ABSTRACT
We have studied the natural history of a first episode of dislocation after primary total hip replacement (THR) to clarify the incidence of recurrent dislocation, the need for subsequent revision and the quality of life of these patients. Over a six-year period, 99 patients (101 hips) presented with a first dislocation of a primary THR. A total of 61 hips (60.4%) had dislocated more than once. After a minimum follow-up of one year, seven patients had died. Of the remaining 94 hips (92 patients), 47 underwent a revision for instability and one awaits operation (51% in total). Of these, seven re-dislocated and four needed further surgery. The quality of life of the patients was studied using the Oxford Hip Score and the EuroQol-5 Dimension (EQ-5D) questionnaire. A control group of patients who had not dislocated was also studied. At a mean follow-up of 4.5 years (1 to 20), the mean Oxford Hip Score was 26.7 (15 to 47) after one episode of dislocation, 27.2 (12 to 45) after recurrent dislocation, 34.5 (12 to 54) after successful revision surgery, 42 (29 to 55) after failed revision surgery and 17.4 (12 to 32) in the control group. The EuroQol-5 dimension questionnaire revealed more health problems in patients undergoing revision surgery.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Hip Joint/surgery , Joint Dislocations/surgery , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Follow-Up Studies , Hip Prosthesis , Humans , Joint Dislocations/etiology , Joint Instability/etiology , Joint Instability/surgery , Male , Middle Aged , Prosthesis Failure , Quality of Life , Recurrence , Reoperation/methods , Reoperation/rehabilitation , Treatment OutcomeABSTRACT
The importance of visualizing the entire cervical spine on radiological examination in patients with cervical trauma is well known. A review of the cervical films of 98 patients attending an accident and emergency (A&E) department was undertaken in order to assess the adequacy of imaging. It was found that 33.7% of the films were not sufficient to exclude fracture or dislocation of the cervical spine. The number of patients with inadequate views was significantly reduced when an advanced trauma life support trained senior doctor was involved.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Spinal Injuries/diagnostic imaging , Adult , Cervical Vertebrae/pathology , Emergency Medicine , Emergency Service, Hospital , Female , Humans , Male , Radiography , Retrospective Studies , Sensitivity and Specificity , Spinal Injuries/diagnosisSubject(s)
Arthroscopy/methods , Bone Screws , Osteochondritis Dissecans/surgery , Humans , Knee Joint/surgeryABSTRACT
A total of 45 patients, with fractures of the tibial plateau, were assessed. A method of joint evaluation is proposed that modifies the existing grading of these fractures to give a better assessment for treatment.
Subject(s)
Tibial Fractures/surgery , Follow-Up Studies , Hip Joint/physiopathology , Humans , Retrospective Studies , Tibial Fractures/classification , Tibial Fractures/physiopathologyABSTRACT
A series of patients who were found at operation to have sustained splenic rupture is described and their immediate presenting features are detailed. Signs of peritoneal irritation were not always present and patients were not often 'shocked' when first seen. Helpful early signs included a low haemoglobin and pallor. There is a tendency to underestimate the significance of left quadrant pain in the presence of rib fractures. Peritoneal lavage and ultrasound should be more readily employed. Text book features should not be expected early and this must be taught to junior doctors who work in accident and emergency medicine.
Subject(s)
Splenic Rupture/diagnosis , Adolescent , Adult , Aged , Child , Diagnosis, Differential , Female , Hemoglobins/analysis , Humans , Male , Middle Aged , Pallor/blood , Pallor/etiology , Peritoneal Lavage , Retrospective Studies , Splenic Rupture/blood , Splenic Rupture/complications , Time Factors , UltrasonographyABSTRACT
A prospective trial was undertaken on 85 adult patients with open fractures of the distal phalanges of less than 6 hours duration, treated by conventional surgery. They either received no antibiotic therapy, or cephradine in short or long courses. The infection rate was 30% in the group without antibiotics and less than 3% in the treated groups. Three different antibiotics regimes were compared, with no difference in the infection rate: therefore the simplest and surest method, a single pre-operative dose and a single post-operative dose, is recommended.
