Compression stockings in the management of fractures of the ankle: a randomised controlled trial.

In this randomised controlled trial, we evaluated the role of elastic compression using ankle injury stockings (AIS) in the management of fractures of the ankle. A total of 90 patients with a mean age of 47 years (16 to 79) were treated within 72 hours of presentation with a fracture of the ankle, 31 of whom were treated operatively and 59 conservatively, were randomised to be treated either with compression by AIS plus an Aircast boot or Tubigrip plus an Aircast boot. Male to female ratio was 36:54. The primary outcome measure was the functional Olerud-Molander ankle score (OMAS). The secondary outcome measures were; the American Orthopaedic Foot and Ankle Society score (AOFAS); the Short Form (SF)-12v2 Quality of Life score; and the frequency of deep vein thrombosis (DVT). Compression using AIS reduced swelling of the ankle at all time points and improved the mean OMAS score at six months to 98 (95% confidence interval (CI) 96 to 99) compared with a mean of 67 (95% CI 62 to 73) for the Tubigrip group (p < 0.001). The mean AOFAS and SF-12v2 scores at six months were also significantly improved by compression. Of 86 patients with duplex imaging at four weeks, five (12%) of 43 in the AIS group and ten (23%) of 43 in the Tubigrip group developed a DVT (p = 0.26). Compression improved functional outcome and quality of life following fracture of the ankle. DVTs were frequent, but a larger study would be needed to confirm that compression with AISs reduces the incidence of DVT.

Extracranial and transcranial ultrasound assessment in patients with suspected positional 'vertebrobasilar ischaemia'.

OBJECTIVES: A diagnosis of 'positional' vertebrobasilar ischaemia is considered in patients presenting with dizziness/vertigo during lateral neck rotation/extension and is attributed to bony 'nipping' of the vertebral artery (VA). This study reviewed our experience with extracranial and transcranial ultrasound to determine whether a diagnosis of 'positional' vertebrobasilar ischaemia was associated with any changes in flow in the extracranial VA and the P1 segment of the posterior cerebral artery (PCA) during head turning. METHODS: A retrospective case note review was undertaken in 46 patients with an accessible window for transcranial Doppler who had undergone extracranial and transcranial assessment of flow velocity and flow directionality in the VA and PCA while the head was moved into positions that normally triggered the patient's symptoms. RESULTS: Positional 'vertebrobasilar symptoms' were triggered by lateral head rotation in 35 patients (76%), while 11 (24%) developed symptoms following neck extension. Only one patient was found to have a significant carotid stenosis (symptoms unchanged following carotid endarterectomy) and none had significant disease in the extracranial VAs. None of the patients exhibited any change in extracranial VA flow during head turning/extension and none had reversal of flow either. Similarly, there was no change observed in the PCA flow characteristics during head turning. The majority of patients (74%) were subsequently referred to the Ear, Nose and Throat (ENT) department, and 94% of the patients noted an improvement in symptoms following entry into a vestibular rehabilitation programme. CONCLUSIONS: A diagnosis of 'positional' vertebrobasilar ischaemia should be made with extreme caution and only after a specialist assessment in a Balance Centre.

Security swipe cards and scanners are a potential reservoir for hospital-acquired infection.

INTRODUCTION: Hospital-acquired infections complicate 10% of hospital admissions resulting in increased morbidity, mortality and cost to hospitals. Most hospitals issue doctors with plastic swipe cards that function as electronic keys to access clinical areas. The card is handled many times a day, often before direct patient contact. The aim of this study was to determine if swipe cards harbour potentially harmful bacteria. SUBJECTS AND METHODS: On a single day, doctors working in the surgical directorate completed a questionnaire to determine their pattern of swipe card use. Cards were inoculated onto agar plates and incubated for 48 h under standard laboratory conditions, following which the number of colony forming units (CFUs) cultured from each card was determined. Representative colonies were sampled and sub-cultured for staphlococcal, enterococcal, coliform and pseudomonad species. Isolated bacterial pathogens were tested for antimicrobial sensitivity. Swipe-card scanners were swabbed for microbiological culture on the same day. RESULTS: All cards were colonised with environmental bacteria (mean, 73 CFU). Of cards, 21% were contaminated with pathogenic bacteria including Staphylococcus aureus (5.1%), Pseudomonas putida (2.6%), and coliform species (12.8%). The pattern of card use did not significantly affect the amount of bacterial contamination, but infrequent use of the card and keeping the card in a pocket or wallet was associated with higher levels of contamination. Environmental bacteria were cultured from 88% of card scanners, the highest counts coming from scanners in main theatres and the day-surgery unit. CONCLUSIONS: Doctors' swipe cards are contaminated with, and may therefore be a reservoir for, pathogenic bacteria implicated in hospital-acquired infection.