Retrograde Intramedullary Nailing for Femoral Shaft Fractures in Elderly Patients with Previous Ipsilateral Dynamic Hip Screw Fixation.

PURPOSE: We present our experience in managing femoral shaft fractures in elderly patients with previous ipsilateral dynamic hip screw fixation for extracapsular neck of femur fractures using retrograde intramedullary nailing implants. METHODS: This was a prospective consecutive study of patients presenting with a femoral shaft fracture and an ipsilateral dynamic hip screw fixation treated with unreamed retrograde femoral nailing. The Wilde modification of the Neer knee score was used as a primary outcome measure. RESULTS: A total of 16 patients were included (5 males, 11 females), with a mean age of 82 years (range 74-101). All fractures were closed and were due to low-energy trauma. There were 7 patients with 32-A1 fractures, 5 patients with 32-A2 fractures and 4 patients with 32-B1 fractures. All patients had an ipsilateral 4-hole plate dynamic hip screw implant. Minor surgical complications were recorded in 5 patients. Two patients died due to medical complications and were excluded from the final analysis. All remaining 14 patients achieved satisfactory outcomes at 12 months of follow-up with a mean Wilde modification of the Neer knee score of 15.5 (SD 2.53; range 13-20). CONCLUSIONS: Unreamed retrograde femoral nailing can achieve good functional recovery in elderly patients with a femoral shaft fracture and a previous ipsilateral dynamic hip screw fixation.

Primary septic arthritis of the acromio-clavicular joint: case report and review of literature.

Primary septic arthritis of the Acromio clavicular joint is an uncommon disorder and is rarely seen even in an immunocompromised individual. We report a case of primary septic arthritis of the acromio-clavicular (A-C) joint caused by Staphylococcus aureus without any predisposing factors. The patient was admitted with left shoulder pain, restricted movements and fever. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Blood cultures were positive for Staphylococcus-aureus. Magnetic resonance imaging (MRI) using Gadolinium enhancement revealed marked effusion in the A-C joint. Aspiration from the A-C joint revealed a heavy growth of Staphylococcus-aureus. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection and return to full function.

Targeted early rehabilitation at home after total hip and knee joint replacement: Does it work?

PURPOSE: This study evaluates the benefits of targeted early rehabilitation at home after total hip or knee replacement surgery and analyses the cost effectiveness of such a scheme. METHOD: Patients recovering from Total hip replacement (THR, n = 220) and Total knee replacement (TKR, n = 174) were assessed in a NHS District General Hospital setting. Suitability of patients for early rehabilitation at home scheme (RAHS) was assessed at the pre-operative clinic by rehabilitation team. Length of in-patient stay (LOSH), duration on the scheme, number of bed days saved, cost appraisal, readmission rates and complications were recorded. RESULTS: Targeted early rehabilitation resulted in reduced hospital stay (from 14-8.17 days for THR and from 12-8.21 days for TKR), without any increase in complication rates. Significance testing revealed no statistical difference between the patient groups with regards to age, residence status, mobility and transfer ability on their length of stay in hospital or on the rehabilitation scheme. The patients who underwent total knee replacement required significantly more number of visits by the rehabilitation team than those who underwent total hip replacement (p value < 0.05). This resulted in an overall saving of pound 301,124 for the trust over the study period. CONCLUSIONS: Targeted early rehabilitation resulted in reducing the length of hospital stay without an increase in complication rates. The use of such a scheme brought significant savings to the trust without an increase in readmission rates.