Traumatic facet joint dislocation in Western Australia.

INTRODUCTION: Facet joint dislocation is a traumatic injury, which frequently results in devastating clinical outcomes. In Western Australia (WA), Royal Perth Hospital (RPH) provides a statewide Spinal Trauma Service and accepts all referrals from the entirety of the state. The economies of distance in WA mean that there is often a considerable delay between initial presentation at the peripheral hospital and enlocation of the dislocation in Perth. This study aims to identify any prejudicial clinical outcomes as a consequence of this delay. METHODS: This study retrospectively examines all facet joint dislocations that presented to RPH between in a 46-month period. Data were collected on the demographics of patients, mechanism of injury, neurological assessment at presentation of injury based on the American spinal injury association (ASIA), initial presentation to RPH, post-surgical reduction and post rehabilitation. RESULTS: Over this time there were 23 urban patients and 28 rural patients. In the urban group, 18 patients had a final ASIA score of D or E while 5 patients had a final ASIA score of A, B or C. In the rural group, 17 patients had a final ASIA score of A, B or C while 11 patients had a final ASIA score of D or E. CONCLUSION: This study confirms the challenges of management of these injuries in a large geographical area, with a centralised spinal trauma service. Generally, facet joint dislocations that had delayed reductions had a poorer outcome. We hope that the proposed protocol would deliver better management of these injuries.

Haematogenous Spread of Staphylococcus aureus from an Iliacus Abscess to an ACL Reconstructed Knee.

We describe a case of a 19-year-old male who presented to the South West Health Service with a septic knee, secondary to haematogenous spread from an iliacus abscess. Thus far, there have been no reported cases of haematogenous spread of infection from an iliacus abscess to an ACL reconstructed knee, let alone in a healthy young person with no risk factors. The patient has had several washouts of the knee along with the drainage of the abscess. The ACL graft was saved with the patient making a complete recovery.

Rationalization of outcome scores for low back pain: the Oswestry disability index and the low back outcome score.

BACKGROUND: The two commonly used questionnaires to assess low back pain are the low back outcome score (LBOS) and the Oswestry disability index (ODI). This study aims to identify unique questions and remove redundant questions to develop a composite questionnaire. METHODS: Eighty-seven consecutive patients attending the practice of a single spinal surgeon completed both the ODI and the LBOS as part of their initial assessment. Both questionnaires were analysed to eliminate questions that exhibit floor-ceiling bias and questions that are interdependent and correlate strongly. Total scores and the scores obtained for each question were then compared (Spearman's rho). A principal axis factor analysis using a varimax rotation was performed to reduce data and identify questions that were interdependent. Using these data, a composite questionnaire was proposed that would minimize overlap in clinical data. RESULTS: Eighty-seven patients completed the LBOS and ODI. The mean age is 54, with a range between 18 and 80. The male to female ratio was 50:37. By eliminating questions that contain biases and overlap in clinical data, the composite questionnaire contains 11 questions. From LBOS; housework, dressing, sleeping, sitting, walking and travelling. From the ODI; pain, standing, social life and lifting. CONCLUSION: Analysis of the questionnaires identified eight questions that were similar in both questionnaires. Two questions were included that were unique to each questionnaire. The proposed composite questionnaire is of similar size as the original questionnaires and retains questions that are unique to each other while eliminating questions that are redundant and exhibit bias.

Kirschner wire migration into intramedullary canal of ulna during open reduction and internal fixation.

At Bunbury Regional Hospital, we recently saw a case where Kirschner wires (K-wires), used during open reduction and internal fixation of olecranon, were propelled down the intramedullary canal intraoperatively. The K-wire was only secured unicortically. From our experience, we have developed steps to prevent this complication. First, where the wires are being used as part of a tension band wire construct, we suggest drilling the distal hole prior to the placement of the K-wires and, secondly, where K-wires are being used to secure the fracture fragment, the K-wires can be secured with artery clips to ensure that the wires remain in position.

Outcomes of open subacromial decompression after failed arthroscopic acromioplasty.

Aim. To prospectively assess the effectiveness of revision with open subacromial decompression in patients who had a previous unsatisfactory outcome with the arthroscopic procedure. Methods. 11 patients were identified for the study, who did not demonstrate expected improvement in symptoms after arthroscopic acromioplasty. All patients underwent structured rehabilitation. Functional evaluation was conducted using the Hospital for Special Surgery, New York, shoulder rating questionnaire. Results. M : F was 7 : 4. The mean age was 57 years. The average shoulder score improved from 49.6 preoperatively to 56 postoperatively at an average followup of 16 months. Two patients showed deterioration in their shoulder scores after revision while the rest showed only marginal improvement. All except one patient stated that they would opt for surgery again if given a second chance. Conclusion. In the group of patients that fail to benefit from the arthroscopic decompression, only a marginal improvement was noted after revision with open decompression.

Age related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients.

INTRODUCTION: Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups. METHODS: Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and 84 years of age), and group C (patients over the age of 85). RESULTS: Of the 1177 patients included in the study, there were 90 patients in group A, 702 patients in group B and 385 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001). Mortality was higher in older patients. CONCLUSIONS: Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This could be attributed to retention of native bone, better propioception and shorter operation time.

Outcomes of operatively treated acute knee dislocations.

Knee dislocation is a complex and rare injury often presenting in the context of high velocity trauma. The aim of this study is to establish the subjective outcomes of surgically treated knee dislocations. A total of 20 knees dislocations treated by open repair were reviewed. Their progress and outcomes were assessed by using a modified Lysholm score questionnaire. Data was obtained on patient demographics, details of injury, investigation, treatment, rehabilitation, 24 months objective outcome and subjective outcomes. Six patients had a vascular deficit and six had neurological deficits. The median range of motion was 0 degrees -100 degrees . Patients with an initially lower pre-injury level of function were able to return an activity level comparable to their pre-injury status. 22% of competitive athletes retuned to competitive sports. 38% of patients undertaking heavy activity returned to comparable pre-injury level of activity and 67% of patients undertaking moderate level of activity before injury returned to a comparable level after repair. 68% regularly had problems running, 70% problem squatting, 40% swelling and 42% problem with stairs. Most patients however did not have locking of the knee or problems with knees giving way. Patients pain scores decreased over time to an acceptable level. Despite the severity of the injury, majority of patients achieved a satisfactory outcome, although none of the patients reached the same level of function as before the injury. 80% of the patients were satisfied with their outcome. All dissatisfied patients suffered postoperative complications.

Consultation of orthopaedics cases using multimedia messaging services.

BACKGROUND: Frequently, radiological data is transferred verbally between the Emergency Department (ED) and orthopaedic registrar. Given the different language skills and medical experience of health staff, there is often a limit to the adequacy of the verbal description that could lead to suboptimal patient care. This study proposes that concurrent review of MMS teleradiology with traditional verbal reporting results in a significant therapeutic benefit. METHODS: Case notes of 40 patients who presented to ED were reviewed. Images were captured and sent to an Orthopaedic registrar along with a brief clinical synopsis. Information was collected on the diagnosis of the MMS radiograph, need for urgent admission and management plan outlined to ED. RESULTS: Correct diagnosis was made in 27 of 40 cases. Using the latest technology available, MMS teleradiology had 79% sensitivity, 83% specificity and an accuracy of 80%. 50% of paediatric fractures and 60% of undisplaced fractures were diagnosed successfully. CONCLUSION: MMS teleradiology is not suitable by itself as a remote diagnostic tool. However, when combined with existing clinical practice, it is effective in screening patients, enhances confidence in decision making and communication between doctors.