Reliability of the radiological assessments of radiolucency and loosening in total hip arthroplasty using PACS.

We evaluated the reliability of three commonly used radiological assessments of total hip arthroplasty (THA) using the electronic picture archiving and communications system (PACS). Thirty-three patients were selected at random at a mean of 7.2 years after THA. The Barrack, Gruen and Hodgkinson evaluations of cementing quality, loosening/radiolucency were graded. Three observers assessed each radiograph (one consultant orthopaedic surgeon, one senior orthopaedic registrar and one senior house officer). Four weeks after the initial assessment, each radiograph was reviewed a second time. The findings indicated that the intra- and inter-observer reliability of the Barrack, Gruen and Hodgkinson methods were questionable. Inter-observer reliability using the Gruen system was poor, using the Barrack system it was moderate to good, and fair to good using the Hodgkinson assessment. Intra-observer reliability was moderate to good for Barrack assessment, poor to good using Gruen zone assessments, but good to very good for the Hodgkinson assessment. The use of Barrack, Gruen and Hodgkinson assessments to evaluate femoral and acetabular loosening should be questioned since these exhibit limited inter- and intra-observer reliability on PACS radiographs, but of the three, the Hodgkinson system is the most reliable.

W.S.B.--a fluoroscopy C-arm communication strategy.

BACKGROUND: Good communication between an operating clinician and the attending radiographer when using C-arm fluoroscopy is vital. Efficient and safe use of ionising radiation protects all theatre staff. The object of this study was to design and test a single communication language for use in all fluoroscopy-assisted procedures. METHOD: A clinician guiding a radiographer performed a control 'no-rules' experiment of 56 targeting manoeuvres with a fluoroscopic C-arm on a scientific model. A single beam laser replaced the usual ionising radiation beam. The time taken for each targeting along with the laser exposure required was recorded. Following a period of instruction, the experiment was repeated using only our pre-defined communication strategy. The data was collected for statistical analysis. RESULTS: A statistically significant reduction was seen in the time taken for each targeting manoeuvre and the laser exposure required when using our strategy. CONCLUSION: This study shows that using our pre-prepared communication strategy could significantly improve efficiency and safety of fluoroscopic C-arm use.

Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): technique description with prospective series of 20 tibial fractures.

Bridging-MILPO provides an alternative to other internal and external devices in the management of tibial fractures. A pre-contoured, stainless steel locking compression plate (Synthes) is fed subcutaneously through a small incision from a site distant to the zone of injury across the fracture site, respecting the fracture haematoma. Two or three locking screws are placed specifically at the ends of the plate. This 'spring leaf' like construct allows micro-motion at the fracture site. This induces callus formation, initially on the opposite cortex from the plate, accelerated by the allowance of immediate full weight bearing post-operatively. Twenty cases were performed over a 3-year period. Excellent final results were obtained in 19 out of the 20 cases. Complications included two superficial wound infections, one delayed union and one case needed revision plating. No loss of reduction was seen in any of the cases.