Surgery of the femur in HIV positive patients: a retrospective review from 2005 to 2011.

BACKGROUND: There are an estimated 6,900 people with HIV living in Ireland. There is a significant prevalence of femoral osteonecrosis and risk factors for osteoporotic fractures. With this potential, increasing surgical workload, it is important to assess surgical demand and audit outcomes. METHODS: The hospital's electronic records were examined. Between January 2005 and August 2011, 17 femoral surgeries were identified in seven patients. Patient records were retrospectively reviewed. RESULTS: Elective operations undertaken were eight hip replacements and one nail dynamisation. Eight emergency operations were undertaken: two DHS, one plating, one nailing, one revision nailing, two incision and drainages and one biopsy. All procedures were carried out using appropriate safety guidelines. Indications for surgery included femoral head osteonecrosis (n = 7), osteomyelitis (n = 3), proximal femoral fracture (n = 2), femoral shaft non-union (n = 1), dynamisation of a nail (n = 1), osteoarthritis (n = 1), fractured femur (n = 1), and revision nailing (n = 1). For two procedures the patient was not on highly active anti-retroviral treatment. All elective patients had CD4 counts greater than 200 pre-operatively. Six patients had undetectable viral loads. Of the eight emergency procedures, four procedures had no preoperative immune status recorded. Complications recorded were three non-unions, one nail fracture, one lesser trochanter fracture and recurrence of osteomyelitis. No surgical site infections were recorded. CONCLUSIONS: Complications were not related to immune status. The rate of surgical site infection in both elective and emergency procedures was low. The elective surgery patients can safely receive orthopaedic treatment in their regional orthopaedic unit. Due to the high non-infectious complication rates recorded in the emergency group, transfer to a tertiary facility with infectious disease expertise is advised.

Ultrasound changes in the extensor pollicis longus and flexor pollicis longus tendons following open reduction and internal fixation of displaced intra-articular fractures of the distal radius.

A previous ultrasound study showed inflammation around the extensor pollicis longus tendon and surrounding structures at 6 weeks after manipulation, with or without pin fixation, and immobilization for distal radius fracture. Ultrasound examination after plating of distal radius fracture followed by early active mobilization of the wrist showed a short-lived inflammatory response, evident at 2 weeks but not at 6 weeks, around the extensor pollicis longus tendon (26 wrists examined) and flexor pollicis longus tendon (18 wrists examined). Early active mobilization of the wrist appears to limit the duration of inflammation around these tendons.

The surgical management of aortic root vessel anomalies presenting in adults.

Anomalies of the aortic root vessels may present in adults and are common incidental findings during standard vascular imaging. Knowledge of their presentation and management is important for surgeons dealing with vascular pathology within these anomalous vessels. A comprehensive literature search was conducted and a review of the current opinion performed on the embryology, clinical features, and surgical treatment of aortic root vessel anomalies, with particular emphasis on their management in adults. A classification system for aortic arch anomalies based on arch configuration is presented: (1) double aortic arch, (2) right aortic arch, (3) left aortic arch with abnormal branching, and (4) interrupted aortic arch. Anomalies of the aortic root vessels may be classified based on their presence or absence, their anomalous size or course, or their atypical origin, bifurcation, or subsequent branching pattern. A symptomatic aberrant right subclavian artery may be encountered by vascular surgeons, and a right supraclavicular approach would appear the most appropriate method of repair. Knowledge of aortic arch and root vessel anomalies is important for any clinician dealing with cardiothoracic, head and neck, or intracranial pathology. Vascular surgeons may encounter these anomalies during routine practice and may need to deal with their clinical sequelae.

Pleural puncture: an unusual complication of a thoracic epidural.

Thoracic epidural analgesia is a common method of pain relief for major thoracic and abdominal surgery. Numerous complications may occur, including temporary or permanent neurological injury. A rare and potentially life-threatening complication of thoracic epidural analgesia is pleural puncture by the needle or the catheter. Such a case is presented and pleural puncture in association with attempted thoracic epidural catheter placement is discussed.