Motorised mobility scooters; upper limb fractures in elderly novice users.

We describe three upper limb injuries admitted in one year to our institution resulting from falls from motorised mobility scooters (MMS) where all three users were novices, using their MMS for less than 6 weeks. They sustained injuries in close proximity to their homes, necessitating admission to hospital. None had received any formal training before commencing use of their respective devices. Use of MMS devices increases independence in mobility, enhances quality of life, improves self-esteem, facilitating social participation in everyday life. Use of these devices is not without risks, and no clear safety guidelines or competency testing exists for users. We believe these injuries in novice users highlights this deficiency, and should alert prescribers of these devices to advocate some form of driver training for new users.

The complications of septic arthritis in the elderly.

BACKGROUND AND AIMS: An epidemiological analysis of cases of spontaneous community acquired septic arthritis in an elderly population at a university teaching hospital. METHODS: Confirmed cases of spontaneous septic arthritis in the over-65 population were studied. Patients with prosthetic joint infections were excluded from the study. Analysed data included initial presenting complaint and clinical examination, hematological and microbiological tests together with ultimate patient outcome. RESULTS: There were 7 confirmed cases of spontaneous septic arthritis in the over 65 population in the past 6 months (2 hips, 5 knees). The mean age was 72.14 (range 65-82) with a mean length of stay of 49 days. Those with septic arthritis of the knee presented with swelling, pain and immobility. Hip cases presented with pain and immobility. All patients were systemically well at the time of presentation, with no other foci of infection detected after septic screening. All patients had confirmed aspirate and arthroscopic/arthrotomy infection. Staphylococcus aureus was isolated from 6 joint aspirations and Pseudomonas Aeruginosa from one patient. Complications of treatment included acute renal failure, cardio/respiratory failure, disseminated infection, and death (1 case). CONCLUSION: Septic arthritis must be considered as a differential diagnosis in all patients with joint pain, swelling and immobility. This diagnosis is not confined to the pediatric population. A background of degenerative disease and occult presentation in the elderly may delay diagnosis. Sepsis must be considered in the elderly with joint pathology, and treatment must be initiated in a prompt and aggressive manner, to prevent sequelae.

Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study.

BACKGROUND: The aim of operative treatment for ankle fractures is to allow early movement after internal fixation. The hypothesis of this study was that early mobilization would improve functional recovery in patients after surgery for ankle fractures. METHODS: In a prospective randomized controlled study, 66 consecutive patients with ankle fractures that required open reduction and internal fixation (ORIF) were assigned to one of two postoperative regimens: immobilization in a nonweightbearing below-knee cast or early mobilization in a removable cast. Four patients were excluded from the study, leaving 62 for review. RESULTS: Patients who had early mobilization in a removable cast had higher functional scores (Olerud-Molander and AOFAS) at 9 and 12 weeks postoperatively. They also returned to work earlier (67 days) compared with those treated in nonweightbearing below-knee cast (95 days), p<0.05. There was no statistical difference in Quality of Life (SF-36 Questionnaire) at 6 months between the two groups. We had an approximately 10% postoperative infection trend (one superficial and two deep) in the early mobilization group. CONCLUSION: Despite the overall short-term benefit of early mobilization, we had three patients in the early mobilization group who had wound complications. Both the surgeon and patient should be aware of the higher risk of wound complications associated with this treatment, and thus the accelerated rehabilitation protocol should be individualized.

Diagnosis of thoracic neurilemoma incidental to a traumatic clavicle fracture.

This report highlights the importance of thorough examination of the complete radiograph in a fracture setting.

Unreamed intramedullary nail versus external fixation in grade III open tibial fractures.

BACKGROUND: The optimum method for skeletal stabilization of severe open fractures of the tibial shaft remains controversial. METHODS: We compared the results of the AO unreamed tibial nail (URTN) with external fixation (Ex-Fix) in the treatment of patients with a grade III injury of the tibial diaphysis. Thirty patients were retrospectively reviewed, with a mean follow-up of 25 months (range, 12-56 months). Seventeen patients were treated with external fixation (grade IIIA, 12 patients; grade IIIB, 4 patients; and grade IIIC, 1 patient) and 13 with a URTN (grade IIIA, 6 patients; grade IIIB, 6 patients; and grade IIIC, 1 patient). Both groups were comparable with respect to age, gender, fracture severity, and Injury Severity Score. RESULTS: Mean time to full weight bearing was 37.4 weeks in the Ex-Fix group versus 22.2 weeks in the URTN group (p = 0.0069, t test). Seven patients in the Ex-Fix group required further surgery for nonunion versus two in the URTN group. There were four significant pin track infections. Removal of URTN was required in one case of deep infection. CONCLUSION: This study supports the use of the URTN over external fixation in the treatment of severe open tibial fractures.