Rare case of a low energy traumatic anterior dislocation of the native hip.

Anterior dislocations of the native hip are rare injuries, and normally a result of high energy trauma such as road traffic accidents. Delays in reduction of over 12 hours have been shown to increase the risk of avascular necrosis to the head of the femur significantly. We report the case of an elderly man who sustained an anterior dislocation of his native hip following a fall. The case highlights that prompt appropriate management can lead to excellent clinical outcomes.

Gram stain microscopy in septic arthritis.

Septic arthritis is a serious condition that can lead to rapid destruction of joint if it is not rapidly diagnosed and treated appropriately. The reported annual incidence is 10 in 100 000 although this increases to 70 in 100 000 in those with risk factors for developing septic arthritis mainly rheumatoid arthritis and immune-compromised patients. The aim of this study is to examine the sensitivity and specificity, and thus the clinical usefulness, of gram stain results. This was a single centre, retrospective case series. All joint aspirates over a three year period from May 2015 to April 2018 were reviewed. The gram stain and final culture results noted. 830 samples were included from both native and replaced joints. Native joints accounted for a total of 701 cases (84%) of the aspirates, whilst those obtained from prosthetic joints 129 (16%). In 74 (9%) cases there was a discrepancy between the gram stain and culture results. The sensitivity of the gram stain in this case series is 22% and the specificity of the test is 99.6%. The clinician should have a low threshold for overlooking a negative gram stain result and place greater emphases on the clinical findings in conjunction with biochemical markers.

Video presentation of the second stage of a two-stage repair for proximal hypospadias: a safe and reproducible technique.

OBJECTIVE: The aims of proximal hypospadias repair are good cosmetic outcomes with low rates of complication, with a low number of operative exposures, before the age of genital difference realisation. Neo-urethral fistula and stenosis are well recognised complications; with international rates of 3.8-16% and 1.3-15.6% respectively. We present the key steps of the second of a two staged repair in video format. METHOD: Video recording of the procedure performed on an 18-month-old with mid-penile hypospadias is presented. The steps are described; the importance of tension free tubularisation, layered urethral closure, suture technique, vascularised prepucal graft technique, optimal glanuloplasty, and penile shaft skin repair are highlighted. RESULT: The child was brought back to the day ward for catheter removal at 7 days; follow-up in clinic showed good postoperative appearance. This technique has been performed on 31 boys with a fistula rate and stenosis rate favourable to the literature. CONCLUSION: We demonstrate a two-stage technique by video format for proximal hypospadias which is reproducible and gives results comparable to the literature.