Survivorship of the C-Stem total hip replacement using the "French Paradox" technique.

BACKGROUND: This study evaluates the survivorship of the C-Stem total hip replacement, using the "French Paradox" method, at medium-term follow-up. METHODS: 321 cemented total hip replacements in 307 patients were performed, using the canal-filling technique for the femoral stem. Survival analysis was performed for all-cause revision. The secondary outcome was aseptic loosening of the stem. RESULTS: Revision rate for all reasons was 2%. Overall ten-year survival was 95%. There were no revisions for femoral stem aseptic loosening. CONCLUSION: This is a unique study demonstrating successful outcomes of total hip replacement using the "French Paradox" technique with a triple-tapered stem.

Arterial Injury in the Upper Limb Resulting from Dog Bite.

Dog bites in the upper limbs have particular significance, because despite the small size of the puncture wounds, penetration is deep, causing serious injuries to deeper structures. There is currently very little data relating to upper extremity dog bite arterial injury. We present the case of a 32-year-old man who sustained a dog bite injury to his right arm, leading to direct puncture and spasm of the brachial artery. He was successfully treated with a jump bypass graft to the right brachial artery, with the use of the reversed ipsilateral cephalic vein as a conduit. We identified 34 cases in the literature reporting upper limb arterial injury secondary to dog bite. Twenty-two cases in the literature detailed axillobrachial artery damage (65%), 24% radial artery, 3% ulnar artery, and 9% combined. Presentation was most commonly with diminished pulses found in at least 45% of the patients. Arterial thrombosis occurred in 29% of cases of single artery injury, transection in 15%, intimal tear in 9% of cases, and undisclosed in 44%. Management most commonly included interposition graft (47%) and primary repair (20%), while 15% did not undergo surgical intervention, 9% underwent ligation, and 3% were treated with thromboembolectomy. Follow-up data for these patients are scarce, with some experiencing residual neurological deficit. This report highlights the importance of prompt recognition and treatment of vascular injury following dog bite to attain an optimal outcome and minimize complications.

Ankle fractures: Getting it right first time.

INTRODUCTION: Ankle fractures are common injuries presenting to trauma departments and ankle open reduction and internal fixation (ORIF2) is one of the first procedures targeted in early orthopaedic training. Failure to address the fracture pattern with the appropriate surgical technique and hardware may lead to early failure, resulting in revision procedures or premature degenerative change. Patients undergoing revision ORIF are known to be at much greater risk of complications and many of these secondary procedures may be preventable. METHOD: A retrospective analysis of all patients attending our unit for ankle ORIF over a two year period was undertaken. Patients were identified from our Bluespier database and a review of x-rays was undertaken. All patients undergoing re-operation within eight weeks of the primary procedure were studied. The cause of primary failure was established and potential contributing patient and surgical factors were recorded. RESULTS: 236 patients undergoing ankle ORIF were identified. 13 patients (5.5%) returned to theatre for a secondary procedure within eight weeks. Within this group, seven (54%) patients returned for treatment of a neglected or under treated syndesmotic injury, three (23%) for complete failure of fixation, two (15%) with wound problems and one (8%) for medial malleolus mal-reduction. Of the patient group, five (39%) were known type 2 diabetics. Consultants performed two (15%) procedures, supervised registrars five (39%) and unsupervised registrars six (46%) operations. CONCLUSION: Errors are being made at all levels of training in applying basic principles such as restoring fibula length and screening the syndesmosis intra-operatively. Appropriate placement and selection of hardware is not always being deployed in osteopenic bone resulting in premature failure of fixation and fracture patterns are not being fully appreciated. Patients are undergoing preventable secondary procedures in the operative treatment of ankle fractures.