Neil G Burke

A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements

AIM OF THE STUDY It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing. METHOD 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient. RESULTS The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups. CONCLUSION The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate.

Attitudes of the medical profession to whole body and organ donation

Cadaveric dissection remains an important part of undergraduate medical education in anatomy. In a concerted effort to rise the number of doctors in practice in Ireland the amount of medical school placements has been increased steadily since 1995. This poses a problem as the number of cadavers has remained unchanged despite an overall increase in the population Ireland over the last twenty years. The medical profession plays a central part in raising public awareness of living and post-mortem organ donation. Previous studies have examined the attitudes of medical students to whole body donation, however to our knowledge this is the first study that evaluates the attitudes of medical professionals. We assess the opinions of junior and senior doctors at the time of their dissection experience and in their current practice. We show that their attitudes have changed as their clinical experience grows.

Patient-reported outcomes after Silastic replacement of the trapezium for osteoarthritis

This retrospective study evaluated 69 Swanson trapezium replacements performed between 1990 and 2009 for trapeziometacarpal osteoarthritis in 58 patients. Pain and function were assessed using the Michigan Hand Questionnaire and the Disability of the Arm, Shoulder and Hand questionnaire. Patients had a mean age of 62 years at the time of surgery, with a mean time of 7.7 years (range 9 months to 19 years) from surgery to follow-up interview. There was no association between outcome scores and the length of follow-up, suggesting that the results are maintained over time (Spearman’s rank correlation test < ±0.2). Scores for activities of daily living and work-related activities were higher when surgery was on the dominant hand (p < 0.05). Silicone trapezium replacement remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to nonoperative management.

Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study.

Purpose. To compare the efficacy of locking plate fixation with and without inferomedial screws in maintaining the reduction of a proximal humeral fracture. Methods. 22 synthetic humerus models were used. A standardised 3-part proximal humeral fracture with a 4-mm wedge segment was created and fixed with a locking plate and screws with (n=11) and without (n=11) inferomedial screws. The intrafragmentary motion of the construct at 250, 500, 750, and 1000 cycles of 532 N loading, and the load to failure of the 2 groups were compared. Results. Locking plate fixation with inferomedial screws reduced the mean intrafragmentary motion in all cycles (p±0.01) and increased the load to failure (1452 N vs. 1159 N, p±0.001), compared to fixation without inferomedial screws. Conclusion. Additional inferomedial screws provide medial column support for fracture healing. This may reduce intrafragmentary motion and thus implant complications resulting from varus malalignment such as screw perforation or loss of reduction.

Locking plate fixation for proximal humerus fractures.

Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

The Segond fracture: a clue to intra-articular knee pathology.

This short report presents the case of a 32-year-old man with a knee injury sustained while playing football. A plain radiograph revealed a Segond fracture and a subsequent MRI confirmed a complete anterior cruciate ligament rupture. While the Segond fracture, and its associated intra-articular pathology, is well recognised among orthopaedic surgeons, it is less well recognised among staff in the emergency department. The report aims to emphasise the importance of plain radiographs in patients with a history of knee injury and to highlight that this seemingly innocuous avulsion fracture may reveal more severe underlying pathology.

Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.

Musculoskeletal oncology training during residency

Purpose. To evaluate the efficacy of a musculoskeletal oncology training module during residency. Methods. 24 orthopaedic residents with differing years of experience were recruited. 12 of them received musculoskeletal oncology training for 6 months. The remaining 12 were controls who did not attend the training and had no clinical experience in a musculoskeletal oncology unit but had at least 3 years of postgraduate surgical training. Upon completion, residents in both groups were assessed by a knowledge test and then an objective structured clinical examination (OSCE). Results. Residents who attended the training module had better mean knowledge test scores (48 vs 25 out of 58, p<0.0001) and OSCE scores (32 vs 22 out of 42, p<0.004), compared to those who did not attend. No residents who attended the training module marked an inappropriate biopsy site that would have compromised definitive surgery, compared to 5 (42%) of the untrained residents who marked an inappropriate biopsy site that may have resulted in an unnecessary amputation. All residents who attended the training module agreed that such a module should be included in the orthopaedic residency programme. Conclusion. Residents who attended the training module were more aware of the biopsy principles and risks. A training module for musculoskeletal oncology should be included in the orthopaedic residency programme.

Scoliosis secondary to a rib haemangioma

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 25 juin 2011

Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures

Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.