Assessment of Range of Movement, Pain and Disability Following a Whiplash Injury.

BACKGROUND: Whiplash has been suggested to cause chronic symptoms and long term disability. This study was designed to assess long term function after whiplash injury. MATERIAL & METHODS: A random sample of patients in the outpatient clinic was interviewed, questionnaire completed and clinical examination performed. Assessment was made of passive cervical range of movement and Visual Analogue Scale pain scores. One hundred and sixty-four patients were divided into four different groups including patients with no whiplash injury but long-standing neck pain (Group A), previous symptomatic whiplash injury and long-standing neck pain (Group B), previous symptomatic whiplash injury and no neck symptoms (Group C), and a control group of patients with no history of whiplash injury or neck symptoms (Group D). RESULTS: Data was analyzed by performing an Independent samples t-test and ANOVA, with level of significance taken as p<0.05. Comparing the four groups using a one-way ANOVA showed a significant difference between the groups (p<0.001). There were significant differences when comparing mean ranges of movement between Group A and Group D, and between Group B and Group D. There was no significant difference between Group C and Group D. similar differences were also seen in the pain scores. CONCLUSION: We conclude that osteoarthritis in the cervical spine, and whiplash injury with chronic problems cause a significantly decreased cervical range of movement with a higher pain score. Patients with shorter duration of whiplash symptoms appear to do better in the long-term.

Has the introduction of an admissions lounge affected theatre start times in a busy teaching hospital environment?

The Admissions Lounge (AL) was introduced with the aims of reducing the number of late starts, improving the patient experience and reducing preoperative length of stay to save bed days. To determine whether a reduction in number of late starts was achieved, 237 start times from pre and post introduction of the AL were collected and analysed. There was no statistically significant difference (p > 0.05) between the percentage of lists delayed or the mean delay between pre and post introduction of the AL (mean delay for post AL was 10.17 minutes compared to 9.85 minutes pre AL). The AL had no impact on theatre start times, neither improving nor reducing the operating theatre efficiency in this respect.

Total hip arthroplasty after ipsilateral intra-articular steroid injection: 8 years follow up.

The purpose of the study was to assess the safety of Intra-articular steroid hip injections (IASHI), prior to ipsilateral total hip arthroplasty (THA). We investigated whether there was an excess of infection in such a group 7-10 years after total hip arthroplasty. A database of 49 patients who had undergone IASHI followed by ipsilateral THA was reviewed. The mean length of time between injection and arthroplasty was 12.1 months (5.1-19 months). We found 7 major complications. Ten patients died with no further hip surgery at a mean of 28 months from surgery ; 3 were lost to follow-up. The remaining group (36) were contacted by telephone at a mean of 97.8 (85-117) months from their surgery. No objective signs of joint infection were found. We believe our results show that ipsilateral steroid injection does not confer an increased risk of complications following subsequent THA, over an extended follow up.

Can patients with low energy whiplash associated disorder develop low back pain?

800 consecutive claimant generated medicolegal reports were analysed for symptomatology of whiplash associated disorder (WAD) including the presence of mid and low back pain. We aimed to establish whether the two were linked and if so if there were correlations between accident vector and severity. We also aimed to establish if a low back injury could result from a vehicular accident in the absence of a neck injury. In addition we examined if occupant bracing and occupant neutral position at the time of the accident affected symptom patterns. We found that a claimed back injury following WAD was independent of both accident severity and accident vectors, approximately 40% claiming injury in low, medium and high violence groups and with rear, frontal and side impact. We established that it was unusual to have a back injury in the absence of a neck injury (18 out of 325, 5.5%) without a past medical history of back pain (72.2% of this group having previous back pain). Occupant bracing was not protective. We also showed that occupant neutral position was not protective against a back injury. We were surprised that patients with next to no car damage had the same incidence of back pain as those involved in more violent crashes when biomechanically unlikely. The complex biopsychosocial response and the relationship to constitutional factors are discussed. The literature concerning forces across the lumbar spine and possibilities of injury is reviewed.

Surgery for fractured neck of femur - are patients adequately consented?

INTRODUCTION: Obtaining valid consent is a legal and ethical obligation when performing any procedure in clinical practice. This study was performed to identify the validity and effectiveness of the new consent form and any potential improvement that could be made when taking consent. PATIENTS AND METHODS: Case notes of 173 patients undergoing surgery for fractured neck of femur were retrospectively reviewed. Risks and complications of the surgery as listed on the consent form were noted. Sixty-five cases were excluded from the study as they had either old consent forms with no risks recorded or a consent form signed by a consultant due to patient inability to consent. Six of the consent forms could not be located in the notes. This left 102 consent forms to be analysed. RESULTS: The number of risks documented on each form ranged from 0-8 (mean, 3.92). No risks were recorded in 2 of these 102 forms. Most commonly recorded risks were infection (95.1%), DVT/PE (81.4%) and failure of procedure (59.8%). It was shown that many of the consent forms analysed did not have all the serious or frequently occurring risks recorded on them and that a large proportion of the forms had acronyms or phrases that may mean nothing to the patient. Comparison of documented risks for different hip surgery were made using Fisher's exact test showing no significant difference between the risks recorded on the forms for each type of procedure. CONCLUSIONS: Although documentation of risks has been improved compared to old consent forms, patients are not necessarily given the most appropriate information to ensure consent is valid. Further refining of consent forms may be necessary to ensure that all major risks are explained and understood by patients and that there is satisfactory recording of this information.

Minimal surgical approach for recurrent hip dislocation using the posterior lip augmentation device for the Charnley hip arthroplasty.

We present the management of recurrent posterior dislocations in cemented Charnley total hip arthroplasties treated with acetabular augmentation. Certain patients are elderly with comorbid conditions and diminished reserves. We have used a minimal surgical approach to implant 21 posterior lip augmentation devices in elderly patients. Ninety percent of the hips are stable with follow-up of 1 to 3 years (mean, 1.9 years). Eighty-four percent of the patients were satisfied with the outcome. Two cases, which redislocated, were further stabilized by changing the position of the posterior lip augmentation device and are stable. Because of a minimal surgical approach, the time duration of surgery, blood loss, transfusion requirement, inpatient stay, and morbidity are reduced. Posterior lip augmentation device surgery with a minimal approach is a safe and effective procedure for elderly patients who do not have any obvious cause for dislocation.

Extra help required by litigants after simple fractures--a questionnaire based study.

A questionnaire based interview of 100 patients under fracture clinic review was undertaken to assess the help required with the activities of daily living (ADL) in the first 2 weeks following fractures of the hand, wrist, neck of humerus, foot or ankle. The amount of help patients required was correlated with whether or not the patients were claiming compensation for their injuries. Twenty-five percent were litigating and this was shown to influence the amount of help a patient reported having received with dressing, shopping, cooking, housework, personal hygiene and travelling (p<0.0001) and feeding (p<0.0022), but not with getting in/out of bed (p=0.52). Complications of the fracture were not shown to increase litigation. On average litigants required over 3 h extra help per day compared with non-litigants (6.4 h versus 2.75 h).