No additional value of routine check X-rays after internal fixation of hip fractures.

PURPOSE: Annually approximately 18,044 patients are admitted to Dutch hospitals with hip fractures. This is an increasing demand for medical care due to the increasing amount of elderly people. Although previous studies showed that routine check of X-rays following hip fracture surgery is unnecessary, it remains routine in most clinics in the Netherlands. In addition to the radiation exposure to the patient, it is painful and leads to unnecessary costs. This study aims to establish if routine check X-rays 1 day after internal fixation for hip fracture with adequate image intensifier guidance influence postoperative management. PATIENTS AND METHODS: A retrospective study was performed for all patients undergoing internal fixation of hip fractures with image intensifier guidance in the period from January 2006 until December 2007 in our hospital. RESULTS: In that period 294 patients underwent internal fixation of hip fractures, 254 underwent a check X-ray and were included in this study. In only two patients the check X-ray did change patient management. CONCLUSION: A check X-ray following internal fixation of hip fractures after adequate peroperative image intensifier guidance is not useful. Dismissing this unuseful medical investigation, leads to less radiation exposure, less pain and less costs.

Treatment of an osteoporotic vertebral compression fracture with the StaXx FX system resulting in intrathoracic wafers: a serious complication.

PURPOSE: To report a serious complication of the StaXx FX system used to stabilize an osteoporotic vertebral fracture. CASE REPORT: A 76-year-old woman presented with a painful vertebral fracture. Treatment by means of a PEEK wafer kyphoplasty was complicated by malposition of the wafers. The patient recovered fully after removal of the wafers by means of a thoracotomy. CONCLUSIONS: New treatment modalities have their own pitfalls and possible complications, as demonstrated in this case report. Caution regarding implementation of new treatment modalities should be practiced.

Registering the critical view of safety: photo or video?

BACKGROUND: One of the most important ways to reduce biliary duct injury in laparoscopic cholecystectomy is to achieve the critical view of safety (CVS) before transection of the cystic artery and duct. Documenting CVS is possible with photo prints, video imaging, or both. These documentations can be used as a proof of the right procedure in case of biliary duct injury, but only if the documentation is good enough to be judged independently by others. METHODS: In 102 consecutive laparoscopic cholecystectomies, CVS was recorded by photo prints and video images. Imaging was done just before transection of the cystic artery and duct. The photo prints and video images were analyzed independently by two surgeons. These surgeons had to judge whether the documentation method was of sufficient quality to determine whether CVS was achieved. RESULTS: Photo prints were made for 81% and video images for 59% of the 102 patients treated with a laparoscopic cholecystectomy. The mean age of the patients was 54 years (range, 22-83 years), and 71% were women. The diagnosis for 62 of the patients was symptomatic cholecystolithiasis, and 18 patients had acute cholecystitis. The remaining patients had earlier experienced acute cholecystitis, biliary pancreatitis, or endoscopic retrograde cholangiopancreatography (ERCP). Respectively, 30% and 21% of the CVS photo prints were judged to be of insufficient quality to determine whether CVS had been established, mostly because of difficulties adequately showing the lateral side (κ = 0.67). In all but two video images, achievement of CVS was documented sufficiently to be judged 97% (κ = 1.00). CONCLUSION: Photo prints are inferior to video images for judging achievement of CVS. Therefore, a practical and logistical solution must be devised in hospitals for storage and insight in all video documentation, for example, by implementation of a link with the electronic patient database.

The linea arcuata hernia: a report of two cases.

Two male patients presented to the surgical outpatient clinic with a paramedian abdominal bulge. In the first patient, the hardly known diagnosis linea arcuata hernia (LAH) had been missed at a previous exploration 8 years ago. In the second patient, pre-operative imaging showed an abdominal wall hernia. Diagnostic laparoscopy revealed an LAH. In both cases, the hernia was repaired with a mesh graft.

The surgical treatment of stage III empyema: the effect on lung function.

AIM: The aim of this study was to evaluate the surgical treatment of stage III empyema. METHODS: Between 2002 and 2005, 30 patients underwent surgery for treatment of diagnosed stage III empyema preoperatively. Patients were referred for spirometry to evaluate lung function postoperatively. RESULTS: Twenty nine patients underwent primary thoracotomy because of an extended stage III empyema, 1 patient video-assisted thoracoscopic surgery (VATS). Mean age was 62 years. Mean period from onset of symptoms until hospital admission was 29 days and mean time interval between admission and surgery was 11 days. Intraoperative complication happened in one patient (3%), in whom a phrenic nerve lesion was diagnosed. Overall mortality rate was 3%. In 17 patients postoperative spirometry was performed, showing normal vital capacity in 59% of the patients. CONCLUSION: There was no reluctance in performing primary thoracotomy in our population with a stage III empyema. Decortication by means of thoracotomy restored the complete expansion of the lung; the authors claim that vital capacity returned to normal values, as it was shown by the spirometry results postoperatively. Early referral to the respiratory department in case of a non-responding pneumonia and early surgical consultation in case of a parapneumonic effusion, will prevent progression to an extensive organized stage III empyema requiring decortication by thoracotomy.

Pericardial cyst located in the anterior mediastinum mimicking a thymoma. A presentation of two cases.

Pericardial cysts are rare but well recognized tumors of the mediastinum. Most pericardial cysts are located in the right or left cardiophrenic angle. At other locations these cysts may pose a diagnostic problem. We present two cases of an atypically located pericardial cyst and a short review of the literature.

Taurolin in the treatment of experimental post traumatic osteitis.

Post-traumatic osteitis (PTO) still constitutes a medical and surgical problem. Although different treatment regimes have been tested, controversial results have been obtained. Taurolin-gel® 4% and Taurolin®-collagen are broad spectrum synthetic antibacterial agents used for the local treatment of PTO. This study was designed to evaluate Taurolin under standardised conditions using an animal model for experimentally induced PTOIn 21 rabbits a PTO was induced in the left femur and they were assigned into three groups. Four weeks after this operation the second operation followed: in group A (n=5) the intramedullairy rod was removed and the marrow cavity flushed with Ringer lactate solution. In groups B and C (n=16) Taurolin®-gel 4% or Taurolin®-collagen was installed into the marrow cavity after the same debridement. The disease was monitored by hematologic, roentgenografic and bacteriological parameters.After 4 weeks all animals showed signs of an osteitis. At obduction the marrow flush and bone cultures of group A all consisted S. aureus. In group B three out of eight and in group C two out of eight cultures showed bacterial grows.Treatment of an animal PTO is more difficult than the human disease for thorough debridement is difficult. Even though we achieved a succespercentage of 69%. This is a number which is also described in clinical studies. Further investigations with Taurolin® are necessary to develop an optimal treatment regime and to determine to what extent it can be integrated in everyday clinical practise.

A new model for posttraumatic osteomyelitis in rabbits.

A new animal model for posttraumatic osteomyelitis was designed. This model mimics the pathogenesis of the human disease more accurately than models presently available. Femora of New Zealand white rabbits were exposed at the greater trochanter and a stainless steel rod was inserted into the marrow cavity. A Staphylococcus aureus suspension was placed in and around a bone defect, which was drilled midshaft. The disease was evaluated by clinical observation and roentgenographic, hematologic, bacteriologic, and histologic parameters. Osteomyelitis developed in all 24 infected rabbits. None of the five rabbits receiving only an intramedullary rod developed an osteomyelitis. This model proves that an experimental posttraumatic osteomyelitis associated with a foreign body can be reliably induced, even when no infection-promoting chemical agents, small inoculum of bacteria, or minimal bone trauma is present.