Awareness About Sharps Disposal Leads to Significant Improvement in Healthcare Safety: an Audit of Compliance in the National Health Service During the COVID-19 Pandemic.

Needle-stick injuries (NSIs) pose serious health risks and can transmit blood-borne diseases (BBDs), such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus from the patient to the staff member. The purpose of this study was evaluation of appropriate and safe disposal of sharps within a 730-bed acute district general hospital (DGH) in the UK. One hundred sharps containers were audited in November 2019 to assess whether they complied with the health and safety regulations across surgical, medical, and acute wards. Meetings with the appropriate staff members were organised and posters placed throughout the hospital to raise awareness. One hundred twenty-five sharps containers were re-audited in July 2020, in the midst of the COVID-19 pandemic to ascertain if there was an improvement. In November 2019, a total of 56% of sharps containers were overfilled and hence were non-compliant with safety regulations. A re-audit performed in July 2020 found only 17% of sharps containers to be overfilled, which was a significant improvement (p = 0.0064) in practice. We noted that the overall compliance improved from being 44% in 2019 to 82.64 in the year 2020. This audit showed a significant improvement in the compliance of sharps bin containers in a DGH, signifying the increased awareness. It is necessary to audit sharps management regularly to accurately assess practice and prevent exposure to BBDs.

Outcomes of Magnetic Resonance Imaging Detected Occult Neck of Femur Fractures: Do They Represent a Less Severe Injury with Improved Outcomes?

PURPOSE: Occult hip fractures in the elderly can be missed on standard radiographs and are a known cause of morbidity. These are generally diagnosed on either magnetic resonance imaging (MRI) or computed tomography scan, depending upon local hospital policy. While there is an abundance of literature on hip fractures in general, little is known about the clinical outcome of patients with occult hip fractures. The aim of this study was to review the demographics, injury characteristics, management and clinical outcome of patients diagnosed with occult femoral neck fractures on MRI. MATERIALS AND METHODS: Using an existing hospital database, a retrospective analysis of all patients with occult hip fractures diagnosed by MRI scan from 2005 to 2014 was conducted. RESULTS: Sixty-four patients (23 males and 41 females) were included. The mean duration of hospitalisation was 16 days. A significantly higher percentage of patients were discharged to their pre-existing residence compared to National Institute for Health and Care Excellence (NICE) commissioning guidelines (66% vs. 45%). The 30- and 60-day mortalities were 3% and 10%, respectively. Mortality was lower in patients who underwent internal fixation (n=3/31) compared with those undergoing replacement (hemi/total hip arthroplasty) (n=5/12) (P=0.056). CONCLUSION: Patients with occult hip fractures diagnosed on an MRI scan are more likely to be discharged to their pre-existing residence and have lower mortality rates compared to NICE guidelines and National Hip Fracture Database (NHFD).

Phalangeal Osteomyelitis Caused by Staphylococcus lugdunensis - A Case Report of a Rare Association and Review of Literature.

INTRODUCTION: Staphylococcus lugdunensis is a skin commensal and its association with bone infections is rare. This case is first of its kind in literature where phalangeal osteomyelitis was caused by S. lugdunensis. CASE REPORT: A 56-year-old man presented with a chronic history of index fingertip pain to the orthopedic clinic. There was a partial resolution of symptoms earlier when commenced on anti-inflammatory and antibiotics in community by the general practitioner. A thorough clinical and radiological evaluation followed by a surgical debridement completely cured his symptoms. S. lugdunensis was isolated on culture in this case. CONCLUSION: Chronic finger-tip infections can be quite challenging to treat and one should have a high index of suspicion in treating such infections, especially with respect to the virulence of commensal micro-organisms.

Nail or plate fixation for A3 trochanteric hip fractures: A systematic review of randomised controlled trials.

Continuing controversy exists for the choice of implant for treating A3 trochanteric hip fractures so we undertook a systematic review of randomised controlled trials from the year 2000 onwards that have compared an intramedullary nail with an extramedullary fixation implant for the treatment of these fractures. Data on the occurrence of any fracture healing complications was extracted and the results combined to calculate Peto odd ratio. Nine studies involving 370 fractures were identified. Three studies involving 105 fractures compared an intramedullary nail with a static fixation (condylar, blade or locking plate). Plate fixation was associated with a fivefold increase risk of fracture healing complications (19/52(36.6%) versus 4/53(7.5%), odds ratio 0.14, 95% Confidence intervals 0.04-0.45). Six studies involving 265 fractures compared an intramedullary nail with a sliding hip screw. No statistically significant difference was found in the occurrence of facture healing complications between implants (13/137(9.5%) versus 11/128(8.6%) odds ratio 0.28, 95% Confidence intervals 0.50-2.80). Bases on the evidence to date from randomised trials, the use of fixed nail plates for surgical fixation of this type of fracture cannot be justified. Intramedullary nail fixation and the sliding hip screw have comparable fracture healing complication rates.

Arthroscopic Retrieval of over 100 Loose Bodies in Shoulder Synovial Chondromatosis: A Case Report and Review of Literature.

