Aspirin for lower limb arthroplasty thromboprophylaxis: review of international guidelines.

INTRODUCTION: Aspirin is one of the pharmacological agents used for thromboprophylaxis. MATERIALS AND METHODS: National thromboprophylaxis guidelines, peer-reviewed studies and data from national joint register of England and Wales were analysed for evidence regarding the efficacy of aspirin versus other agents in thromboprophylaxis and the recommendations of guidelines. RESULTS: Two of five guidelines reviewed recommend the use of aspirin for thromboprophylaxis. Aspirin is used as thromboprophylactic agent in approximately 25% of patients undergoing total hip and total knee arthroplasty in year 2006 in England and Wales. There is no difference in mortality in these patients compared to patients on other pharmacological agents. CONCLUSION: There is conflicting evidence and differences in interpretation of the data from the literature. If specific outcome measures and complications such as symptomatic DVT, PE and bleeding were logged in arthroplasty registers, the resulting data would be useful in individualised decision-making.

European Working Time Directive: implications for surgical training.

The forthcoming implementation of the European Working Time Directive (EWTD) for non-consultant hospital doctors (NCHDs) poses a number of challenges in the areas of patient care, training, service provision and quality of life for workers. Surgery, as a craft-based speciality, will face a greater impact on training of future surgeons as operating time could be lost to service provision. The EWTD acts a stimulus for reform of current working practices and re-configuration of services. It will necessitate transformation of the way in which surgeons are trained, if current standards are to be maintained.

Palsy of the common peroneal nerve after traumatic dislocation of the knee.

Injury to the common peroneal nerve was present in 14 of 55 patients (25%) with dislocation of the knee. All underwent ligament reconstruction. The most common presenting direction of the dislocation was anterior or anteromedial with associated disruption of both cruciate ligaments and the posterolateral structures of the knee. Palsy of the common peroneal nerve was present in 14 of 34 (41%) of these patients. Complete rupture of the nerve was seen in four patients and a lesion in continuity in ten. Three patients with lesions in continuity, but with less than 7 cm of the nerve involved, had complete recovery within six to 18 months. In the remaining seven with more extensive lesions, two regained no motor function, and one had only MRC grade-2 function. Four patients regained some weak dorsiflexion or eversion (MRC grade 3 or 4). Some sensory recovery occurred in all seven of these patients, but was incomplete. In summary, complete recovery occurred in three (21%) and partial recovery of useful motor function in four (29%). In the other seven (50%) no useful motor or sensory function returned.

Plating of humeral shaft fractures--has the pendulum swung back?

We reviewed 49 patients following plate osteosynthesis of humeral shaft fractures. There were no complications as a result of surgery. Union occurred in 47 patients (96%) at a mean of 9 weeks. Two patients required secondary procedures to achieve union. All patients had full range of motion in the elbow and shoulder joints following union. In the light of the popularisation of intramedullary nailing techniques in the last decade, with recognised complications of iatrogenic radial nerve injury, inadequate rotational stabilisation, non-union and shoulder impingement, we advocate plating of humeral shaft fractures as the surgical treatment of choice.

Kyphectomy in children with myelomeningocele: a long-term outcome study.

Twenty-four children with myelomeningocele and a kyphotic deformity treated by surgical correction between 1980 and 1994 were reviewed. Different techniques of instrumentation and spinal fusion were used. The mean age at surgery was 9.5 years. The mean kyphotic angle was 121 degrees preoperatively, 50 degrees postoperatively, and 57 degrees at final follow-up. The postoperative complication rate was high. Delayed wound healing and late skin breakdown with exposure of instrumentation were common problems. Further surgery to remove protruding hardware was necessary in 18 patients. Long posterior instrumentation with fixation to the pelvis had significantly better stability on follow-up than other methods. Despite the prolonged postoperative morbidity in the majority of the study group, the long-term clinical and radiologic outcome at a mean follow-up of 10 years was excellent.

Spontaneous regression of tumoral calcinosis in an infant: a case report.

A case of tumoral calcinosis presenting as a supraclavicular mass in an infant is reported. After confirmation by incisional biopsy, the lesion spontaneously resolved without further surgical or medical treatment. This phenomenon has not been described previously in a child with this condition.

Correction of soft tissue contractures of the wrist using the Ilizarov technique.

The Ilizarov technique can allow new histiogenesis of soft tissue as well as bone. Three cases of wrist contracture successfully treated by this method are described. One patient had transient superficial pin site infections. There were no other complications. At 2 years follow-up there was no recurrence of contractures.

Puncture wound related pseudomonas infections of the foot in children.

Eleven children with Pseudomonas aeruginosa infection complicating foot puncture wounds were reviewed. Delay in presentation (mean 2 days) and diagnosis (mean 9 days) due to a paucity of clinical signs of deep infection was characteristic of this condition. Septic arthritis (5 patients) and osteomyelitis (3 patients) were frequent complications. Treatment involved multiple surgical debridements and prolonged intravenous antibiotic therapy. The clinical outcome was good although long-term radiographic changes were common.