Progress in bioactive surface coatings on biodegradable Mg alloys: A critical review towards clinical translation.

Mg and its alloys evince strong candidature for biodegradable bone implants, cardiovascular stents, and wound closing devices. However, their rapid degradation rate causes premature implant failure, constraining clinical applications. Bio-functional surface coatings have emerged as the most competent strategy to fulfill the diverse clinical requirements, besides yielding effective corrosion resistance. This article reviews the progress of biodegradable and advanced surface coatings on Mg alloys investigated in recent years, aiming to build up a comprehensive knowledge framework of coating techniques, processing parameters, performance measures in terms of corrosion resistance, adhesion strength, and biocompatibility. Recently developed conversion and deposition type surface coatings are thoroughly discussed by reporting their essential therapeutic responses like osteogenesis, angiogenesis, cytocompatibility, hemocompatibility, anti-bacterial, and controlled drug release towards in-vitro and in-vivo study models. The challenges associated with metallic, ceramic and polymeric coatings along with merits and demerits of various coatings have been illustrated. The use of multilayered hybrid coating comprising a unique combination of organic and inorganic components has been emphasized with future perspectives to obtain diverse bio-functionalities in a facile single coating system for orthopedic implant applications.

Brachialis muscle metastasis: An unusual, presenting site of metastatic adenocarcinoma of the colon.

Skeletal muscle metastasis from gastrointestinal system tumours is extremely rare. We report an unusual presentation of skeletal muscle metastasis in the brachialis muscle as a presenting feature of a previously undiagnosed colonic adenocarcinoma in a 66-year-old male. He presented to us with a painful, flexion deformity of his elbow and suspected to have a biceps brachii rupture. We review the clinico-radiological findings and the relevant literature. This case-report highlights the importance of a thorough clinical evaluation especially in presence of red flag signs, early multi-disciplinary team (MDT) discussion and biopsy to formulate a plan of management.

What does the orthopaedic surgeon want in the radiology report?

Complementary imaging is crucial in the diagnosis and management of the spectrum of Musculoskeletal (MSK) pathologies. Like in all medical specialities, its role in trauma and orthopaedic conditions has evolved. A radiology report following an imaging study should provide an accurate, timely interpretation of images and be presented in a format that allows formal analysis or clarification of a patient's diagnostic dilemma. It is essential that it is descriptive enough to allow clinico-pathological correlation to a patient's condition. A high-quality report follows clinical governance processes, provides clinical feedback, and when appropriate, incorporates advice regarding differential diagnosis or further investigation/management that can be undertaken, permitting the attending clinician to formulate a suitable treatment plan for their patient. In this narrative we explore common radiological investigations and reporting information in trauma and orthopaedic conditions, which would be useful to the attending surgeon.

Traumatic rotator cuff tears - Current concepts in diagnosis and management.

Rotator cuff tears represent one of common shoulder pathologies presenting over a wide spectrum of age groups and varying presentation. Typically, rotator cuff tears occur more frequently in elderly than in younger patients, following a chronic or acute-on-chronic course and usually secondary to due to tendon degeneration. Though there has been a considerable debate in the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears, there appears to be consensus about the need for early diagnosis to facilitate prompt surgical treatment and the improve patient outcome. Significant differences in rotator cuff tears between those occurring in younger and older patients could be due to mechanism of injury, presentation, severity of the tear, biological healing potential and rehabilitation. Acute traumatic rotator cuff tears especially in younger age group represent a distinct entity from other patterns of rotator cuff tears. Consequently, a high index of suspicion, focused clinical examination, complementary imaging is a pre-requisite for an early diagnosis and effective management. We analyze the biomechanical consequences of acute rotator cuff tears along with characteristic mechanism of injury and spectrum of tendon involvement. The evolving concepts in the diagnosis and management of these distinct injuries are discussed with review of current literature.

Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

BACKGROUND AND PURPOSE: There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients. METHODS: This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge. RESULTS: 28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations. CONCLUSIONS: Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services.

Total knee arthroplasty in stiff and ankylosed knees.

A retrospective study was done to evaluate the results of total knee arthroplasty performed on 84 knees in 53 patients with spontaneously ankylosed knees, having a preoperative arc of movement between 0 degrees and 20 degrees (average, 14 degrees). The difficulties encountered in surgical exposure were managed by using various extensile exposure techniques. Follow-up ranged from 4 to 15 years (average, 9 years). The average postoperative arc of movement at final follow-up was 75 degrees, with a significant average gain of 61 degrees (P < .01). The average extensor lag was 6 degrees. Four knees had a residual flexion contractures of 5 degrees or less. Total knee arthroplasty in ankylosed knees can achieve correction of deformity with a significant gain in range of motion and marked improvement in quality of life.