Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties.

PURPOSE: We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. METHODS: 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. RESULTS: 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. CONCLUSION: Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

Positioning of the wrist for scaphoid radiography.

PURPOSE: The purpose of this cadaver study was to determine the ideal position of the wrist for scaphoid radiography. MATERIALS AND METHODS: Four cadaver wrists were rotated around their longitudinal axis in 15 degrees increments and exposures were taken. Seven postero-anterior images were taken as well. Thus, 18 images of each wrist were available for assessment. Views were determined in which the main anatomic regions of the scaphoid were visualized undistorted. The size and localization of the overlap of other carpal bones were also evaluated. Finally, views with the best visualization of anatomic landmarks were selected. The results of these three investigations were compared to literature data. RESULTS: We consider the following four images the most valuable in the diagnostic imaging of scaphoid bone: (1) Postero-anterior view in ulnar deviation of wrist and fist position of the hand; (2) oblique view in 60 degrees of pronation; (3) oblique view in 60 degrees of supination; (4) lateral view. CONCLUSION: We concluded that our four views are sufficient for proper radiographic evaluation of the scaphoid.

Repair of steps and gaps in articular fracture models.

To examine the healing of surface defects in articular fractures, gaps measuring 0.5 mm wide and 2 mm deep were created in 0.5-mm coronal step-offs on the medial femoral condyles of 16 rabbits, and identical gaps without step-offs were created in another set of 13 rabbits. Evaluation of repair was done 6, 12, and 24 weeks postoperatively. Histologically, subchondral bone restoration of gaps in step-offs was complete by 24 weeks, whereas restoration was incomplete in most gap-only lesions. Bone density measured by peripheral quantitative computed tomography was normal in gaps in step-offs by 24 weeks, but values were less than in controls in the gap-only group. A moderate degree of degeneration was detected only at the high sides of step-off + gap lesions. The joint surface was restored by fibrous cartilage that showed gradually improving maturity in all defects, however, real integration with adjacent original cartilage did not occur. Immunohistologic examination showed decreasing collagen Type I and increasing Type II staining intensity in repair tissue of both types of lesions. These observations suggest that minor surface gaps and steps of articular fractures may regenerate without inducing severe early joint degeneration. However, certain repair features make the long-term outcome of these defects uncertain.

Obesity and low back pain.

Obesity and low back pain (LBP) are common health problems among patients attending Primary Health Care (PHC) in general practice at the United Arab Emirates (UAE). The objective of this study was to determine whether obesity is associated with low back pain. A cross-sectional face-to-face interview questionnaire survey was conducted. The questionnaire was a modified version of the Roland-Morris Scale for evaluating back disability. The interviews were conducted in Arabic by qualified nurses. A multi-stage stratified sample 1,103 UAE national aged 25-65 years, who attended PHC clinics for any reason, were invited to participate but only 802 subjects were eligible to be included for the statistical analysis. The data were analyzed using univariate and multivariate statistical methods. Of the 802 subjects, 428 (53.4%) were males and 374 (46.6%) were females. The mean age of the males was 40.5 +/- 11.5 years and females was 38.2 +/- 10.5 years (p = 0.004). The mean BMI of the males was 26.4 +/- 7.4 and females was 27.8 +/- 5.6 (p = 0.002). The overall prevalence of LBP in the present study was 64.9% (95% confidence interval, 61.0-68.8) and respectively, 56.1% in males and 73.8% in females. The results revealed that there was association between BMI and some socio-demographic variables with the respect of with low back pain. Back pain had more influence on the life style habits on females than in males. Stepwise multiple regression analysis showed that only age (p < 0.0001), educational level (p = 0.001), gender (p = 0.002), place of living (p = 0.019), BMI (p < 0.0001), and housing condition (p = 0.02) had significant effect on the presence of LBP in patients. The present study showed that obesity is moderately associated with low back pain.

Multifocal simultaneous Salmonella typhi osteomyelitis in an immunocompetent adult.

We report a case of Salmonella typhi osteomyelitis that presented as a pathologic fracture of the left femur and had additional silent manifestations in the right tibia and humerus in an otherwise healthy adult. This is the first report in the literature of multifocal simultaneous Salmonella osteomyelitis in an adult with no underlying medical condition.

Epiphyseal separation of the distal humerus.

A case of epiphyseal separation of the distal humerus is presented, emphasizing the clinical and radiological features of this rare birth trauma. Conservative treatment resulted in complete recovery.