Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients.

PURPOSE: The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. METHODS: Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months). RESULTS: Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. CONCLUSION: While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.

Management of Gustilo-Anderson IIIB open tibial fractures in adults-a systematic review.

INTRODUCTION: Open tibial fractures are the most common open long bone fracture, despite this, the management of these complex injuries still remains a topic of discussion amongst orthopaedic surgeons. SOURCES OF DATA: We searched the EMBASE, MEDLINE and Google Scholar and a systematic review of 7500 articles, leaving 23 after exclusion criteria were applied, in order to analyse the management of open tibial fractures. AREAS OF AGREEMENT AND CONTROVERSY: Infection was noted to be the most significant concern amongst authors, with definitive external fixation having a high rate of superficial pin-site infection and internal fixation having a high deep infection rate. GROWING POINTS: It is essential to have a combined ortho-plastic approach to the management of these fractures as muscle flaps were the most common form of soft tissue coverage. AREAS TIMELY FOR DEVELOPING RESEARCH: A national pragmatic trial into the management of open tibial fractures is required looking at fixation methods and soft tissue coverage, with at least a 2-year follow-up in order to ascertain the most appropriate management of these fractures and patient-related outcomes.

The Success and Evolution of a Urological "Boot Camp" for Newly Appointed UK Urology Registrars: Incorporating Simulation, Nontechnical Skills and Assessment.

BACKGROUND: Urological training has dramatically changed in recent years. Training durations are shorter and a drive toward consultant led care has reduced trainees experience. Within the UK, approximately 50 registrars annually embark on a 5-year Urology training programme, with variable levels of basic urological experience. OBJECTIVE: To describe a simulation programme aimed at delivering the knowledge and skills necessary to safely and effectively start working as a registrar in Urology by intensive training with a 1:1 faculty to delegate ratio. DESIGN, SETTING, AND PARTICIPANTS: Our course content mirrors the UK training syllabus for junior Urology registrars. We delivered 8 modules over a 4-day programme with a fifth day of assessments. Delegates level of urological knowledge, operative competency and confidence pre-, immediately post-training and at 3-months postcourse were assessed. Objective delegate and faculty feedback was also collected. Technical skills modules include; inguinoscrotal surgery, ureteroscopy, transurethral resection, urodynamics, and Botox administration as well as basic reconstructive and laparoscopic operative skills. "Nontechnical" skills included simulated ward round, out-patient, and emergency scenarios. RESULTS: Feedback from delegates and faculty members has been overwhelmingly positive. We have used this feedback to tailor the content of the course for following years. An increased knowledge level (based on mean examination scores [precourse 55.5%, postcourse 70.1%]) and operative competency was observed in all skills assessed (transurethral resection of the prostate, transurethral resection of bladder tumor, Ureteroscopy, laparoscopic skills, and instrument assembly). Operative confidence was increased immediately and at 3-months postcourse. CONCLUSIONS: Our "boot camp" course provides a realistic introduction and foundation to begin Urological practice. Being delivered at the beginning of the training scheme, prior to intensive patient exposure, registrars are in an optimum position to develop their newly acquired knowledge and skills to enhance training and intends to improve patient safety and satisfaction.

The treatment of chyluria secondary to advanced carcinoma of the prostate.

Chyluria has not been previously reported as being associated with carcinoma of the prostate. The most common cause is lymphatic filariasis, a parasitic disease. Non-parasitic chyluria is rare. We describe a case of chyluria associated with carcinoma of the prostate. We describe our successful management in this case and highlight how urologists may overcome problematic chyluria in patients with advanced carcinoma of the prostate.

Painful leg and missing pulses: a case report.

Popliteal artery entrapment syndrome (PAES) is a rare but potentially limb threatening anatomical anomaly occurring predominantly in young adults. We report a case of a 14 year old boy who presented with limb threatening ischaemia requiring urgent surgery. The pathology, presentation, and management are discussed.

Growth and development of a hospital-based lactation program and mother's own milk bank.

This article describes the development and characteristics of a hospital-based lactation program and mother's own milk bank in a large pediatric hospital in the southwestern United States. Professional and technical staffing, physical space of the milk bank area, and the program's services and special features are outlined. Quality control issues about human milk preparation, fortification, storage, and transport are discussed.

[Optimal exchange of resources and the administration of bibliographical services]. / Intercambio óptimo de recursos y administración de servicios bibliográficos.

It is pointed out in this paper that an optimal exchange of resources requires a maximum availability of materials and services at minimum cost. The author is of the view that each activity of the biomedical information network will have to be subjected to critical scrutiny including a calculation of its costs. The overall plan will determine whether current activities can be maintained or expanded and new activities launched. The primary given to access to materials rather than to their possession is a step toward user-oriented networks, and therefore means that future development will be assessed in relation to the customer. The author is convinced that the recording and analysis of the use actually made of services by the user will generate many of the criteria that will govern some of the most important decisions to be taken in the future in connection with the network.

Intercambio optimo se recursos y administracion de servicios bibliograficos. / Optimal resource sharing and administration of bibliographic services

Se senala en este trabajo que el intercambio optimo de recursos entrana una disponibilidad maxima de materiales y servicios con un minimo de gastos. Considera el autor que para cada actividad de la red de informacion biomedica habra que hacer un examen critico con calculo de costos. El plan global determinara se pueden mantenerse o ampliarse las actividades actuales o si cabe iniciar una nueva actividad. La preponderancia concedida al accesso a los materiales en vez de a su posesion significa el paso a redes orientadas hacia los usuarios y, por consiguiente, que la evolucion futura se evaluara sobre la base del cliente. Esta convencido el autor que el analisis y registro del uso efectivo de los servicios por el usuario aportara muchos de los criterios a que habran de ajustarse algunas de las decisiones mas importantes que tengan que adoptarse en el futuro en relacion con la red

Intercambio óptimo de recursos y administración de servicios bibliográficos / Optimal exchange of resources and the administration of bibliographical services

It is pointed out in this paper that an optimal exchange of resources requires a maximum availability of materials and services at minimum cost. The author is of the view that each activity of the biomedical information network will have to be subjected to critical scrutiny including a calculation of its costs. The overall plan will determine whether current activities can be maintained or expanded and new activities launched. The primary given to access to materials rather than to their possession is a step toward user-oriented networks, and therefore means that future development will be assessed in relation to the customer. The author is convinced that the recording and analysis of the use actually made of services by the user will generate many of the criteria that will govern some of the most important decisions to be taken in the future in connection with the network (Au)