Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Femoral neck fractures are one of the most common fractures treated by an Orthopaedic surgeon. Arthroplasty is the recommended management for intracapsular neck of femur fractures in the elderly population owing to the high risk of avascular necrosis of the femoral head following an internal fixation. Elderly patients with intracapsular fractures deemed high risk for anaesthesia (American Society of Anaesthesiology Grade more than 2) are recommended a hip hemiarthroplasty. Routine practice throughout the United Kingdom is to obtain a postoperative check radiograph for all hip hemiarthroplasty patients prior to their discharge from the hospital. This may be done for various reasons like checking the presence of any peri-prosthetic fracture, the position of the components along with the presence of any dislocation. However, it is unclear whether a radiograph is the sole identifier of such complications. Through this study, we aim to analyse whether routine recommendation of post-operative radiographs following hip hemiarthroplasty affects the clinical outcome, and whether it is effective in identifying potential complications before the patients report any signs or symptoms.

Fracture Nonunions and Delayed Unions Treated With Low-Intensity Pulsed Ultrasound Therapy: A Clinical Series.

The incidence of nonunion of fractures has been steadily rising owing to improved life expectancy following severe injuries along with rising cases of polytrauma. Once a nonunion is established, the chances of spontaneous healing are deemed to be quite low. Fracture nonunion continues to be a challenge in clinical practice with nonunions having a considerable impact on patient's quality of life causing both functional and psychosocial disability. Low-Intensity Pulsed Ultrasound (LIPUS) therapy is being projected as a viable and non-interventional alternative to surgical management of nonunions and delayed unions. LIPUS therapy is being widely recommended as a standalone treatment option for the treatment of established nonunions and delayed unions as it is believed to promote healing in all phases of fracture healing viz., inflammatory, intramembranous ossification, chondrogenesis, endochondral ossification and remodelling. In the current scenario of varying results and unclear clinical role of LIPUS therapy, we present a prospective case series of fracture nonunions and delayed unions treated with LIPUS therapy at a large District General Hospital.

A Biomechanical Comparison of Two Techniques of Latarjet Procedure in Cadaveric Shoulders.

Traumatic anterior instability of the shoulder is commonly treated with the Latarjet procedure, which involves transfer of the coracoid process with a conjoint tendon to the anterior aspect of the glenoid. The two most common techniques of the Latarjet are the classical and congruent arc techniques. The aim of this study was to evaluate the difference in force required to dislocate the shoulder after classical and congruent arc Latarjet procedures were performed. Fourteen cadaveric shoulders were dissected and osteotomised to produce a bony Bankart lesion of 25% of the articular surface leading to an "inverted pear-shaped" glenoid. An anteroinferior force was applied whilst the arm was in abduction and external rotation using a pulley system. The force needed to dislocate was noted, and then the shoulders underwent coracoid transfer with the classical and congruent arc techniques. The average force required to dislocate the shoulder after osteotomy was 123.57 N. After classical Latarjet, the average force required was 325.71 N, compared with 327.14 N after the congruent arc technique. This was not statistically significant. In this biomechanical cadaveric study, there is no difference in the force required to dislocate a shoulder after classical and congruent arc techniques of Latarjet, suggesting that both methods are equally effective at preventing anterior dislocation in the position of abduction and external rotation.

Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging findings in 33 patients.

STUDY DESIGN: Study of magnetic resonance imaging (MRI) of tuberculosis of spine to determine the incidence and features of isolated tuberculous involvement of the posterior spinal elements. OBJECTIVE: To describe the MRI findings in patients with isolated tuberculous involvement of the posterior spinal elements. SUMMARY OF BACKGROUND DATA: Spinal tuberculosis is more common in the eastern countries than in the western world. Recently, there has been a renewed interest in tuberculosis in the west because of its re-emergence, especially in immunocompromised patients (e.g., HIV). The classic radiologic picture of "two vertebral disease with the destruction of the intervertebral disc" is easily recognized and readily treated, but its atypical forms are often misdiagnosed and mistreated. METHOD: A total of 33 patients 13-53 years of age (16 men, 17 women; mean age 28.30 years) with proven tuberculosis of posterior element of the spine were retrospectively evaluated. The clinical and imaging data were studied in all 33 patients. RESULTS: Involvement occurred from C2 to L5 vertebral levels. Most commonly, involvement was seen in the thoracic vertebrae (16 patients, 48.5%) followed by lumbar vertebrae (13 cases, 39.4%) and cervical vertebrae (4 patients, 12.1%). The laminae were most commonly involved (24 patients, 72.7%; 8 bilateral, 16 unilateral) followed by pedicles (20 patients, 60.6%; 6 bilateral, 14 unilateral), articular processes (19 patients, 57.5%; 5 bilateral, 14 unilateral), spinous processes (19 patients, 57.5%), and transverse processes (12 cases, 36.4%; 5 bilateral, 7 unilateral). Bone destruction and marrow changes were seen in all patients. Involvement of the entire posterior arch was seen in eight patients. A total of 23 patients revealed extraspinal soft tissue collections. Intraspinal extradural granulation tissue/abscess was seen in 11 patients. Spinal cord was either displaced or compressed in 15 patients, and abnormal high signal intensity intrinsic cord changes were seen in eight patients. CONCLUSION: In tuberculosis of the posterior element of the spine, MRI is extremely useful in evaluating the extent of involvement and response to therapy of isolated tuberculosis of posterior elements. Involvement of posterior elements due to tuberculosis is not so uncommon.