The use of the RegJoint™ implant for base of thumb osteoarthritis: Results with a minimum follow-up of 2 years.

The RegJoint™ (Scaffdex Oy, Finland) implant is a bio-absorbable poly-L/D-lactide implant which acts as a temporary support in resected joint spaces. It can be used in base of thumb surgery as a spacer to prevent first metacarpal subsidence. However, high rates of adverse tissue reactions and bone osteolysis have been reported recently by one group. The objective of this study was to investigate the outcome of patients treated in our institution with this implant. Patients underwent a postoperative clinical and radiological assessment. The QuickDASH questionnaire, Patient Evaluation Measure (PEM) and a visual analogue scale for pain assessment were used. Grip strength, key pinch, pinch strength, thumb palmar and radial abduction and opposition were measured. Trapeziometacarpal height was used to evaluate thumb shortening compared with the preoperative value. Periprosthetic bone-erosion of the trapezium and metacarpal were measured. Subluxation of the joint was evaluated by measuring the step-off between the radial edge of the trapezium and the base of the first metacarpal bone. Twenty-two patients from 2013-2016 were included. There were no postoperative wound complications. There was no significant difference in grip strength, key pinch or pinch between the operated and the contralateral hand. There was no significant difference in the trapeziometacarpal height, trapezial height or the degree of subluxation pre-or post-operatively. Contrary to recent reports, we did not find any adverse soft tissue reactions or significant bone erosion. There was no significant change in hand function. We consider the RegJoint™ a useful adjunct in the management of a select cohort of patients with base of thumb arthritis.

Motec Wrist Arthroplasty: 4 Years of Promising Results.

BACKGROUND: The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty is an implant with promising intermediate results. An alternative to primary wrist fusion, total wrist arthroplasty is an option for active patients, who wish to retain their wrist function. It is indicated in cases of degenerative osteoarthritis, post-traumatic arthritis and rheumatoid (inflammatory) arthritis. METHODS: A prospective review of patient demographics, pre and post-operative Disabilities of the Arm Shoulder and Hand (DASH), MAYO scores, range of movements and grip strengths. All complications in follow up were recorded across the 4 year period. RESULTS: 25 implants on 23 patients over 5.5 years, mean age 61; 8 females and 15 male. 10 patients with SLAC, 3 SNAC, 5 inflammatory and 7 patients with generalized osteoarthritis. The patients showed significant improvements of MAYO and DASH scores post-operatively, as well as the flexion/extension arc and grip strengths. There was just one case of implant loosening- the radial screw after a wound infection, which was revised with a longer screw. Two implants were converted to Motec fusion due to pain. One implant was dislocated and relocated. The remaining patients have had good wrist function. Only 6 patients were unable to return to work. CONCLUSIONS: Similar to published studies, this series shows the Motec implant to be a good motion preserving alternative to total wrist fusion.

Monitoring of Polycyclic Aromatic Hydrocarbons (PAHs) in Scottish Deepwater environments.

Polycyclic aromatic hydrocarbons (PAHs) were measured in environmental samples (sponges, fish and sediment) collected in 2014 and 2016 from the Faroe-Shetland Channel and Rosemary Bank Seamount. These data could be used to provide a baseline against which any changes can be assessed in the event of an oil spill and contribute to any environmental impact assessment. Concentrations in all samples were low, often below the detection limits, and were typical of reference sites. Sponges can be used as an alternative indicator species to mussels for monitoring PAHs in the marine environment as they can accumulate PAHs from both the dissolved and particulate phase. PAH concentrations in marine sponges from Scottish waters have not previously been reported. Concentrations were low, but contained a higher proportion of heavier 4- to 6-ring PAHs compared to the fish samples.

An assessment of persistent organic pollutants (POPs) in wild and rope grown blue mussels (Mytilius edulis) from Scottish coastal waters.

