over a typical competitive season and to establish if player age, experience, training, and use of bracing are related to overuse injuries. PATIENTS AND METHODS: A prospective study was conducted over a 12-week period, using a recently developed questionnaire. Data were collected on overuse injuries in the knee, ankle, and shoulder areas every week. RESULTS: Thirty-seven players responded to the questionnaire, with an average response rate of 65%. The total prevalence of overuse injuries identified was 52.7%, with ankle problems accounting for 26% (75 cases), knee problems accounting for 21.2% (61 cases), and shoulder problems accounting for 5.5% (16 cases). Ankle injuries increased over the study period, while knee and shoulder problems decreased. Injuries were more common in players over 36 years old or those with less than 5 years of playing experience. Players who used a brace were more likely to have an overuse complaint. Training volume was not associated with increased risk. CONCLUSION: Overuse injuries are common in netballers, particularly of the knee and ankle. Shoulder overuse complaints are higher than previously reported. Risk factors for injury include older age and less playing experience, and these should be considered when planning injury prevention programs for this sport.

Non-Operative Rehabilitation of Isolated Popliteus Tendon Rupture in a Rugby Player.

Isolated rupture of the popliteus tendon is uncommon; instead, it is often seen as part of multi-ligamentous posterolateral corner injuries. In this report, we present a case of a 22-year-old professional rugby player who sustained a lateral blow to his semi-flexed knee in a tackle during a competitive game. A complete popliteus tendon rupture at its musculo-tendinous junction was diagnosed on magnetic resonance imaging despite a relatively unremarkable physical examination. The aims of this report are to highlight the diagnostic challenges with this rare injury as physical signs are often subtle and non-specific. Furthermore, we demonstrate the viability of conservative management in the setting of a direct contact mechanism. Indeed, our patient was successfully treated with a specific rehabilitation protocol via isometric quadriceps contractions, gastrocnemius-soleus and hamstring strengthening exercises and graded activity with successful return to full contact activities at 4 weeks and regular season matches shortly after.

Foodborne Illness Outbreak Investigation in a High-Profile Sports Club.

A foodborne illness outbreak involving an elite sports team was investigated by a public health unit in Sydney, Australia. An epidemiological association was established between gastrointestinal illness and the consumption of food supplied by an external caterer, with a lamb meal most strongly associated with illness. Genetically identical Salmonella isolates were identified from clinical specimens, residual food items, and an environmental swab taken from the catering premises. The training schedule and other club operations were significantly affected by this outbreak. Increased susceptibility due to regular shared activities and the potential for significant impact upon performance indicates that sports clubs must ensure that food suppliers comply with the highest standards of hygiene. Collaboration with public health authorities assists in source identification and prevention of further transmission.

Position of the sciatic nerve and effect of gluteus maximus release during hip arthroplasty.

Eight Thiel embalmed hips were dissected. The distance between the sciatic nerve and the femoral neck was measured before and after hip dislocation, and before and after release of the gluteus maximus tendon. There was a significant reduction in the mean distance between the neck of femur and the sciatic nerve in both the gluteus maximus tendon release and the unreleased groups at 60° and 90° of hip flexion, p < 0.05. The mean distance between the neck of femur and sciatic nerve was greater in the release group for all positions.