Hani B. Abdul-Jabar

Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff – a questionnaire study

INTRODUCTION Pneumatic tourniquets are used frequently in orthopaedic theatres to provide a bloodless field whilst operating on the extremities. Their use has given rise to complications and preventable damage due to over-pressurisation and prolonged application. We designed a questionnaire to assess the knowledge on tourniquet use among operating department assistants (ODAs) and specialist registrars (SpRs) in orthopaedic surgery. SUBJECTS AND METHODS A questionnaire was constructed using set guidelines from the Association of periOperative Registered Nurses (AORN) for recommended practice of tourniquet application. This was distributed to orthopaedic registrars with varying levels of experience and ODAs from five different NHS hospitals. The unpaired, two tailed t-test was used to test for statistical significance of results. RESULTS A total of 54 completed questionnaires were collected for analysis. The study population included 29 orthopaedic SpRs and 25 ODAs. The mean score for the orthopaedic SpRs as a group was 41.3% (SD 6.85; range, 29.0-54.8%). The mean score for the ODAs was 46.7% (SD 9.64; range, 23.3-62.9%) with a P-value of 0.024. CONCLUSIONS Most surgeons are taught how to use pneumatic tourniquets by their senior colleagues as no formal teaching is given. Most of the complications are infrequent and preventable. However, their consequences can be devastating to the patient with medicolegal implications. Our results show suboptimal knowledge of tourniquets and their use among SpRs and ODAs. This study highlights the need for amendments in training to improve the knowledge and awareness of medical practitioners on the application and use of tourniquets to prevent adverse events and improve patient safety.

A rare case of primary psoas abscess causing hip pain in a patient with hip replacement

The number of primary hip replacement procedures performed each year has exponentially increased, with a subsequent increase in associated revision procedures. Prosthetic infection is a serious concern for all arthroplasty surgeons. Psoas abscess is a rare condition with unknown etiology, and diagnosis is often missed or delayed, with subsequent increased morbidity, mortality and even possible inappropriate management. We report a patient presenting with a total hip replacement complaining of sepsis and right hip pain. No focus for the infection was isolated and an open washout of the right hip was performed due to suspected prosthesis infection. Investigations identified a psoas abscess with no evidence of prosthesis loosening. The psoas abscess was drained and the patient improved without the need to revise the prosthesis.

Tissue Factor Expression in the Symptomatic Carotid Plaque

Background The aims of this study were to identify that the differences in the natural history of patients with symptomatic and asymptomatic carotid stenosis may be reflected in differences in the expression of procoagulant protein factors. Methods Carotid artery plaques were obtained from 33 symptomatic and 4 asymptomatic patients with internal carotid artery stenosis of greater than 70%. These plaques were stained with monoclonal antibody against human tissue factor. Areas of staining for the cap and core were analysed using the analySIS computer programme. Results There were 37 patients, of whom 27 were male with a mean age 69.3 years and a range of 53 to 83 years. Statistical analysis using non-parametric tests revealed a significant increase in the area of positive staining for tissue factor in plaques taken from symptomatic patients when compared to those who were asymptomatic (P = 0001). Within the symptomatic patients group there was significantly increased tissue factor in the plaque core of those who were the most recently symptomatic (P = 0.003). Conclusions The unstable carotid artery plaque is associated with significantly increased tissue factor expression in the cap and core. Plaques from the most recently symptomatic patients have significantly more tissue factor in the core and this may represent part of the mechanism responsible for plaque destabilisation. More research is needed in this important area. Keywords Tissue Factor; Carotid stenosis; Stroke; Plaque stability