The importance of vitamin B12 for individuals choosing plant-based diets.

Vitamin B12 is an essential nutrient that is not made by plants; consequently, unfortified plant-based foods are not a reliable supply. Recent estimates suggest high rates of vitamin B12 deficiency among the vegetarian and vegan populations, particularly in pregnant women or women of child-bearing age who, for ethical and health reasons, are shifting towards higher consumption of plant-based foods in ever-increasing numbers. Vitamin B12 plays crucial metabolic roles across the life-course and in particular during pregnancy and in early development (first 1000 days of life). Evidence now implicates vitamin B12 deficiency with increased risk to a range of neuro, vascular, immune, and inflammatory disorders. However, the current UK recommended nutrient intake for vitamin B12 does not adequately consider the vitamin B12 deficit for those choosing a plant-based diet, including vegetarianism and in particular veganism, representing a hidden hunger. We provide a cautionary note on the importance of preventing vitamin B12 deficits for those individuals choosing a plant-based diet and the health professionals advising them.

Assessment and correction of femoral malrotation following intramedullary nailing of the femur.

Rotational deformity is a more common problem than one might expect in the treatment of femoral shaft fractures. This review presents two cases of femoral malrotation following intramedullary nailing of the femur. The presentation, importance of early recognition, investigation with a CT scan, and the technique of correction is discussed in detail. The importance of intra-operative assessment to avoid this complication is highlighted and a review of the current literature on this problem and its treatment is presented.

Skating on thin ice: a study of the injuries sustained at a temporary ice skating rink.

In recent years, ice skating and temporary ice skating rinks have become increasingly popular. Regular elite competitors are known to be at risk of both acute and chronic injuries. It may be postulated that skaters at the temporary rinks are at high risk of acute injuries from falls due to both their lack of expertise and the inherent dangers of ice skating. Injuries sustained at skating rinks present a significant burden to local healthcare resources, in particular orthopaedic departments. For the first time, Cambridge hosted such a facility from November 24, 2007 through January 6, 2008. We sought to identify the most common injuries encountered and to quantify the orthopaedic burden. All Emergency Department or Fracture Clinic attendances for an eight-week period from the opening of the rink were investigated. Details of age, sex, injury and management were recorded for the 84 patients who sustained ice rink related injuries. A total of 85 injuries were recorded in 84 patients. Of these injuries 58% were fractures, of which 98% involved the upper limbs. Seven patients (8% of all injuries) required admission for operative fixation. On average, two injuries per day were seen in the Emergency Department or Fracture Clinic, with an average of one orthopaedic admission per week. It is evident that the ice rink in Cambridge has had an impact on local healthcare resources. The vast majority of injuries affected the upper limbs and were sustained following a fall on the out-stretched hand. We therefore encourage the education of skaters as to how to break their falls more safely and recommend the use of wrist protectors as a primary preventative measure.

Less invasive stabilization system for the management of periprosthetic femoral fractures around hip arthroplasty.

We present a study of 18 periprosthetic femoral fractures treated with less invasive stabilization system between September 2001 and March 2005. Three patients died during the follow-up period owing to unrelated causes and are excluded from the final results. The average age was 81.6 years, and the average follow-up period was 11.7 months. Twelve patients had significant comorbidities preoperatively. The surviving 15 patients had satisfactory fracture union, although one patient required replating with a less invasive stabilization system plate after a fall. One patient developed deep infection with a chronic sinus. Three patients were noted to have mild to moderate discomfort around the prominent implant.

The behaviour of the periosteum during callotasis.

Periosteal behaviour during callotasis has been studied in animals but not in humans. Markers were inserted into the periosteum of seven patients who underwent callotasis. All of them had tibial callotasis, five patients had bone transport procedure and two had leg lengthening due to congenital disorder. They were followed up radiologically at regular intervals and during the distraction the movement of the periosteal markers was recorded. This enabled observation of the way the periosteum elongates during the procedure and also the calculation of periosteal strain at different stages at the points where the periosteum is fixed to bone. The study indicated that in most cases the periosteum acts as an elastic sleeve surrounding the newly formed tissue during lengthening. The site of attachment between sleeve and cortex became established early during lengthening, and hardly changed position at later stages. There was a wide spread of attachment sites and periosteal strains. Attachment sites were not related to pin or wire entry points, and strains were not predictive of callus shape or healing time.