Radiological healing of lumbar spine stress fractures in elite cricket fast bowlers.

OBJECTIVES: Review magnetic resonance imaging (MRI) of elite adult fast bowlers with a history of lumbar spine stress fracture for evidence of bone healing. The findings will determine whether bone healing can occur in this population, and whether MRI may be used as a tool to assess bone healing and inform clinical decision making. DESIGN: Retrospective cohort. METHODS: Participants were elite Australian fast bowlers who sustained a lumbar spine stress fracture confirmed on MRI and had at least one subsequent MRI. Two radiologists independently reviewed all images. RESULTS: Thirty-one fractures from 20 male fast bowlers were reviewed. Median maximum fracture size was 6mm (range 2-25mm). Twenty-five fractures achieved bone healing, with a median 203 (IQR 141-301) days between the initial MRI (to confirm diagnosis) and the MRI when bone healing was observed. Fracture size and signal intensity of bone marrow oedema were positively associated with the number of days to the MRI when bone healing was observed (r2=0.245, p<0.001 and r2=0.292, p<0.001 respectively). Fractures which occurred at the same site as a previously united fracture took longer to heal than the first fracture (median 276 days to the MRI when bone healing was observed compared to 114 days for first fracture; p=0.036). CONCLUSIONS: Lumbar spine stress fractures in elite adult fast bowlers are capable of achieving complete bone healing, as demonstrated in the majority of bowlers in this study. Larger fractures, greater bone marrow oedema, and history of previous injury at the same site may require longer healing time which may be monitored with MRI.

Perioperative fluid therapy in elective colectomy in an enhanced recovery programme.

BACKGROUND: Although intraoperative fluid restriction is thought to provide clinical benefits, it may not be suitable for patients with significant co-morbidities, who may ultimately require greater amounts of intravenous fluid (IVF) post-operatively. This study investigates whether intraoperative fluid restriction can be implemented uniformly in patients undergoing elective colectomy within an Enhanced Recovery after Surgery (ERAS) protocol and investigates the association between fluid administration and clinical outcomes. METHODS: A retrospective review of prospectively collected data was conducted for all patients who underwent elective colectomy from September 2006 to 2010 within our ERAS programme. Patients received intraoperative fluid restriction with post-operative fluid administered as per clinical indications. Demographic data, American Society of Anaesthesiology (ASA) status, IVF administered and clinical outcomes were recorded. RESULTS: There were 227 patients (ASA 1: 47; ASA 2: 108; ASA 3: 72) with a median age of 71 years. Patients received a median of 2000 mL of crystalloid intraoperatively. There were no statistically significant differences between post-operative IVF amounts. Patients who experienced complications received significantly greater amounts of IVF post-operatively (5000 mL versus 2000 mL; P < 0.01) and post-operative IVF administration was the strongest predictor of complications in a logistic regression model. There was a trend suggesting higher median post-operative IVF prior to patients experiencing major complications (3000 mL versus 2000 mL; P= 0.07). CONCLUSION: Intraoperative fluid restriction can be employed uniformly in ASA 1-3 patients undergoing colectomy. Post-operative administration of greater fluid volumes was associated with adverse outcomes.