Nonoperative modalities to treat symptomatic cervical spondylosis.

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means.

Cervical laminoplasty for multilevel cervical myelopathy.

Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes.

Can a periarticular levobupivacaine injection reduce postoperative opiate consumption during primary hip arthroplasty?

Background: Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery.

Patient-reported outcomes after Silastic replacement of the trapezium for osteoarthritis.

This retrospective study evaluated 69 Swanson trapezium replacements performed between 1990 and 2009 for trapeziometacarpal osteoarthritis in 58 patients. Pain and function were assessed using the Michigan Hand Questionnaire and the Disability of the Arm, Shoulder and Hand questionnaire. Patients had a mean age of 62 years at the time of surgery, with a mean time of 7.

Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee.

Background: Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome.

A cadaveric model for suprascapular nerve injury during glenoid component screw insertion in reverse-geometry shoulder arthroplasty.

Background: Reverse-geometry shoulder replacement requires fixation of a baseplate (called a metaglene) to the glenoid, to which a convex glenosphere is attached. Most systems use screws to achieve this fixation. The suprascapular nerve passes close to the glenoid and is known to be at risk of injury when devices and sutures are inserted into the glenoid.

Hypoglycaemia secondary to labetalol infusion.

A 42-year-old multigravida with severe pre-eclampsia had an emergency caesarean section under spinal anaesthesia. Peri-operatively, her arterial pressure was controlled with oral methyldopa and an intravenous infusion of labetalol. Postoperatively, in the Intensive Care Unit, she had recurrent episodes of hypoglycaemia which required treatment with intravenous glucose.

Outcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.

Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed.

High power, low frequency ultrasound: meniscal tissue interaction and ablation characteristics.

This study evaluates high power low frequency ultrasound transmitted via a flat vibrating probe tip as an alternative technology for meniscal debridement in the bovine knee. An experimental force controlled testing rig was constructed using a 20 kHz ultrasonic probe suspended vertically from a load cell. Effect of variation in amplitude of distal tip displacement (242-494 μm peak-peak) settings and force (2.

Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures.

Foot and ankle surgery--the Achilles heel of medical students and doctors.

Background: Numerous studies have shown that deficiencies exist in orthopaedic and musculoskeletal medical training resulting in students and doctors regularly failing basic orthopaedic exams. However, there have not been any studies addressing the attitudes of medical students towards the orthopaedic subspecialties.

Objectives: This study aimed (i) to determine if foot and ankle surgery was the orthopaedic specialty with which students and doctors have the most difficulty, (ii) to appraise attitudes towards teaching of foot and ankle surgery, and (iii) to suggest ways teaching might be improved.

The flow patterns of caudal epidural in upper lumbar spinal pathology.

Epidural steroid injections are an important therapeutic modality employed by spinal surgeons in the treatment of patients with chronic low back pain with or without lumbar radiculopathy. The caudal epidural is a commonly used and well-established technique; however, little is known about the segmental level of pathology that may be addressed by this intervention. This prospective study of over 50 patients aimed to examine the spreading pattern of this technique using epidurography.

The meniscofemoral ligaments influence lateral meniscal motion at the human knee joint.

Purpose: The purpose of this study was to investigate the effect of the meniscofemoral ligaments on lateral meniscal motion during flexion and extension of the human knee joint.

Methods: A cadaveric biomechanical study was performed. The effect of meniscofemoral ligament tension on the dynamics of the posterior horn of the lateral meniscus was determined by image analysis.

Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study.

Background: Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.

Methods: This pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA).

Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: a comparative study.

The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal. We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method.

Whole-body imaging modalities in oncology.

This article outlines the expanding approaches to whole-body imaging in oncology focusing on whole-body MRI and comparing it to emerging applications of whole-body CT, scintigraphy, and above all PET CT imaging. Whole-body MRI is widely available, non-ionizing and rapidly acquired, and inexpensive relative to PET CT. While it has many advantages, WBMRI is non-specific and, when compared to PET CT, is less sensitive.

Overuse ankle injuries in professional Irish dancers.

Background: Overuse ankle injuries have been described in elite athletes and professional ballet dancers however the spectrum of injuries experienced by professional Irish dancers has not been defined.

Methods: A troupe of actively performing dancers from an Irish-dance show were recruited (eight male, ten female; mean age, 26 years). The prevalence of overuse injuries in the right ankle was determined from magnetic resonance imaging.

The management and outcome of lateral process fracture of the talus.

Background: Lateral process fractures of the talus are a rare injury with significant associated morbidity when missed. Only a small number of case series' and reports are available and the appropriate management of these fractures is not really known.

Methods: We reviewed available English language literature for reports and series of lateral process fractures of talus.

Increasing financial burden of revision total knee arthroplasty.

We reviewed the peri-operative and financial data of patients who underwent revision total knee arthroplasty in our institution between 1997 and 2006. The aims were to compare difference in cost between aseptic and septic cases and to identify the sources of preventable cost increase in revision knee procedure. The study group comprised 117 women (65%) and 62 men (35%).

Website malfunction: a case report highlighting the danger of using electrical insulating tape for buddy strapping.

A case of injury to the third web space of the right hand of a rugby player, as a result of buddy strapping with electrical insulating tape of the little and ring finger, is presented. A deep laceration of the web space and distal palmar fascia resulted, necessitating wound exploration and repair. This case highlights the danger of using electrical insulating tape as a means to buddy strap fingers.

Imaging of soft tissues adjacent to orthopedic hardware: comparison of 3-T and 1.5-T MRI.

Objective: The purpose of this study was to compare metal artifact reduction techniques at 1.5-T and 3-T MRI.

Materials And Methods: A titanium plate with steel screws was placed in a freshly harvested pig leg.

Analysis of revision procedures for failed unicondylar knee replacement.

Introduction: Unicondylar knee arthroplasty (UKA) is argued to be a conservative procedure which permits a later total knee arthroplasty (TKA) should it be required.

Aim: The aims of the study were to assess the modes of early failure of UKA and see whether the conversion to TKA improved the functional scores, range of motion, pain and patient satisfaction.

Method: Fourteen revision procedures performed after failed unicompartmental knee arthroplasty (UKA) were evaluated.

'I am in blood Stepp'd in so far...': ethical dilemmas and the sports team doctor.

There are many ethical dilemmas that are unique to sports medicine because of the unusual clinical environment of caring for players within the context of a team whose primary objective is to win. Many of these ethical issues arise because the traditional relationship between doctor and patient is distorted or absent. The emergence of a doctor-patient-team triad has created a scenario in which the team's priority can conflict with or even replace the doctor's primary obligation to player well-being.

Total hip replacement in patients with neurological conditions.

Neurological conditions affecting the hip pose a considerable challenge in replacement surgery since poor and imbalanced muscle tone predisposes to dislocation and loosening. Consequently, total hip replacement (THR) is rarely performed in such patients. In a systematic review of the literature concerning THR in neurological conditions, we found only 13 studies which described the outcome.

The effect of body mass index on outcomes after total ankle replacement.

Total ankle replacement is an established alternative to ankle fusion in selected patients. One of the possible exclusions used is the presence of a high BMI. This is based on our experience with hip and knee replacements where poor outcomes have been associated with obesity, however little work has been done on this subject in the ankle.