Cardiopulmonary resuscitation on television: are we miseducating the public?

BACKGROUND: Out-of-hospital cardiac arrest survival rates in the UK are poor, and non-medically trained individuals have been identified to perform substandard cardiopulmonary resuscitation (CPR). Millions watch televised medical dramas and, for many, these comprise their only education on CPR. This study aims to investigate the quality of CPR portrayed on these programmes and whether this has an effect on public knowledge. METHODS: Prospective observational study of 30 consecutive episodes of three popular medical dramas. Public knowledge of CPR and viewing habits were assessed with a survey of non-medically trained personnel. RESULTS: 90 episodes were reviewed with 39 resuscitation attempts shown. Chest compression rates varied from 60 to 204 compressions per minute with a median of 122 (95% CI 113 to 132). Depth varied from 1.5 to 7.5 cm with a median of 3 (3.15-4.31). Rate and depth were significantly different from the UK Resuscitation Council Guidelines (2010) (p<0.05, t-test). Survey participants (n=160, 80% response rate) documented what they thought was the correct rate and depth of chest compressions and were scored accordingly. Those who documented watching medical dramas regularly scored significantly worse than those who watched occasionally (p<0.05, Mann-Whitney test). CONCLUSION: Televised medical dramas depict CPR inaccurately and laypersons may be less well informed about the correct technique the more they tune into these programmes. While there may be other confounding variables, given the popularity of television medical dramas, the poor depiction may be significantly contributing to poor public CPR knowledge and represent a potential new avenue of public education.

A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail.

Aim: To present a novel technique developed in our institution to remove incarcerated and broken intramedullary (IM) tibial and femoral nails. Background: IM nails are commonly used to treat diaphyseal fractures in both the tibia and femur. These nails can become problematic for the orthopaedic surgeon when they need to be removed, especially in the rare event that the nail has failed and broken. This can leave part of the nail deep in the bone and incarcerated. Multiple techniques have been described to remove a broken nail but we present a novel technique developed based on our experience. Technique: After all other methods to remove the broken nail have failed, a window technique can be employed. This requires a small window of bone to be removed from the cortex overlying the remaining IM nail. A carbide drill is then used to drill a hole into the nail to gain purchase. The edge of an osteotome is placed in the hole in the nail through the window and gently hammered upwards to push the nail towards the over-reamed nail entry point. The nail is repeatedly drilled and pushed until the nail can be removed. The bone window is then replaced. Conclusion: This is a novel technique that works when all other options including hooks, wire stacks and specialist nail removal techniques have failed. It is simple, efficient and effective for both the tibial and femoral nails. How to cite this article: Somerville CMB, Hanschell H, Tofighi M, et al. A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail. Strategies Trauma Limb Reconstr 2022;17(1):55-58.

Accuracy and reproducibility of visual estimation of the acetabular cup positioning in total hip arthroplasty on plain radiographs by orthopaedic surgeons.

OBJECTIVES: To examine whether trauma and orthopaedic surgeons could visually assess the anteversion and inclination of a total hip replacement acetabular component from standard anteroposterior radiograph and anteversion on a standard lateral radiograph with accuracy or reproducibility.Main outcome measurement: The main outcome was accuracy of visual estimations of angles. The secondary outcome was whether these estimations were reproducible though intra-observer variability. RESULTS: Mean angles of anteversion on the anteroposterior, inclination on the anteroposterior and anteversion on the lateral on formal measurements were 15.2°, 45.4° and 19.9°; and the visual estimates were 17.5°, 45.9° and 18.2°, respectively. When comparing the visual estimates of surgeons and formal measurements, the results ranged from very poor to very good. Intra-observer reproducibility was moderate for all angles. The difference between the consultants and speciality registrars was not significant. CONCLUSION: This study illustrated that not all orthopaedic surgeons were able to visually estimate angles well. Although some of our participants were very accurate, there were some who statistically were very poor. This level of inaccuracy can lead to inconsistency and we strongly suggested specialist software is used to assess acetabular cup position on postoperative plane radiographs rather than relying on 'visual estimations'.

Tropical Pyomyositis: An Unusual Cause for Sepsis and Hip Pain in Adults the United Kingdom.

Introduction: Pyomyositis is a bacterial infection, commonly due to Staphylococcus aureus infection resulting in myositis on muscle biopsy and abscess formation in skeletal muscle. . Although often prefaced with the term '"tropical' tropical" alluding to its prevalence in tropical climates this disease does present, albeit rarely, in adult patients residing in temperate climates as well. Case Presentation: A 60 year -year-old woman living in the UK with no risk factors presented apyrexial with native left hip and thigh pain and was initially diagnosed with sciatica and discharged from the Emergency Department. She subsequently re-presented days later with worsening pain and inability to weight bear; blood tests showed she had worsening inflammatory markers. Her magnetic resonance imaging (MRI) scan showed a collection in the musculature of her left hip adductors. She was diagnosed with Pyomyositis. The collection was drained via ultrasound and she was treated with intravenous IV antibiotics, followed by oral antibiotics, and made a full recovery. Conclusion: Our report highlights the need for thorough and complete investigation, including MRI scanning for patients with unclear causes of hip pain and raised inflammatory markers. It demonstrates how conditions such as pyomyositis can still arise outside the expected demographics and this could have been easily confused with a septic hip had she not undergone further imaging.