Farmed, rope grown mussels (Loch Etive and Loch Ewe, both on the west coast of Scotland) and wild mussels (Straad on the west coast and Shell Bay and Aberdeen Breakwater, both on the east coast of Scotland) were collected on a monthly basis and analysed for persistent organic pollutants (POPs) with the aim of assessing the status of Scottish mussels, with respect to concentrations of POPs, and investigating site-specific and seasonal differences. Samples were analysed for polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs) and chlorobiphenyls (CBs). Total PAH (2- to 6-ring parent and alkylated) concentrations in mussels from three pristine sites (ref. 1: ICES Marine Chemistry Working Group Report 2008, http://www.ices.dk/reports/MHC/2007/MCWG07.pdf) (Loch Etive, Loch Ewe and Straad) were significantly lower than in mussels from sites with greater coastal influences (Aberdeen Breakwater and Shell Bay). Seasonal trends in the PAH concentrations were evident at the pristine sites, with concentrations being significantly higher for samples collected between November and March compared to those collected between April and October. The PAH data was assessed using a recently proposed traffic light system, based on the assessment criteria adopted by OSPAR for use in the 2008 Coordinated Environmental Monitoring Programme (CEMP) assessment. Concentrations were compared to Background Assessment Concentrations (BAC; blue/green transition) and Environmental Assessment Concentrations (EACs; green/red transition). All sites were classed as 'green' for the PAHs analysed, being below EACs, where available. The pristine sites were also below BACs for some PAHs and therefore would be classed as 'blue' for these PAHs. CBs and PBDEs were measured in mussels collected between 2006 and 2008 inclusive. Concentrations for CB and PBDEs were significantly higher in the Aberdeen Breakwater mussels than for all other sites. Concentrations at all sites were low with many congeners being below the detection limits for both contaminant groups. No seasonal trends were observed in the CBs or PBDE concentrations or composition at any of the five sites. The green-red transition (described by the EACpassive) was exceeded for CB118 in mussels from Aberdeen Breakwater and surprisingly at the pristine site of Loch Etive. As such both sites were classed as 'red'. All other ICES7 CBs were below EACs and therefore classed as 'blue' or 'green'.

Composition and concentration of hydrocarbons in sediment samples from the oil producing area of the East Shetland Basin, Scotland.

The East Shetland Basin is one of the areas that the Fisheries Research Services (FRS) has concentrated on to assess the possible impacts of oil exploration and production on the marine environment. A stratified random survey of the sediment was carried out in 2002. TOCs were low across the basin and were positively correlated with grain size. The total PAH concentrations (2- to 6-ring parent and alkylated PAHs, including the 16 US EPA PAHs) were less than 150 microg kg(-1) dry weight and their composition indicated a predominantly pyrolytic input to the basin in 2002. Minor unresolved complex mixtures in the n-alkane profiles indicated a slight petrogenic input but further examination of the biomarkers (hopanes and steranes) showed a mixed North Sea and Middle Eastern source. The Middle Eastern source is likely due to inputs from shipping activity, as it is widely used as bunker fuel. Grid surveys were carried out in 1986, 1988-89 and 1994 and areas were selected for which there was data for all the historic grid surveys and the 2002 stratified random survey. Although referring to only a small part of the East Shetland Basin, comparison with these historic surveys shows clearly that the concentrations of Forties crude oil equivalents and total PAH concentrations were highest in 1988-89 and by 2002 had returned to concentrations the same as or less than observed in the original survey in 1986.

Dorsal plating of unstable distal radius fractures using a bio-absorbable plating system and bone substitute.

This study reports the results of open reduction and internal fixation of 26 unstable, intraarticular, dorsally displaced fractures of the distal radius using a bio-absorbable dorsal distal radius (Reunite) plate and calcium phosphate (Biobon) bone substitute. The bio-absorbable plate has the advantage of being low profile, easily contourable and angularly stable. In the majority of cases, this plate produces functional results comparable with metal plates. The Gartland and Werley score was excellent or good in 21 patients. The theoretical advantage over metal plates is in eliminating the need to remove the plate and hence the need for a second operation if implant-related extensor tenosynovitis occurs. Inflammatory tissue reaction to the degradation products of the plate is a potential concern, although the co-polymer ratio used in this plate appears to have reduced the severity of this reaction, which was seen in two patients in this series. The reduction was lost in five patients with severe dorsal comminution. Following this experience, we do not recommend this plating system for fractures with a metaphyseal gap of greater than 7 mm following reduction.

The effects of oil exploration and production in the Fladen Ground: composition and concentration of hydrocarbons in sediment samples collected during 2001 and their comparison with sediment samples collected in 1989.

