Thumbs up: Needle marker technique for preoperative localisation of radiolucent foreign bodies with ultrasonography.

BACKGROUND: A 26-year-old man presented with pain and swelling after pricking his right thumb pulp with a thorn, gardening three-weeks previously. TECHNIQUE: After a thumb digital ring block with local anesthetic, a linear array ultrasound (US) transducer (frequency XX) identified a foreign body (FB) in both longitudinal and transverse planes. This was a hyperechoic FB, 5mm in length with surrounding hypoechoic shadow, denoting granulation tissue and fluid collection. Two 20G needles were passed orthogonally, in-line with the US transducer, from the fingertip and ulnar aspect. The needle tips were placed touching, just deep to the FB, preventing displacement. A longitudinal incision was made over the intersection, revealing the FB. DISCUSSION: Here, we describe peri-operative localization of radiolucent FBs with ultrasonography needle placement in superficial or deep planes as an adjunct to necessary surgical exploration. This method has a small learning curve, reduces the required incision and helps prevent pushing the FB deeper during dissection.

Intrarater and interrater reliability of the socket version marker in total hip replacement.

The aim of this study was to evaluate the intraobserver and interobserver variability in determining the socket version using the wire marker. 100 anteroposterior pelvis radiographs of cemented primary total hip replacements were reviewed by two orthopaedic consultants and registrars, twice. Intrarater and interrater reliability were assessed using Cohen's kappa. Intrarater kappas for junior doctors were 0.78 and 0.80, 0.73 and 0.62 for Consultants. Interrater kappas were 0.60 between the two Consultants and 0.63 between the two Junior Doctors. The kappas between Consultant A and Junior Doctor A was 0.61, between Consultant A and Junior Doctor B was 0.59, between Consultant B and Junior Doctor A was 0.53 and between Consultant B and Junior Doctor B was 0.46. Intrarater reliability was substantial for the two junior doctors and the two consultants. Interrater reliability was moderate-to-substantial between the two consultants, between the two junior doctors and between each pair of junior doctors/consultants.