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Intramedullary reaming has been proven to be a safe and effective method for enhancing the union rates of long bone fractures. However, there is a risk of equipment failure, which can lead to severe complications. We present two cases of reamer failure during femoral nailing which illustrate the rare occurrence of intraoperative instrument failure. Our report also underscores the importance of routinely inspecting reaming equipment and provides technical insights to reduce the risk of failure.

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The aim of this study was to determine the rate of preoperative transthoracic echocardiography in hip fracture patients and to evaluate its effects on time to surgery and length of stay. We conducted a retrospective review of all patients with hip fractures treated at a tertiary referral hospital. Data examined included age, sex, comorbidities, time to surgery, length of stay, fracture type and transthoracic echocardiography findings. Forty-eight patients with hip fractures underwent surgery (men 41.7%; mean age 77.2 (49-95)). Nine patients (18.7%) had a preoperative transthoracic echocardiography. Preoperative transthoracic echocardiography was associated with a significantly longer time to surgery an abbreviation for days e.g dys should be added after the values to indicate what time frame is being measured (14.7 versus 6.8, p = 0.0051) and length of stay (23.6 versus 10.4, p = 0.0002). This study demonstrates a high rate of preoperative transthoracic echocardiography in hip fracture patients. The role of transthoracic echocardiography should be reassessed in view of its association with significant surgical delays.

Assuntos

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Ipsilateral humerus and forearm fractures, or 'floating elbow,' are high-energy injuries, uncommon in children and usually due to falls or motor vehicle accidents. Early models of washing machines were associated with various reports of upper extremity injuries in children, mostly occurring when the child attempted to remove clothes from a spinning machine. Some of these accidents resulted in serious injuries, including amputation, but have become considerably less common with the introduction of improved safety features in modern appliances. We describe the successful management of a child with multiple complex upper limb fractures caused by a modern washing machine.

Assuntos

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An earthquake in 2018 resulted in irreparable damage to the Port of Spain General Hospital, Trinidad and Tobago, and severely affected orthopaedic services. This study investigates the rate and reasons for cancellation on the day of surgery of orthopaedic cases during the post-earthquake period. We prospectively collected data on all cases scheduled to undergo surgery during the study period. Information was gathered on patient demographics, the number and reasons for cancellation. Data were analysed using Analyse-it for Microsoft Excel 5.40 (Analyse-it Software Ltd). Our results show that 43 patients were cancelled, resulting in a 44.3% cancellation rate. Patients who had their surgery cancelled were older, with a higher American Society of Anesthesiologists class compared with patients whose surgery was not cancelled. Hospital-related factors were found to be responsible for the majority of cancellations. Placed in context, our findings suggest that limited operating time due to the earthquake-induced hospital damage was the principal reason for the high rate of surgery cancellations.

Assuntos

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Introduction: Arteriovenous malformations (AVM) are developmental vascular malformations consisting of abnormal arteriovenous shunts surrounding a central nidus. These lesions are relatively uncommon, comprising just 7% of all benign soft-tissue masses. Most AVMs occur in the brain, neck, pelvis, and lower extremity and rarely manifest in the foot. When they do form in the foot, non-specific pain and the absence of clinical features contribute to the high rate of misdiagnosis on initial presentation. Although surgical excision combined with embolotherapy has emerged as the preferred treatment for large AVM, controversy exists over the best treatment for small lesions in the foot. Case Presentation: A 36-year-old Afro-Caribbean man was referred to the clinic with a 2-year history of increasing pain in his forefoot, affecting his ability to stand or walk comfortably. There was no history of trauma, and despite changing his footwear, the patient continued to have significant pain. Clinical examination was unremarkable except for mild tenderness over the dorsum of his forefoot, and radiographs were normal. A magnetic resonance scan reported an intermetatarsal vascular mass but could not exclude malignancy. Surgical exploration and en bloc excision confirmed the mass to be an AVM. One year post-surgery, the patient remains pain-free with no evidence of recurrence. Conclusions: The rarity of AVM in the foot, combined with normal radiographs and non-specific clinical signs, contributes to the long delay in diagnosing and treating these lesions. Surgeons should have a low threshold for obtaining magnetic resonance imaging in cases of diagnostic uncertainty. En bloc surgical excision is an option for treating small suitably located lesions in the foot.

