Safety of the neurovascular bundles when performing minimally invasive calcaneal osteotomy: A cadaveric study.

BACKGROUND: Calcaneal osteotomies correct hindfoot deformities and are often performed using a minimally invasive technique. The aim was to compare the safety of three calcaneal osteotomy techniques (oblique, chevron with apex anterior and chevron with apex posterior). METHODS: Each osteotomy technique was performed on five cadavers (n = 15). These were then dissected to identify any injury to the neurovascular bundles. The distance between the burr and these structures was measured. RESULTS: Using the apex posterior technique, the burr was closer to the medial and lateral neurovascular structures, and in one case the sural nerve was injured. There were no neurovascular injuries using the other techniques. CONCLUSIONS: Minimally invasive surgery using a burr is generally a safe, reliable method for performing calcaneal osteotomies. The chevron with apex posterior osteotomy should be performed with caution given the closer relationship between the burr and neurovascular bundles. The other two techniques provide safer alternatives.

Immobilisation of the knee and ankle and its impact on drivers' braking times: a driving simulator study.

The purpose of this study was to investigate the effects of right leg restriction at the knee, ankle or both, on a driver's braking times. Previous studies have not investigated the effects of knee restriction on braking performance. A total of 23 healthy drivers performed a series of emergency braking tests in a driving simulator in either an above-knee plaster cast, a below-knee cast, or in a knee brace with an increasing range of restriction. The study showed that total braking reaction time was significantly longer when wearing an above-knee plaster cast, a below-knee plaster cast or a knee brace fixed at 0°, compared with braking normally (p < 0.001). Increases in the time taken to move the foot from the accelerator to the brake accounted for some of the increase in the total braking reaction time. Unexpectedly, thinking time also increased with the level of restriction (p < 0.001). The increase in braking time with an above-knee plaster cast in this study would increase the stopping distance at 30 miles per hour by almost 3 m. These results suggest that all patients wearing any lower-limb plaster cast or knee brace are significantly impaired in their ability to perform an emergency stop. We suggest changes to the legislation to prevent patients from driving with lower-limb plaster casts or knee braces.

[Cement plug embedded in the patella: a rare complication of total knee arthroplasty.

An unusual delayed complication of total knee arthroplasty involving the unresurfaced patella is described. The complication is due to the impaction of a loose cement plug used to seal the defect left by the femoral intramedullary alignment rod. The origin, presentation, and management are discussed.

Rupture of the pectoralis major muscle: surgical treatment in athletes.

Pectoralis major tendon rupture is a relatively rare injury, resulting from violent, eccentric contraction of the muscle. Over 50% of these injuries occur in athletes, classically in weight-lifters during the 'bench press' manoeuvre. We present 13 cases of distal rupture of the pectoralis major muscle in athletes. All patients underwent open surgical repair. Magnetic resonance imaging was used to confirm the diagnosis in all patients. The results were analysed using (1) the visual analogue pain score, (2) functional shoulder evaluation and (3) isokinetic strength measurements. At the final follow-up of 23.6 months (14-34 months), the results were excellent in six patients, good in six and one had a poor result. Eleven patients were able to return to their pre-injury level of sports. The mean time for a return to sports was 8.5 months. The intraoperative findings correlated perfectly with the reported MRI scans in 11 patients and with minor differences in 2 patients. We wish to emphasise the importance of accurate clinical diagnosis, appropriate investigations, early surgical repair and an accelerated rehabilitation protocol for the distal rupture of the pectoralis major muscle as this allows complete functional recovery and restoration of full strength of the muscle, which is essential for the active athlete.

The effect of laminar air-flow on the results of Austin-Moore hemiarthroplasty.

INTRODUCTION: A second cycle audit to evaluate the results after introduction of water impervious surgical gowns and drapes while performing Austin-Moore hemiarthroplasty as recommended by our previously published study. AIM: To assess the difference in the re-operation rate following Austin-Moore hemiarthroplasty between procedures performed under laminar air-flow to those performed in conventional (non-laminar flow) theatres, after the introduction of water impervious gowns and drapes in 2000. MATERIALS AND METHODS: A consecutive cohort of patients who had Austin-Moore hemiarthroplasties performed at our district general hospital between August 2000 and July 2004 were included in the study. The minimum follow-up period was 1 year. Of the total of 435 patients, 223 were operated in non-laminar air-flow theatres and 212 were operated in laminar air-flow theatres. Peri-operative antibiotics and water-impervious surgical gowns and drapes were used in all cases. RESULTS: The overall re-operation rate for all indications was 1.4% (3/212) in the laminar air-flow theatre group and 5.8% (134/223) in the non-laminar air-flow theatre group. CONCLUSION: The rate of re-operation for all indications in the non-laminar air-flow theatre group was four times greater than in the laminar air-flow group. We recommend that Austin-Moore hemiarthroplasty procedures should be performed in laminar air-flow equipped theatres.

Autologous blood transfusion following total knee arthroplasty: is it always necessary?

A retrospective study of 85 patients undergoing primary total knee replacement (TKR), who also received autologous blood transfusion (ABT) to compensate for the perioperative blood loss. In our series 16.4% of the patients needed allogenic blood transfusion. Of the remaining 83.4% only 49.5% received autologous transfusion. Autologous transfusion was withheld in 34.1% of cases either because the blood volume was inadequate or because the collection time exceeded the recommended time limit. The mean haemoglobin (Hb) level with or without autologous transfusion was 10 g, raising the question of the necessity of using autologous transfusion in primary total TKR.