Synovial chondromatosis is a rare and benign condition of unknown cause. It is also known as synovial osteochondromatosis. It is characterized by involvement of the synovial tissue, which lines various joints of our body. Initial symptoms range from pain in the joint, locking of the joint at times, especially the knee, to arthritis of the joint that is a late feature of this condition. Although large joints such as the knee are commonly affected, involvement of the shoulder joint is a rare occurrence. Historically an open arthrotomy was preferred for removal of loose bodies coupled with a thorough synovectomy. However, arthroscopy for loose body retrieval has gained popularity over the past two decades. Arthroscopic surgery is an extremely skilled procedure and there is a learning curve for operating in certain anatomical areas such as the shoulder. However, not only does an arthroscopy provide the surgeon with an excellent view of the shoulder but the patient also has a faster recovery. We report a rare case of shoulder synovial chondromatosis in which more than 100 loose bodies were successfully retrieved by an arthroscopy in an individual who had an excellent outcome post-surgery, reaffirming our faith in the procedure. A detailed literature review of arthroscopic procedures is also presented.

Intraosseous Ganglion Cyst of Scaphoid: An Uncommon Cause of Radial Wrist Pain.

Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain.

Treatment of infective hepatitis: Where biomedicine has no answers, Ayurveda has!!

BACKGROUND: Infective hepatitis is a major health hazard in the Indian sub-continent with a large population and improper sanitation adding to the malady. Water-borne or infective hepatitis has no treatment in modern medicine. However, there are multiple accounts of how infective hepatitis can be successfully cured by Ayurvedic medicine. AIM: To review relevant studies in Ayurveda claiming to treat hepatitis. MATERIALS AND METHODS: A comprehensive PubMed search was conducted using 'Treatment of Hepatitis' and 'Ayurveda' as the primary search criterion. RESULTS: 27 articles were revealed by the search. 16 of these 27 articles were selected after reading all abstracts. All 16 articles were reviewed in detail and thereafter the current article was written. CONCLUSION: Ayurveda definitely has a lot to offer in terms of the treatment of hepatitis. However, a mass awareness of this potential of Ayurvedic medicine is desirable to achieve a larger impact on the society.

Double Dislocation of Interphalangeal Joints Accompanied with Contralateral Shoulder Dislocation: A Case Report.

Dislocation of any joint is an orthopaedic emergency and needs immediate attention by the attending physician. A delay in reducing a dislocated joint can lead to disastrous complications both immediately as well as in the long run. Although anterior dislocation of a shoulder joint is by far the commonest dislocation encountered by any emergency care physician, other joints may also get dislocated. In certain cases two joints may get dislocated simultaneously. Such dislocation is known as a double dislocation. Double dislocation of the proximal interphalangeal joint and the distal interphalangeal joint in the same finger is a rare injury. High impact loading at the fingertip is the primary cause in most cases and it is often associated with younger individuals playing contact sports. The right little finger is the digit commonly involved and this injury is evident in football players more often than not. Although closed reduction is a preferred treatment, it may not be always successful. Time of presentation, tendon interposition, associated swelling and co-existent phalangeal fractures are certain key impediments to a successful closed reduction manoeuvre. In patients with an open injury, a thorough wash out and appropriate antibiotic cover is mandatory. We report a rare case of double dislocation of the interphalangeal joints accompanied with contralateral shoulder dislocation in an elderly man sustained after a fall which was treated successfully with closed reduction and early mobilization.

Return to driving after total knee arthroplasty.

OBJECTIVE: The aim of this study was to ascertain the duration from time of surgery to resumption of driving after total knee arthroplasty (TKA) and to examine recommendations in the literature. METHODS: All patients who underwent primary unilateral TKA and were driving within 6 months preceding the arthroplasty were included. The patients' age, gender and side of the TKA were noted. The time taken to resume driving by each patient as well as the type of vehicle were noted. RESULTS: Ninety-eight patients were included in our survey. Fifty-five patients (56%) underwent TKA on their left knee and 94 (96%) were manual car drivers. Seventy-seven patients (79%) were able to resume driving within 6 weeks of TKA; 18 patients (18%) were able to do so at Week 12 postoperatively. The remaining 3 patients (3%) did not feel confident enough to drive at Week 12 postoperatively. No patient reported deterioration in driving ability, whereas 27 patients (27%) felt a subjective improvement in their driving ability. CONCLUSION: The vast majority of patient resumed driving by 6 weeks postoperatively. Only a small number did not return to regular driving. Patients are advised to resume driving after 6 weeks but should wait until they feel comfortable and confident enough to do so.

Ulnohumeral debridement arthroplasty: a retrospective study and midterm outcome results.

INTRODUCTION: Osteoarthritis of the elbow (OA) is an uncommon entity. In most cases, it can be attributed to long-standing occupational stress, previous injury, loose bodies in the joint. Patients complain of pain and stiffness at the extremes of movements. This can be caused by degenerative changes at the radio-capitellar, ulnohumeral joint or due to ulnar nerve symptoms. We perform the Outerbridge-Kashiwagi (OK) procedure at our institution for the management of problematic primary elbow osteoarthritis. OBJECTIVES: The purpose of this retrospective study was to evaluate the outcome of ulnohumeral arthroplasty in 13 elbows which was done over a period of 6 years in our institution. Range of movement (ROM) and pain were measured, and X-rays were assessed. METHODS: Thirteen patients who underwent ulnohumeral arthroplasty between 2006 and 2012 were included in the study. There were 11 males and 2 females with an average age of 54 years (35-78), with a mean follow-up of 4 years. RESULTS: The pain score improved from 8 (6-10) to 2 (0-2) using the visual analogue scale. Eleven patients were completely pain-free. There was an improvement of 27° in the flexion extension arc. There were no complications. CONCLUSIONS: Ulnohumeral arthroplasty can yield good pain relief and moderate improvement in the range of movement. It is a relatively easy and safe procedure to perform in patients with primary degenerative osteoarthritis of the elbow.

Bite injuries to the hand - review of the literature.

Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.