Due to the potentially accumulative nature of the Fladen Ground, an area of intense oil activity in the North Sea, a survey was carried out in 1989 to map the distribution of contamination in relation to these oil activities. All the sediments collected were screened by ultraviolet fluorescence (UVF) for polycyclic aromatic hydrocarbons (PAHs) and selected samples were analysed for n-alkanes (by GC-FID), PAHs and biomarkers (by GC-MSD). This survey was repeated in 2001, with all the 1989 sites being resampled. All of these sediments were analysed for UVF oil equivalents, PAHs, n-alkanes and biomarkers. The concentrations of these parameters decreased between 1989 and 2001, with average decreases ranging from 43% to 88%. In addition, no significant difference was found, for all the parameters, between near field (<5 km from an oil installation) and far field (>5 km from an oil installation) sites in 2001 indicating that the Fladen Ground is approaching a 'steady state' or background concentration for contamination.

Polycyclic aromatic hydrocarbon (PAH) concentration and composition determined in farmed blue mussels (Mytilus edulis) in a sea loch pre- and post-closure of an aluminium smelter.

Concentrations of polycyclic aromatic hydrocarbons (2- to 6-ring parent and branched PAH) from an actively producing commercial shellfish farm in Loch Leven, Scotland, were found in excess of 4000 ng g(-1) wet weight tissue. These concentrations were considerably greater than had been recorded from mussels sampled elsewhere around the Scottish mainland. The PAH composition of the mussels from Loch Leven was dominated by the 5-ring, parent compounds; benzo[b]fluoranthene was the dominant compound. This data was consistent with the source being a discharge from an aluminium smelter. The individual compounds benz[a]anthracene, benzo[a]pyrene and dibenz[a,h]anthracene returned values of 304 ng g(-1), 446 ng g(-1) and 39 ng g(-1) respectively; these were well above the 15 ng g(-1) pragmatic guideline limit. Over the two year monitoring period, the concentrations of these compounds in mussels from Loch Etive, a reference location, ranged between 'not detected' and 4 ng g(-1)(for benz[a]anthracene). Mussels were transferred from a clean location to Loch Leven which demonstrated that the rate of uptake of PAH was rapid. Following closure of the aluminium smelter, the PAH concentrations in mussels decreased. Differences between the two sites within Loch Leven were noted with the longer-term impact remaining greater for the mussels closer to the original point discharge.

Lunate migration following Darrach's procedure: a case report.

We report a case of a 28-year-old female patient who underwent Darrach's procedure to her dominant right wrist affected by rheumatoid disease. She developed severe pain in the wrist 4 weeks postoperatively. Collapse of the scaphoid and proximal migration of the lunate was noted. Total wrist arthrodesis using the Arbeitsgemeinschaft für Osteosynthesefragen wrist arthrodesis plate was performed, which alleviated the pain. Darrach's procedure is described for conditions causing derangement of the distal radio-ulnar joint, the classical inflammatory cause being rheumatoid arthritis. It is however a potentially destabilising procedure. The extreme complication encountered in this case highlights the risk of Darrach's procedure if pre-existing ligamentous instability is present.

A comparative study between longitudinal and "T" incisions for dorsal plating of the distal radius.

A retrospective review of 24 patients with dorsal incisions for open reduction and internal fixation of Frykman VII/VIII distal radius fractures using a dorsal plate was performed. Half of them had a longitudinal incision while the other half had a T-shaped incision. No difference in the healing properties or wound morbidity could be demonstrated between the two groups. However, the T incision provided improved exposure of the distal radius and patient satisfaction with its cosmetic result was superior. The horizontal limb was well camouflaged within the transverse skin crease on the dorsal aspect of the wrist. The vertical limb did not extend into the dorsum of the hand and could, therefore, be hidden by appropriate clothing.

Predictors of excessive blood loss during operative treatment of hip fractures.

