Shoulder septic arthritis following routine influenza vaccination.

The UK vaccination guidelines state that skin cleansing is not essential in socially clean patients. This report discusses a 69-year-old type 2 diabetic patient with a 4-week history of left shoulder pain with no precipitating factors other than a 'flu vaccination without having had skin alcohol cleansing. She sustained a swollen left painful shoulder. Aspiration fluid grew Staphylococcus aureus and imaging confirmed diagnosis of septic arthritis. She underwent shoulder debridement and was started on antibiotics. Imaging 6 months later shows the sequelae of septic arthritis. The patient had ongoing stiffness and pain at 6 months. This report raises the question of whether there needs to be a revision of routine skin cleansing practice before vaccinations in certain groups of individuals.

Hemidiaphragmatic paralysis: A case report.

Hemidiaphragmatic paralysis is initially recognised as postoperative respiratory distress. The subsequent sequential management of the patient following arthroscopic shoulder surgery under interscalene block is described. Ultrasound-guided technique is considered to be the safest for interscalene block. Reducing the volume of anaesthetic used reduces its spread to the phrenic nerve and thus reduces the incidence of hemidiaphragmatic paralysis. Furthermore, a reduction in anaesthetic volume has equivalent analgesic efficacy.

The impact of a text messaging service on orthopaedic clinic Did Not Attend rates.

BACKGROUND: Missed clinic appointments cause delays in treatment of other patients, under utilization of clinical manpower or facilities and impact upon hospital finances. AIMS: The primary aim of this study is to evaluate whether a text messaging reminder service reduces the Did Not Attend rate. The secondary aim is to evaluate the cost-effectiveness of a mobile text message reminder service. METHODS: The study focused on the outpatient department of a district general hospital. In January 2011 a patient text messaging reminder service was implemented across the outpatient departments in the trust. Data were collected prospectively 24 months prior and 24 months following the implementation of this service. A reminder was sent to patients one week prior to the scheduled appointment as a text message. All patients attending the orthopaedic department were included in the study. Patients who had an appointment and cancelled/rescheduled it prior to their original consultation date were excluded. Children were also excluded from the study. RESULTS: The overall Did Not Attend rate was reduced by 12% following the intervention (p < 0.0001). The new appointment follow-up rate was reduced by 2% (p = 0.74) and the follow-up rate decreased by 13.7% (p < 0.0001). The economic analysis revealed a saving of £19,853 over a two-year period following the intervention. CONCLUSION: Thus mobile technology is a feasible tool in improving attendance rates at outpatient clinics and is economically viable.

Recurrent spontaneous compartment syndrome of the thigh.

Acute comparment syndrome (ACS) is a surgical emergency, in which tissue pressure becomes greater than perfusion pressure leading to tissue ischaemia. It is typically a consequence of trauma. We present a case in which a patient suffers blunt trauma to the thigh, but develops ACS 2 years after this injury and consequently endures 10-episodes of ACS (no perciptating event or cause) in the same thigh over 10 years. On the 10th presentation the patient was found to have arteriovenous malformation on MR angiography which were embolised and the fasciotomy wound closed with a split-thickness skin graft. A thorough literature search deemed this case to be the first reported recurrent spontaneous ACS of the thigh. Prompt recognition and treatment of ACS is vital. Clinicians should thoroughly investigate such patients postoperatively and involve vascular/plastic surgeons and interventianal radiologist to provide optimum care and prevent recurrence.

Surgeons' knowledge about the costs of orthopaedic implants.

PURPOSE. To investigate consultant surgeons' knowledge about the costs of implants for various joint surgeries. METHODS. Questionnaires were distributed to consultant orthopaedic surgeons at 2 hospitals. Respondents were asked to estimate the implant costs of any brand for low-demand and high-demand total hip replacement (THR), total knee replacement (TKR), uni-compartmental knee replacement, arthroscopy shaver blade, total anterior cruciate ligament (ACL) fixation, and meniscal repair. The actual cost of each implant was obtained from the manufacturer. RESULTS. 16 consultant surgeons completed the questionnaires. The respective mean estimated and actual costs for a low-demand THR implant were £1714 (range, £600-3000) and £1448 (range, £985- 2335), with an overestimation of 18.4%. The respective costs for a high-demand THR implant were £2172 (range, £600-6000) and £1737 (range, £1192-2335), with an overestimation of 25%. The respective costs for a TKR implant were £1550 (range, £600-6000) and £1316 (range, £995-1535), with an overestimation of 17.8%. The respective costs for a uni-compartmental knee replacement implant were £1040 (range, £600-2000) and £1296 (range, £698-1470), with an underestimation of 19.7%. The respective costs for an arthroscopy shaver blade were £110 (range, £75-150) and £94 (range, £80-100), with an overestimation of 16.6%. The respective costs for a total ACL fixation implant were £246 (range, £80-500) and £306 (range, £272-335), with an underestimation of 19.4%. The respective costs for a meniscal repair implant were £153 (range, £50-250) and £242 (range, £170-260), with an underestimation of 37%. CONCLUSION. The knowledge among consultant orthopaedic surgeons about implant costs was poor. To reduce implant costs, cooperation between surgeons and hospital managers and measures to increase surgeons' awareness about cost-reduction programmes are needed.

Reviewing the reliability, effectiveness and applications of Licox in traumatic brain injury.

AIMS AND OBJECTIVES: To review the pathophysiology, accuracy, effectiveness and use of Licox for brain tissue oxygen monitoring in traumatic brain injury (TBI). BACKGROUND: The Licox monitoring system allows continuous monitoring of partial pressure of brain tissue oxygen (PbO(2)), brain tissue temperature and intracranial pressure (ICP). The application and effectiveness of the use of Licox in TBI is not clearly explored within the literature. INCLUSION CRITERIA: A date limit of 1995-2009, English language, all animal and human studies and the following terms were searched: Licox, brain tissue oxygenation, cerebral oxygenation and TBI. MEDLINE database was the primary data source. EXCLUSION CRITERIA: All paediatric papers were excluded from the search. Studies not related to pathophysiology and management of TBI and brain tissue oximetry in adults were excluded. Data relevant to the subject under consideration were extracted by three independent clinicians to form a narrative report. Studies were critically evaluated using the NHS Public Health Resource Unit's checklist for each study analysed. CONCLUSIONS: Licox offers new insights into cerebral pathology and physiology. The continuous bedside monitoring provides real-time data that can be used to improve patient management and prognosis in specialist units by trained and experienced staff. More research is required to understand the limitations of this technology and why it is not in widespread use. RELEVENCE TO CLINICAL PRACTICE: A clinical tool that could be utilized more often in the right setting to improve care to patients suffering from TBI by disseminating more information on this unique tool.

The relationship between anabolic androgenic steroids and muscle dysmorphia: a review.

This review explores the condition of muscle dysmorphia (MD) and its relationship with anabolic androgenic steroids (AAS). Particular emphasis is placed upon whether anabolic steroids are a predisposing, precipitating or perpetuating factor of MD. Furthermore, psychiatric complications of AAS abuse are examined. The current evidence from the literature suggests that AAS (ab)use is possibly a perpetuating factor in the evolution of MD. Psychiatric complications of AAS include mood and behavior changes, perceptual abnormalities, and withdrawal symptoms. In addition, there appears to be a credible dependence theory to AAS in fruition.