Findings from a pilot randomized trial of spinal decompression alone or spinal decompression plus instrumented fusion.

Aims: Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted.

Limited sequence MRI to improve standards of care for suspected cauda equina syndrome.

Aims: Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform.

A critical thoracic kyphosis is required to prevent sagittal plane deterioration in selective thoracic fusions in Lenke I and II AIS.

Purpose: Thoracic hypokyphosis following AIS correction may be associated with reduced lumbar lordosis with potential adverse effects on the global sagittal balance. In the present study, we were interested in how the amount of thoracic kyphosis influences the sagittal profile and balance in selective thoracic (STF) and thoracolumbar fusions.

Methods: Out of 154 patients, 86 patients had correction of AIS Lenke I or II with a side-loading pedicle screw system and completed a 2-year follow-up.

Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation.

We reviewed 63 trapeziometacarpal arthrodeses (57 patients) performed in our unit between April 2007 and May 2013 for osteoarthritis. K-wires, plates, headless compression screws and memory staples were used for fixation. The average age of patients was 50 (range 20-78) years and there were 36 men and 21 women with a mean follow-up of 36 (range 6-62) months.

Preoperative grip strength measurement and duration of hospital stay in patients undergoing total hip and knee arthroplasty.

Purpose: This study explored whether a relationship exists between preoperative pinch and power grip strength, and length of hospital stay in patients undergoing hip and knee arthroplasty at a busy UK hospital. We investigated whether handgrip dynamometry could be used preoperatively to identify patients at greater risk of longer inpatient stays. This would allow focussed intervention preoperatively and facilitate predictors of length of stay postoperatively.

Preventing venous thromboembolism in elective upper limb surgery.

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) have considerable clinical and economic consequences. The prevention of venous thrombosis and PE are increasingly seen as quality markers for surgery. Guidance is available from a number of sources to stratify risk for different patients and procedures and to define an appropriate standard of care.

Femoral metastases from ovarian serous/endometroid adenocarcinoma.

Bony metastases from ovarian cancer are rare, tend to affect the axial skeleton and are associated with abdomino-pelvic disease. The median time interval between diagnosis of ovarian carcinoma and presentation of bony metastases is 44 months (1). We describe a rare case of high grade left ovarian serous / endometrioid adenocarcinoma presenting with a pathological right femoral fracture 4 weeks following diagnosis and optimal debulking of the ovarian tumour.

Consent process for elective total hip and knee arthroplasty.

Purpose: To assess the consent process for elective primary total hip replacement (THR) and total knee replacement (TKR) in our hospital.

Methods: Consent processes of 47 THR and 53 TKR patients performed by 11 surgeons were reviewed. Complications that were documented were recorded, as was the grade of surgeon (consultant or specialist trainee) performing consent, and the location at which this took place.

P-selectin antagonism reduces thrombus formation in humans.

Background: Interaction of P-selectin with its glycoprotein ligand (P-selectin glycoprotein ligand type 1) mediates inflammatory processes that may also include vascular thrombosis. Platelet P-selectin expression is increased in patients with coronary heart disease, and its antagonism represents a potential future therapeutic target for the prevention and treatment of atherothrombosis.

Aim: To investigate the effects of the novel small molecule P-selectin antagonist PSI-697 on thrombus formation in humans.