Perinatal outcome of prenatally diagnosed congenital talipes equinovarus.

OBJECTIVE: The purpose of this study was to investigate the perinatal outcome of prenatally diagnosed congenital talipes equinovarus. METHODS: This was a retrospective observational study of all cases of prenatally diagnosed congenital talipes equinovarus referred to a major tertiary fetal medicine unit. Cases were identified from the fetal medicine and obstetric databases and pregnancy details and delivery outcome data obtained. Details of termination of pregnancy, number of patients undergoing karyotyping as well as details of prenatal classification of severity were recorded. RESULTS: A total of 174 cases were identified. Of these, outcome data was available for 88.5% (154/174) of the pregnancies. Eighty three (47.7%) of cases were isolated and 91 cases (52.3%) were associated with additional abnormalities. There was a significant difference in birth weights between the two cohorts. Bilateral abnormality tended to be more severe. A high caesarean section rate was noted overall and a high preterm delivery rate seen in the isolated group. CONCLUSION: This study is important because it provides contemporary data that can be used to counsel women prenatally. In particular, the raised risk of preterm delivery and caesarean section as well as the increased severity of the condition when both feet are affected should be discussed. The poor perinatal outcome when additional anomalies are present and the increased risk of aneuploidy are also important factors.

Predictors of Compartment Syndrome After Tibial Fracture.

OBJECTIVES: The aim of our study was to identify the risk factors associated with the development of acute compartment syndrome (ACS) after a fracture of the tibia. DESIGN: Retrospective cohort study. SETTING: Orthopaedic trauma unit, university teaching hospital. PATIENTS: From our trauma database, we identified all patients who sustained an acute tibial diaphyseal fracture over a 13-year period. A retrospective analysis of 1407 patients was performed to record and analyze the OTA fracture classification, open fracture grade according to Gustilo, soft tissue injury classification according to Tscherne, treatment, development of ACS, and other patient demographics including smoking, occupation, and socioeconomic deprivation. MAIN OUTCOME MEASURE: A diagnosis of ACS was made using clinical signs, compartment pressure monitoring, or a combination of the 2. RESULTS: One thousand three hundred eighty-eight patients were included with a mean age of 39 (12-98) years, and 957 (69%) were male. One hundred sixty patients (11.5%) were diagnosed with ACS. On initial analysis, age, male gender, blue-collar occupation, sporting injury, fracture classification, and treatment with intramedullary nails were predictive of ACS (all P < 0.05). Age was the strongest predictor of developing ACS (P < 0.001), with the highest prevalence between 12-19 years and 20-29 years. Occupation (P = 0.01) and implant type (P = 0.004) were the only factors that remained significant after adjusting for age. On further subanalysis, implant type was not predictive when stratified by Tscherne class (P = 0.11). CONCLUSIONS: We have documented the risk factors for the development of ACS after an acute tibial diaphyseal fracture, with youth the strongest predictor. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Horner's syndrome with epidural anaesthesia.

A 29-year-old woman, primigravida, had labour induced for post-maturity following an uncomplicated antenatal course. She requested an epidural prior to commencement of syntocinon. This was administered in the sitting position without complication. The midwife noted drooping of the right eyelid of the patient 6.5 h following insertion of the epidural. Blood pressure and CTG remained reassuring. The obstetric anaesthetist reviewed the labouring woman and noted a right-sided ptosis as well as the right cheek being flushed and dry. There was no motor block and sensation in T1/T2/S3/S4 was intact. Horner's syndrome was diagnosed and anaesthetic review was recommended prior to further top-ups. The patient progressed well in the second stage of labour and did not require further top-ups and gave birth to a healthy male infant. Horner's syndrome resolved within 4 h following delivery and the postpartum period was uncomplicated.