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Maintaining accurate and complete operation notes is an essential metric of the quality of surgical care. While developed countries have implemented electronic health records to improve documentation, financial constraints prevent this realisation in the Caribbean. Somewhat paradoxically, previous studies in this area have focussed on 'process' while neglecting the key role of the surgeon. We conducted a 25-item Knowledge, Attitudes and Practices survey of orthopaedic doctors to identify any culturally unique health-related behaviours. Our results indicate that while most doctors understand the importance of operation notes, many are unaware of international note-keeping recommendations. Legibility was identified as a significant issue by 92% of doctors. A disturbing and previously unreported finding from the study revealed that 72% of surgeons would occasionally write the operation notes, although they were not scrubbed in for the procedure. We suggest that future studies examine this peculiar behaviour in greater detail.

Assuntos

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The prevalence of osteoporotic acetabular fractures and fracture-dislocations of the hip is increasing worldwide. These injuries are difficult to treat, and outcomes using traditional methods of osteosynthesis have been generally disappointing. Currently, there is debate about the management strategies with no widely held consensus on which technique is best. Studies from tertiary centers in North America and Europe have reported excellent results using the "combined hip procedure" which merges osteosynthesis and acute hip arthroplasty to treat these challenging fractures. As our population ages, these injuries are likely to occur more commonly in the developing world. We describe a case of an 80-year-old man who sustained a posterior fracture-dislocation of his hip and underwent successful treatment using the combined hip procedure in a low-resource setting.

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BACKGROUND: Prosthetic joint infection (PJI) is the second most common cause for revision following hip hemiarthroplasty (HHA) resulting in a mortality rate of 5.6%. The treatment of PJI is both challenging and controversial, without general consensus on best practice. In an attempt to avoid surgery, patients are commonly prescribed antibiotics, reducing the chance of detecting a microorganism, and culture negative infections are reported to occur in up to 21% of all PJI. Two stage revision is arguably the gold standard treatment but frequently these patients are too frail to undergo such extensive procedures. Some surgeons have attempted to avoid this by leaving well fixed implants undisturbed, effectively performing a partial single-stage revision. CASE PRESENTATION: A previously well 83 -year-old female patient presented with a gradual onset of increasing pain and difficulty walking. Just over 1 year prior to this presentation she fell at home and underwent an uncomplicated bipolar hemiarthroplasty. Clinical examination as well as serological and radiological investigations were suspicious for a periprosthetic infection. Her rapidly deteriorating clinical picture required prompt surgical intervention. In theater the patient underwent a single stage partial exchange arthroplasty leaving the well cemented femoral stem undisturbed. Although multiple samples were taken, no microorganism was identified. The patient has been followed up for 1 year and remains well, with no recurrence of infection. Her inflammatory markers have returned to normal and radiographs demonstrate no evidence of loosening of the total hip replacement. CONCLUSION: The burden of infection following hip hemiarthroplasty is likely to parallel the predicted increase in hip fractures. The combination of physiologic frailty, osteoporosis and multiple medical comorbidities are pertinent factors for consideration in the development of a treatment strategy. A partial single stage revision THR performed by an experienced arthroplasty surgeon, along with expertly led antimicrobial therapy may be considered in carefully selected patients.

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Concomitant ipsilateral femoral neck and shaft fractures are uncommon high-energy injuries characteristically occurring in young adults. Between 75 and 100% of these injuries occur in association with polytrauma to other organ systems. Associated femoral neck fractures are typically undisplaced, occurring in 2-9% of all femoral shaft fractures. These injuries present both technical and infrastructural challenges particularly in a low resource environment. Several methods of treatment have been used to successfully treat these fractures but there exists no consensus about the optimal management strategy. The "rendezvous" technique using dual implants in an overlapping fashion has been proposed as one method to treat these fractures. We present three cases of ipsilateral hip and femoral shaft fractures which were satisfactorily treated using this technique. The "rendezvous" technique is a simple method, with a good clinical outcome and a low complication rate that can be used to treat ipsilateral femoral neck and shaft fractures.

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Infection following total knee arthroplasty is a serious and increasingly common complication. Several treatment options are available. Although a two-stage revision remains the gold standard, salvage procedures are sometimes needed. We describe a case of an infected knee arthroplasty that was salvaged using a novel technique combining two linked intramedullary nails and bilateral compression plating.

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Dislocation of the posterior tibial tendon is a rare event, which may occur after trauma particularly sporting accidents. These injuries are frequently misdiagnosed at the initial presentation leading to a delay in treatment. We describe a case of delayed presentation of an atraumatic dislocation of the posterior tibial tendon which was diagnosed accurately and managed with primary repair of the flexor retinaculum.

Assuntos