Shelain Patel

Biodegradable antibiotic delivery systems

Bacterial infection in orthopaedic surgery can be devastating, and is associated with significant morbidity and poor functional outcomes, which may be improved if high concentrations of antibiotics can be delivered locally over a prolonged period of time. The two most widely used methods of doing this involve antibiotic-loaded polymethylmethacrylate or collagen fleece. The former is not biodegradable and is a surface upon which secondary bacterial infection may occur. Consequently, it has to be removed once treatment has finished. The latter has been used successfully as an adjunct to systemic antibiotics, but cannot effect a sustained release that would allow it to be used on its own, thereby avoiding systemic toxicity. This review explores the newer biodegradable carrier systems which are currently in the experimental phase of development and which may prove to be more effective in the treatment of osteomyelitis.

The radiological assessment of total and unicompartmental knee replacements.

Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.

The use of fibrin glue in surgery of the knee

Fibrin glue, also known as fibrin sealant, is now established as a haemostatic agent in surgery, but its role in orthopaedic surgery is neither well known nor clearly defined. Although it was originally used over 100 years ago, concerns about transmission of disease meant that it fell from favour. It is also available as a slow-release drug delivery system and as a substrate for cellular growth and tissue engineering. Consequently, it has the potential to be used in a number of ways in orthopaedic surgery. The purpose of this review is to address its use in surgery of the knee in which it appears to offer great promise.

Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm

The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.

A performance based patient outcome score for active patients following total knee arthroplasty

OBJECTIVE The aim of this study was to develop and validate a user friendly performance based knee outcome score for use in active patients undergoing TKA surgery. DESIGN We prospectively studied a cohort of 50 subjects without any knee symptoms, and 50 patients who underwent TKA for osteoarthritis (OA). The patients were assessed pre- and postoperatively. SF-36 and WOMAC were concurrently administered for comparison. Patients completed seven physical tasks of the finalised outcome instrument which were objectively assessed and scored. RESULTS The mean functional score was 31.7 in the normal subjects. The mean functional score improved postoperatively from 10.0 to 17.7 (P < 0.001) in the TKA group. Our results confirm that the performance based score has a high test-retest reliability (intra-class correlation coefficient (ICC) of 0.89), internal consistency (Cronbachs alpha 0.84) and construct validity showing expected correlations with relevant components of the WOMAC and SF-36 scores. The responsiveness as measured by the effect size compared favourably with the same relevant components of the SF-36 and WOMAC. CONCLUSIONS Our performance based knee function score is a reliable dimension specific tool to detect change in musculoskeletal function after TKA. It complements existing self-reported outcome tools in facilitating a comprehensive assessment of patients following TKA.

Erratum to: A Cohort Study Predicts Better Functional Outcomes and Equivalent Patient Satisfaction Following UKR Compared with TKR

Background Total knee replacement (TKR) is considered the gold standard treatment for advanced osteoarthritis of the knee (Choong and Dowsey, Int J Rheum Dis 14:167–74, 2011; Satku, Singapore Med J 44:554–556, 2003). Unicompartmental disease can be treated with unicompartmental knee replacement (UKR) or TKR. Some surgeons prefer the proven track record of TKR, while others prefer the more normal joint kinematics, enhanced proprioception and range of movement achieved with UKR (Hopper and Leach, Knee Surg Sports Traumatol Arthrosc 16:973–9, 2008; Satku, Singapore Med J 44:554–556, 2003). However, there is reported low satisfaction amongst younger patients undergoing UKR (Robertson et al., Acta Orthop Scand 71:262–7, 2000).

Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report

BackgroundFractures of the clavicle are common injuries. The complications have been well documented in the literature.Case presentationDespite it close proximity to the sternocleidomastoid muscle and myositis ossificans recognised as a known complication of any fracture, the two have never previously been described in association secondary to a fracture of the clavicle. We present a case where myositis ossificans affecting the sternocleiodomastoid was detected in the post-injury phase of a clavicle fracture.ConclusionThis case highlights that traumatic myositis ossificans circumscipta can arise in the sternocleidomastoid muscle following a fracture of the medial third of the clavicle.

Post-traumatic osteonecrosis of the proximal humerus

Post-traumatic osteonecrosis of the proximal humerus represents a challenging problem to the surgeon. It is commonly seen following multi-fragmentary fractures of the proximal humerus which may affect the long-term functional recovery after such injuries. This review summarises the current evidence on risk factors, reasons why estimating its epidemiology is difficult, the vascular supply of the humeral head, classification, and management options.

The accuracy of primary care teams in diagnosing disorders of the shoulder

OBJECTIVE The aim of this retrospective, observational study was to determine the accuracy of diagnoses given by a multitude of primary care services to patients referred to an orthopaedic upper limb surgeon with a focus towards shoulder pathology. METHODS Records of all patients referred to a single upper limb surgeon over a 1-year period were reviewed. The diagnosis in the primary care setting was compared with the initial working diagnosis in the specialist clinic and against the final diagnosis following specialist investigation/intervention. RESULTS 114 eligible patients were identified. General practitioners referred 35% of patients, musculoskeletal triage services referred 63% of patients and independent physiotherapists referred 2% of patients. It was found that 37% of patients were not given a diagnosis by the primary care team. When a diagnosis was given, accuracy was 50% (κ = 0.28) when correlated against that given by an orthopaedic upper limb surgeon. CONCLUSIONS Our findings suggest that knowledge of shoulder conditions is limited amongst primary care practitioners. There does not appear to be any difference in accuracy between general practitioners and musculoskeletal triage services.

Initial Implant Stability Predicts Migration But Not Failure in Cementless Acetabular Revision with Bone Grafting

Host bone contact of less than 50% is perceived but not proven to cause migration and loosening after acetabular revision. A prospective analysis of cementless acetabular revision cases with impaction grafting was performed to determine if this was an independent risk factor for these events. Sixty-two hips in 54 patients were assessed at a mean follow-up of 84.5 months (range 61-112) yielding a probability of 94.6% of retaining the acetabular component using revision for aseptic loosening as the end point. No single factor was independently causative for loosening, although Type III fixation was associated with migration (p=0.0159); subanalysis suggested that achieving host-bone contact in at least part of the dome and posterior column is important.