Sulaiman Alazzawi

Mortality and morbidity following hip fractures related to hospital thromboprophylaxis policy.

Chemical thromboprophylaxis has been shown to reduce the incidence of venous thromboembolism (VTE) for patients with fractures of the hip, but it is not known with certainty whether it use also reduces mortality. Using postal and telephone questionnaires we collected data from English National Health Service (NHS) hospitals about their thromboprophylaxis policy for hip fractures patients from April 2003 to April 2007. Using Hospital Episode Statistics (HES) we ascertained in-hospital mortality rates at 30 days and at one year following admission to hospital. Unplanned hospital readmission rates for all causes (including episodes of thromboembolism and bleeding) within 30 days (all years) and one year (2003 to 2005) were also established. A total of 150 hospitals were contacted and data gathered from 62 hospitals (response rate 41.3%) There were 255841 patients with neck of femur fractures during this five year period who were assessed for morbidity and mortality, and we correlat these with thromboprophylaxis policy. There was no significant difference in hospital readmission within 30 days, or diagnosis of thromboembolism or haemorrhage among hospitals with different thromboprophylaxis policies. The hospitals using low molecular weight heparin (LMWH) in half the dose recommended by the British National Formulary had significantly reduced mortality in-hospital (odds ratio (OR) 0.79, 95% CI 0.69–0.90, P=0.0006), at 30 days (OR 0.8 (0.70 – 0.92), P=0.001) and at one year (OR 0.89 (0.80 – 1.00), P=0.050), compared with those with no such policy. Our data suggest that the thromboprophylaxis regimen for patients with fracture neck of femur should be half dose LMWH for the duration of the hospital stay.

The Conversion Rate of Bipolar Hemiarthroplasty after a Hip Fracture to a Total Hip Arthroplasty

Background Bipolar hip hemiarthroplasty is used in the management of fractures of the proximal femur. The dual articulation is cited as advantageous in comparison to unipolar prostheses as it decreases acetabular erosion, has a lower dislocation rates and is easier to convert to a total hip arthroplasty (THA) should the need arise. However, these claims are debatable. Our study examines the rate of conversion of the bipolar hemiarthroplasty to THA and the justification for using it on the basis of future conversion to THA. Methods All cases of bipolar hemiarthroplasty performed in our unit for hip fractures over a 9-year period (1999-2007) were reviewed. Medical notes and radiographs of all patients were reviewed, and all surviving patients that were contactable received a telephone follow-up. Results Of all 164 patients reviewed with a minimum of 1 year from date of surgery, 4 patients had undergone a conversion of their bipolar prosthesis to THA. Three conversions were performed for infection, dislocation, and fracture. Only one (0.6%) conversion was performed for groin pain. Conclusions Our study show that bipolar hemiarthroplasties for hip fractures have a low conversion rate to THAs and this is comparable to the published conversion rate of unipolar hemiarthroplasties.

Patient-reported complications after elective joint replacement surgery: Are they correct?

Using general practitioner records and hospital notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported complications gathered from a self-completed questionnaire after elective joint replacement surgery of the hip and knee. A total of 402 post-discharge complications were reported after 8546 elective operations that were undertaken within a three-year period. These were reported by 136 men and 240 women with a mean age of 71.8 years (34 to 93). A total of 319 reported complications (79.4%; 95% confidence interval 75.4 to 83.3) were confirmed to be correct. High rates of correct reporting were demonstrated for infection (94.5%) and the need for further surgery (100%), whereas the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism, myocardial infarction and stroke were lower (75% to 84.2%). Dislocation, peri-prosthetic fractures and nerve palsy had modest rates of correct reporting (36% to 57.1%). More patients who had knee surgery delivered incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications may form part of a larger patient-reported outcome programme after elective joint replacement surgery.

Herpes Zoster Virus: An Unusual but Potentially Treatable Cause of Sciatica and Foot Drop

The herpes zoster virus is a rare but potential cause of acute motor weakness. This article describes 2 patients with drop foot secondary to an infection of varicella zoster who were incorrectly referred to an orthopedic clinic from their general practitioners. The first patient was a 74-year-old man who presented with weakness in the right foot and a vesicular rash. The pattern of disease supported the clinical diagnosis of shingles affecting the L5 motor and sensory division. No investigation was required, and the patient was treated with a foot drop splint. The second patient was a 71-year-old man who presented with right leg and foot weakness and a vesicular rash affecting his right buttock and posterior right thigh. Lumbar magnetic resonance excluded a stenotic lesion; electrophysiological studies supported the diagnosis of a lower motor neuron lesion. The patient was treated with a 1-week course of acyclovir and a foot drop splint. The correct diagnosis will aid in correct referral and will prompt management, which will potentially provide a faster and better outcome for the patient.

Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report

We present a case of an ipsilateral tibial shaft fracture and a distal tibial triplane fracture with an intact fibula in a 14-year-old boy. Computed tomography revealed the distal tibial triplane fracture with a 2.6-mm displaced Tillaux fragment and a posterior malleolar shear fragment. Open reduction and internal fixation was performed to optimise healing and outcome. This is a rare injury, for which a high index of suspicion is needed for diagnosis. Missing the intra-articular distal tibial triplane fracture could result in a disabling angular deformity (mostly varus) or limb-length discrepancy secondary to premature partial closure of the distal physis.

Aggressive Early Debridement in Treatment of Acute Periprosthetic Joint Infections After Hip and Knee Replacements

Background: Periprosthetic Joint Infection Remains a Dreaded Complication After Hip and Knee Replacement Surgery. Treatment Options for Acute Postoperative and Acute Hematogenous Infections Include Arthroscopic or Open Debridement With Retention or Exchange of the Prostheses. This Review Article Aims to Summarize the Evidence for Management of Acute Postoperative And Acute Hematogenous Infections. Methods: A Systematic Literature Search Was Performed Using a Computer-based Search Engine Covering Medline (OvidSP), PubMed Database (U.S. National Library of Medicine, National Institutes of Health), Embase, Web of Science, Cochrane and Google Scholar for Relevant Articles. Results: Common Themes Around Treatment of Acute Postoperative and Acute Hematogenous Infections Discussed in this Review Include the Timing of Intervention, Description of the Optimal Procedure and How we Perform it at our Institution, the Role of Arthroscopic Debridement, Most Commonly Isolated Micro-organisms and Prognostic Factors for Infection Control. Conclusion: Success in Treating Acute Postoperative and Acute Hematogenous Infections Depends on Early Diagnosis and Aggressive Surgical Debridement Combined With Effective Antibiotic Therapy.

Management of anterior cruciate ligament injury: pathophysiology and treatment

Anterior cruciate ligament injury, a common soft tissue injury of the knee joint, is increasing in incidence particularly in young active people. It causes instability of the knee that leads to meniscal tears, cartilage defects and early osteoarthritis. This review summarizes aspects of anterior cruciate ligament injury management.

Surgical treatment of anterior cruciate ligament injury in adults

Anterior cruciate ligament injury is among the most common soft tissue injuries of the knee joint and reconstruction of the anterior cruciate ligament is the gold standard treatment for young active symptomatic patients. This review summarizes the surgical treatment of anterior cruciate ligament injury.

Foot and ankle history and clinical examination: A guide to everyday practice

This review summarises the key points in taking a history and performing a comprehensive clinical examination for patients with foot and/or ankle problems. It is a useful guide for residents who are preparing for their specialty exams, as well as family doctors and any other doctor who has to deal with foot and ankle problems in adults.

Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions.