MRSA colonisation in spinal cord injury: implications on patients rehabilitation.

MRSA has become a major cause of nosocomial and community acquired infections in the past few years. Our hypothesis is that MRSA colonisation affects the length of stay in hospital, thereby adding a strain on resources. Data from the last 20 patients admitted to the Spinal Injury Care Unit (SICU) who were MRSA positive (study group) have been analysed and then matched with data from 20 patients who were MRSA negative (control group) to compare their total hospital stay and the factors which affect the length of hospital stay. The mean age of the study group patients was 38.8 years. The average time between injury and admission in SICU was 76.5 days in the study group compared to 28.7 days in the control. The mean stay duration was 412.15 days in the study group as opposed to 187.2 days in the control group. Nearly 45% had developed pressure sores in the study group as compared to 25% in the control group. Our study indicates that MRSA colonisation in spinal injured patients leads to longer hospital stay, delay in admission to spinal care units, and development of pressure sores and further infection. These factors have adverse effects on patients' rehabilitation.

Clinical and user-friendly classification of traumatic digital nerve injuries of hand.

INTRODUCTION: Surgical findings of traumatic neurapraxia and neurotmesis in digital nerve injuries of hand have significantly different prognosis and surgeons managing such injuries must be able to provide the expected incidence of these injuries along with decision on surgical exploration. There is a paucity of data in the literature defining the incidence of traumatic neurapraxia and neurotemesis in lacerated hand injuries with clinical features of digital nerve injury. MATERIALS AND METHODS: We carried out a study in an urban practice to understand this problem on 81 consecutive patients with 82 digital nerve injuries over 1.5 years. Seventy-two percent of the injuries were caused mainly in the domestic accidents by glass and knife. All patients had clinical features of digital nerve injury. RESULTS: Operative findings revealed nerve damage in 76 patients (confidence interval at 95% = 91-97). Seventy-one had severed nerves and underwent repair (CI at 95% = 80-95). There were 7% patients with operative findings of normal looking nerves and 6% of bruised but intact nerves. All of these 13% patients who did not require surgical repair were grouped as traumatic neurapraxia and showed complete clinical recovery. CONCLUSION: Traumatic neurapraxia in digital nerve injuries of the hand are not uncommon, as previously thought, following lacerated injuries to hand and have favourable prognosis. This information is important for clinicians in getting more informed consent and patient education. The classification of digital nerve injuries into traumatic neurapraxia and neurotemesis appears logical for its practical application in routine clinical practice.

Ultrasound guided steroid injection in the treatment of interdigital neuralgia.

The aim of this study was to assess the clinical effectiveness of ultrasound guided injection in the management of Morton's Metatarsalgia. Patients clinically diagnosed with interdigital Morton's neuroma were treated with ultrasound guided injection of local anaesthetic and steroid. Fifty four patients were available for follow-up, and all had detailed telephone questionnaires completed. These questionnaires included a pre and post injection symptom score, and Johnson Satisfaction score. The results indicate that 69% of patients had ultrasound diagnosis of Morton's neuroma and 31% had an ultrasound diagnosis of intermetatarsal bursa. Mean follow-up was 11.4 months. Sixty seven percent of the patients were satisfied with the results of treatment. At follow-up 63% of patients had no limitation in activity levels, and had no need to modify shoe wear. Of all patients included in the study, only three have gone on to require surgery for ongoing symptoms. Although some studies have suggested that neither injection nor imaging have a role in the treatment of Morton's neuroma, this study, however, demonstrates that ultrasound guided placement of local anaesthetic and steroid in either an intermetatarsal bursa or Morton's neuroma gives a good short and medium-term symptom relief and in the majority of cases avoids or at least delays the need for surgery.

Arthroscopic ankle debridement: 5-year survival analysis.

Little information exists regarding the long term prognosis following ankle arthroscopy, particularly in avoiding further major surgery. The purpose of this study is to evaluate the prognosis of arthroscopic ankle treatment. We also investigated the relationship between the arthroscopic treatment and time for a further major ankle surgery. In this consecutive case series study using a prospectively collected database, 80 consecutive patients (80 ankles) having ankle arthroscopy with the finding of osteoarthritis or impingement were identified and their outcome at five years was ascertained. Fifty five (69%) patients had soft tissue impingement, and 25 (31%) patients had osteoarthritic degenerative changes. Seven (9%) patients had further major surgery and 6 (8%) had repeat arthroscopy. The surgery was required for 7 arthritic ankles among which, however, survival analysis showed no significant difference between those under 50 and those over 50 years. Twenty-eight percent of osteoarthritic patients progressed to major ankle surgery, within 5 years of arthroscopic treatment. None of the patients with impingement symptoms required further major surgery. In conclusion, arthroscopically treated impingement ankles were found to have an excellent prognosis, while osteoarthritic ankles had a less favoured prognosis, with a high proportion requiring further major surgery. Age did not appear to affect the prognosis in the osteoarthritic group.

Morton's metatarsalgia: pathogenesis, aetiology and current management.

The aetiology and pathogenesis of Morton's Neuroma remain controversial. It is not true neuroma and therefore, it is better referred to as Morton's metatarsalgia. This article reviews the various thoughts regarding the pathogenesis of this condition. Chronic trauma, ischaemia, bursitis and entrapment neuropathy have been proposed as possible aetiologic factors. Careful history and clinical examination is essential to establish the diagnosis. However, if the clinical picture is doubtful, radiological investigation is recommended. Ultrasound, in the hand of an experienced radiologist, is the modality of choice. Conservative measures such as footwear modification and targeted injection of the hot spot are attempted before considering surgical intervention. Patients must be counselled preoperatively. The success of neurectomy rarely exceeds 83%. When surgery is considered, the dorsal approach is associated with less wound complications than the plantar approach. The neuroma is resected as proximally as possible in order to include plantar digital branches. For recurrent neuromas, a plantar approach is appropriate.