Annals of the Royal College of Surgeons of England
-
Ann R Coll Surg Engl · May 2009
Multicenter StudyDoes the number of trauma lists provided affect care and outcome of patients with fractured neck of femur?
Delay in surgery for fractured neck of femur is associated with increased mortality; it is recommended that patients with fractured neck of femur are operated within 48 h. North West hospitals provide dedicated trauma lists, as recommended by the British Orthopaedic Association, to allow rapid access to surgery. We investigated trauma list provision by each trust and its effects on the time taken to get neck of femur patients to surgery and patient survival. ⋯ Most trusts provided at least one dedicated daily list. This study shows that extra lists may enable trusts to cope better with fractured neck of femur but do not change mortality.
-
Ann R Coll Surg Engl · Apr 2009
Manipulation under anaesthesia for stiffness following knee arthroplasty.
Stiffness following knee arthroplasty is a frustrating complication and a significantly disabling problem. We present our experience of knee stiffness requiring manipulation under anaesthesia (MUA) as the first line of treatment following partial or total knee arthroplasty. ⋯ MUA has a role in the treatment of early stiffness with excellent immediate outcomes. We advocate that MUA should be the first line of management for stiff knee arthroplasties after failed physiotherapy.
-
Ann R Coll Surg Engl · Mar 2009
White cell count and C-reactive protein measurement in patients with possible appendicitis.
Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain. ⋯ This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.
-
Ann R Coll Surg Engl · Mar 2009
Case ReportsMedial humeral condyle fracture with an ipsilateral dislocated radial head.
We present the first reported case of a combined medial humeral condyle fracture with ipsilateral radial head dislocation. This injury was sustained by a 7-year-old girl following a fall on an outstretched hand. The operative technique is described. At 6-month follow-up, the patient had normal alignment of the limb and achieved full range of motion.
-
Ann R Coll Surg Engl · Mar 2009
Do scoring systems help in predicting survival following ruptured abdominal aortic aneurysm surgery?
The aim of this study was to assess the value of the Hardman Index and the Glasgow Aneurysm Score in predicting postoperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA), and to assess the correlation between the two. ⋯ The scoring systems assessed did not help predict the outcome of rAAA surgery, and correlated poorly with each other. They do not aid clinical judgement.