ABSTRACT
There has been a considerable evolution of screws used for internal fixation of scaphoid fractures. We discuss here, early results of a recently introduced implant Synthes 3.0 mm headless compression screw used for scaphoid fracture fixation. Twenty eight patients with scaphoid fractures (five acute and 23 nonunions) were treated with internal fixation by this non-variable pitch screw over a period of 18 months. All nonunions had pedicle vascularized bone grafting. All five patients with acute scaphoid fracture fixation had radiological healing at a mean of 8 weeks. Fifteen of 23 scaphoid fracture nonunions showed definite signs and a further seven showed probable signs of radiological healing at a mean of 8 months. One nonunion has failed to unite after surgery.
Subject(s)
Bone Screws , Fracture Fixation, Internal/instrumentation , Fractures, Bone/surgery , Scaphoid Bone/injuries , Scaphoid Bone/surgery , Adult , Female , Fractures, Ununited/surgery , Humans , Male , Prosthesis Design , Treatment OutcomeABSTRACT
INTRODUCTION: Any increase in perforations in surgical gloves is a concern. We conducted a prospective study to find a clinically acceptable brand of latex-free gloves suitable for orthopaedic surgery. METHOD: Five different brands of gloves approved for use were selected. Two of the latex-free gloves were rejected as their clinical usability in arthroplasty was poor. The Cardinal Esteem latex-free glove has a smooth surface and was slippery, especially in total knee arthroplasty. The Biogel Skin Sense under glove was found to be unacceptably thick, affecting both surgical dexterity and tactility. RESULTS: The three remaining gloves were Biogel latex (control), Synthesis Polyco (latex-free) and Cardinal Esteem SMT (latex-free). Gloves were then collected for testing from 241 arthroplasties. Gloves used for primary knee/hip replacements were tested using a validated water distension test. Latex-free gloves were found to have higher perforation rates compared to latex. CONCLUSION: Our study demonstrates that currently available latex-free gloves have inferior clinical performance and are not recommended for use in arthroplasty surgery.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Gloves, Surgical , Acrylonitrile/analogs & derivatives , Equipment Design , Equipment Failure , Humans , Organic Chemicals , Prospective Studies , Rubber , StyrenesABSTRACT
The purpose of this study was to show the significance of a positive Propionibacterium acnes sample around a joint replacement. Records from the microbiology laboratory data over a 3-year period were reviewed to identify patients with prosthetic joints from whom Propionibacterium acnes was isolated at least once. The medical records of all those patients were retrieved and the demographic, clinical, microbiological and haematological data were collected and examined. The preoperative values of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Fifty patients underwent a routine revision of a joint arthroplasty; six patients had a joint aspiration. Only one patient had further revision surgery for infection. The preoperative values of ESR and CRP were very variable. The presence of a positive sample around a joint arthroplasty is of uncertain significance. Further studies are needed in order to establish uniform criteria for the diagnosis of infection caused by Propionibacterium acnes.
Subject(s)
Arthroplasty, Replacement , Gram-Positive Bacterial Infections/microbiology , Joint Prosthesis/microbiology , Propionibacterium acnes/isolation & purification , Prosthesis-Related Infections/microbiology , Adolescent , Aged , Aged, 80 and over , Blood Sedimentation , C-Reactive Protein/analysis , Female , Gram-Positive Bacterial Infections/diagnosis , Humans , Male , Middle Aged , Propionibacterium acnes/pathogenicity , Prosthesis-Related Infections/diagnosis , Retrospective StudiesABSTRACT
UNLABELLED: Malignant triton tumour (MTT) is a very rare soft tissue tumour. AIM: To report nine patients diagnosed with malignant triton tumour of the thigh between January 1996 and January 2005 to determine the natural history and factors that may affect survival in this aggressive tumour. METHODS: Due to the association of Neurofibromatosis (NF Type I) with malignant triton tumour, two groups of patients were identified: those with NF type I (Group I cases); and those without (Group II). RESULTS: Group I patients accounted for four cases and arose predominantly in young males, all tumours being high grade, >10 cm in size and all four patients died within two years of diagnosis. By contrast, the five patients of Group II were older, had smaller size and lower grade tumours and three patients are long-term survivors. CONCLUSION: Although the number of cases is small, our data supports the views that the natural history of MTT is more aggressive in patients with NF type I. This poor outlook could be attributed to the high frequency of Grade III histology in this disease and the large tumour size.
Subject(s)
Nerve Sheath Neoplasms , Soft Tissue Neoplasms , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Neoplasms, Multiple Primary , Nerve Sheath Neoplasms/mortality , Nerve Sheath Neoplasms/pathology , Nerve Sheath Neoplasms/therapy , Neurofibromatosis 1/pathology , Soft Tissue Neoplasms/mortality , Soft Tissue Neoplasms/pathology , Soft Tissue Neoplasms/therapy , Survival Rate , ThighABSTRACT
We retrospectively studied 35 patients who underwent endoprosthetic reconstruction of diaphyseal bone defects after excision of primary sarcomas. The patients were treated between February 1979 and May 1999 and had more than 5 years follow-up. There were 22 males and 13 females and the median age at diagnosis was 29 (8-75) years. The bone defect measured a mean of 19 (10-27.6) cm. There were 29 femoral reconstructions, three tibial and three humeral. Cumulative overall survival for all patients was 65% at 10 years. Cumulative overall survival for prosthetic reconstruction, using revision surgery as an end point, was 63% at 10 years. Cumulative risk of failure of reconstruction, including infection, fracture, aseptic loosening, local recurrence and amputation, was 60% at 10 years. Tibial and humeral reconstructions fared less well than femoral. Endoprosthetic replacement is a useful method of reconstructing long intercalary defects, especially if situated in the femur.
Subject(s)
Bone Neoplasms/surgery , Plastic Surgery Procedures/methods , Prostheses and Implants , Sarcoma/surgery , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Prosthesis Implantation , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
A compartment syndrome is an orthopaedic emergency which can result from a variety of causes, the most common being trauma. Rarely, it can develop spontaneously and several aetiologies for spontaneous compartment syndrome have been described. We describe a patient with diabetes who developed a spontaneous compartment syndrome. The diagnosis was delayed because of the atypical presentation.
Subject(s)
Anterior Compartment Syndrome/etiology , Diabetes Mellitus, Type 1/complications , Anterior Compartment Syndrome/diagnosis , Anterior Compartment Syndrome/pathology , Humans , Male , Middle Aged , Muscle, Skeletal/pathologyABSTRACT
An audit was performed to describe the current training conditions of senior house officers in neurosurgery in the UK and Eire. A postal questionnaire was sent to all neurosurgery senior house officers in a 6-month training period between February and August 2003. The questionnaire covered most aspects of working pattern, training and job satisfaction by the end of the 6-month post. The results from the audit showed that there are deficiencies in certain areas of the current system being employed for senior house officer training. Improvements to this training system in line with the establishment of a generic neurosciences training programme will benefit future surgical trainees.
