Safety of total hip replacement following an intra-articular steroid hip injection--an audit.

The aim of this study was to determine the deep infection rates in patients who underwent a total hip replacement after having had a prior diagnostic steroid injection into the same hip. We identified and reviewed the case notes, relevant radiographs and microbiology reports of all patients who underwent a total hip replacement after a diagnostic steroid hip injection in our unit from 1 January 2007 to 31 April 2009. There were 40 patients. (10 males and 30 females) Their mean age was 68.4 (52-82) years. The mean time interval from the injection to the joint replacement was 6.2 (2-23) months. The mean follow-up was 23.2 (11-37) months. None of the patients in the study group developed a deep infection during this followup period. Diagnostic intra articular steroid and local anaesthetic injection prior to total hip replacement appears to be safe.

A simple and inexpensive splint for phalangeal fractures.

This article describes the fabrication and application of a simple and inexpensive splint for treating phalangeal fractures.

Leg length discrepancy in computer navigated total hip arthroplasty - how accurate are we?

INTRODUCTION: The success of total hip arthroplasty (THA) depends on the restoration of 2 important parameters - hip offset and leg length. Leg length discrepancy (LLD) after THA is associated with back pain, gait disorder, general patient dissatisfaction and aseptic loosening. Hence it is of utmost importance to minimise LLD. METHODS: This is a retrospective study where we compared the reproduction of leg lengths between navigated THA group (152 patients) and nonnavigated THA group (57 patients). The leg lengths were measured radiologically using Ranawat technique on AP pelvic radiograph. RESULTS: In the navigated group, the leg lengths of the reconstructed hips were restored to within 6 mm of the opposite leg in 146 patients (96.05%) while 6 patients (3.94%) had LLD of more than 6 mm. In the nonnavigated group, 29 patients (51%) had their leg lengths restored within 6 mm of the opposite leg while the remaining 28 patients (49%) had their LLD greater than 6 mm. Statistical analysis of the 2 pairs of LLD measurements (navigated hip and nonnavigated group) using Mann-Whitney U-test revealed significant difference between these two groups (p<0.001). CONCLUSIONS: Based on our results we conclude that computer navigation is an excellent tool to facilitate the successful reproduction of leg length in THA.

Periosteal tension band fixation of a pronation external rotation type fracture of the ankle in a child.

Interposed soft tissues can block the anatomical reduction of displaced physeal fractures in children and may necessitate surgical removal. The authors describe a new technique in which they surgically freed the interposed distal-based periosteal flap in an irreducible Salter-Harris type II fracture in a 6-year-old boy and then used this flap in a tension band mode to stabilize the fracture. The thick periosteal flap was held under tension and was reattached to the tibial metaphysis using a 3.5-mm cortical screw and a multi-spiked soft tissue washer. The fracture healed satisfactorily, and the patient regained his ankle function and range of motion by 2 months. Periosteal tension band fixation achieves good skeletal stabilization and avoids more than 1 surgical incision.

Centromedullary manipulation and stabilization of completely displaced proximal humerus fractures in adolescents.

Completely displaced metaphyseal fractures of the proximal humerus in older children may need reduction and stabilization. The authors describe a technique for closed reduction and intramedullary stabilization of these fractures using a centromedullary pin inserted from the distal humerus through a small distal incision. This technique was used successfully in 2 adolescents. Retrograde elastic nails avoid scars in front of the shoulder, impingement problems from prominent extramedullary metal work, and further surgery of a similar magnitude to remove the metalwork. Based on the authors' experience, they recommend this method for reduction and stabilization of displaced irreducible metaphyseal fractures of the proximal humerus in older children and adolescents.