Injury
-
The reamer-irrigator-aspirator is increasingly being used to harvest autologous bone graft from the femur. The purpose of this study was to investigate the extent of neo-vascularisation and new bone formation that occurs within the medulla following the procedure, and determine if new bone formation would potentially allow a repeat bone harvest in those individuals subsequently requiring further bone graft. Eleven patients who had undergone femoral bone harvest were examined with MRI. ⋯ Intense vascularisation of the endostial cortical surface and neo-vascularisation of the haematoma within the canal occurred as soon as 3 months following bone harvest. From as early as 14 months the tissue was replaced by normal intramedullary bone. The formation of new bone within the medullary canal gives the potential for a repeat reaming, should further bone graft be required at a later date.
-
The aim of this retrospective study with prospectively documented data was to report the clinical results of treatment of long bone non-unions using the "diamond concept". Over a 4-year period, patients that presented with a long bone non-union and were managed with the diamond conceptual framework of bone repair were evaluated. Exclusion criteria were hypertrophic, pathological, and infected non-unions. ⋯ All patients were mobilising pain free and returned to their daily living activities at the final follow up. The application of the "diamond concept" in this cohort of patients was associated with a high union rate by providing an optimal mechanical and biological environment. Such an approach should be considered in the surgeon's armamentarium particularly in such cases where difficulty of bone repair is foreseen.
-
Case Reports
Posterior sternoclavicular joint dislocation with brachiocephalic vein injury: a case report.
Posterior dislocation of the clavicle is an uncommon injury, usually related to road traffic or contact sports accidents. The close proximity of vital structures in the mediastinum should alert the surgeon avoiding a closed reduction in the emergency setting. ⋯ Nevertheless, the risk of developing complications is high. We report this case in order to outline one of the potential complications, to discuss appropriate imaging studies and to describe the details of a safe surgical approach.
-
Nursing staff prospectively collect Waterlow scores (Ws) on all inpatients across most NHS hospitals, identifying patients at risk of pressure ulcers. This bedside score has not been applied in predicting other negative outcomes in patients with neck of femur (NOF) fractures. ⋯ Our study demonstrates a strong relationship between increasing Ws and post-operative infection risk. This raises the interesting yet controversial question of using Ws to identify patients at high-risk of developing post-operative infections and the potential benefit of an extended period of antibiotic prophylaxis.
-
Intramedullary (IM) nailing is a standard surgical technique for treating long bone diaphyseal fractures. However, one complication is breakage of the IM nail. Many methods have been reported for removing broken nails. We devised another technique, using a Nancy nail, for removing a broken IM nail and report on the surgical technique and a case involving the use of our method.