OBJECTIVES: To determine the total blood loss and transfusion needs during operative treatments of hip fracture, and identify predictors of excessive blood loss. METHOD: A prospective study of 242 consecutive patients operated for hip fractures over a 6 month period. The main outcome measure of blood loss was assessed by blood volume in the drainage system and swab weight. A loss of more than 480 mls was considered as excessive blood loss. RESULTS: The study consisted of 190 women and 52 men, mean age was 81.6 years (range 44-99). More than one-third of patients (34%) lost more than 480 mls of blood, and mean units transfused per patient was 2.3. Univariate predictors of increased blood loss were patients of American Society of Anaesthesiology (ASA) grade III and IV, patients at risk of cerebral or cardiac ischemia from volume depletion as defined by the American College of Physicians, patients with two or more pre-existing medical conditions and patients who had a hemiarthroplasty carried out. However, with subsequent multivariate analysis, patients who had undergone a hemiarthroplasty and those at risk predicted increased blood loss. CONCLUSION: Pre-operative characteristics can help determine which patients should have either blood requested on the day of surgery (group and cross-match) or the customary group and save policy.

Prophylactic carpal tunnel decompression during buttress plating of the distal radius--is it justified?

Our objective was to evaluate the role of carpal tunnel decompression in preventing median nerve dysfunction after buttress plating of the distal radius. We studied 69 consecutive patients with distal radial fractures managed by volar plating over a 4-year period. (1995-1998). Patients' clinical notes were assessed for symptoms of median nerve dysfunction and all the patients were followed up for a minimum period of 6 months. Twenty-four patients had prophylactic carpal tunnel decompression and 45 patients did not. Forty-two patients (61%) were women and 27 patients (39%) men. The average age of the patients was 56 years, (range 24-81 years). Overall 17 patients (25%) developed median nerve dysfunction post-operatively of which nine patients had and eight patients did not have formal prophylactic tunnel decompression, respectively; this was not statistically significant (P=0.08). In addition prophylactic decompressed patients had more than twice the relative odds=2.7 (confidence interval: CI=0.94-4.76) of developing median nerve dysfunction. All cases resolved spontaneously except for three cases that required carpal tunnel decompression. We conclude that prophylactic median nerve decompression does not alter the course of median nerve dysfunction and may increase post-operative morbidity.

Stabilization of an acute perilunate dislocation using the "TAG" suture anchor.

A case of acute perilunate dislocation associated with acute scapholunate dissociation and acute carpal tunnel syndrome is described in which the treatment was facilitated by the use of the TAG suture anchor.

Detection of orthopaedic implants by airport metal detectors.

We have assessed the effect of a variety of implants commonly used in fracture fixation and joint replacement on the activation of metal detectors at airport security gates. A volunteer with metal implants strapped on and patients with implants in situ walked through the device. Implants used in fixation do not activate it, except for Richards cannulated screws. An Austin-Moore prosthesis does set off the detector, but a single joint replacement does not. Three or four joint replacements activate the alarm and patients with these implants should be warned of this possibility.

Repair of acute scapho-lunate dissociation facilitated by the "TAG" suture anchor.

A case of acute scapho-lunate dissociation is described in which the operative treatment was facilitated by the use of the "TAG" suture anchor.

Delay in the diagnosis of osteomyelitis pubis.

The pubis is an uncommon site for osteomyelitis, which fact may contribute to difficulty in establishing the diagnosis. Two cases of osteomyelitis pubis in children are presented in which the diagnosis and definitive treatment were delayed.

Patterns of hand fractures and dislocations in a district general hospital.

In a retrospective survey of patients with fractures and dislocations attending the Accident department of a District General hospital, comparison was made between patients with fractures and dislocations in the hand and fractures and dislocations of other sites. Patients with hand injuries accounted for 28% of the total patients seen. They were more likely than other fracture patients to be male and between the ages of 10 and 40 years. Almost a quarter of hand injuries attended on Monday. Leisure activities outside the home formed the commonest aetiological factor. Only 66% of patients with hand injuries attended the Accident department within 24 hours of injury. The little finger was the commonest site of injury. This survey emphasizes the differences between hand injuries and injuries of other sites, identifies the risk factors for hand injuries and has implications for the management of hand injuries in a District General Hospital.

Scapula winging in a sports injury clinic.

Scapula winging is an uncommon condition but one which may be underdiagnosed. Four patients with scapula winging referred to a sports injury clinic are presented. None of the patients was aware of any trauma and a traction injury to the long thoracic nerve is proposed as the aetiology of this condition. These case reports emphasize the importance of excluding winging of the scapula in patients who present to sports injury clinics with shoulder pain.