Central neuraxial blockade-assisted external cephalic version in reducing caesarean section rate: systematic review and meta-analysis.

We review the medical literature on the success, safety and economic value of central neuraxial blockade-assisted (CNB) external cephalic version from randomized controlled studies identified from 1951 to 2009. The result showed that more women had successful ECV with regional anaesthesia with corresponding reduction in caesarean section rate. They were 1.

Simple whiplash?

We describe a case of type-I Arnold-Chiari malformation in a 27-year-old woman who presented on two separate occasions with an apparent whiplash injury. She developed debilitating symptoms after two apparently low velocity vehicle collisions. MRI revealed a type-I Arnold-Chiari malformation.

Implementation of the NICE guidelines for venous thromboprophylaxis; a national survey of hip surgeons.

The 2007 United Kingdom National Institute for Health and Clinical Excellence (NICE) thromboprophylaxis guidelines concerning hip arthroplasty remain contentious in spite of significant evidence. A survey among British Hip Society members was performed to investigate the impact of these guidelines. Information on thromboprophylactic measures before and after guideline publication was gathered for three categories; Total Hip Replacement (THR), hip fracture and high-risk patients (as defined by NICE).

Acute lower limb ischemia associated with use of an immersion suit.

External compression is a rare cause of acute lower limb ischemia. Workers required to wear immersion suits during helicopter simulation training are exposed to external compressive forces which can alter the hemodynamics in arterial bypass conduits. Herein a case of arterial thromboembolization to the lower limb following the wearing of an immersion suit, in a patient who had undergone arterial bypass surgery 13 yr previously is presented.

Fibula osteotomy using a rib cutter.

We find the use of a rib cutter to be a useful alternative instrument in carrying out a fibular osteotomy.

Simultaneous monteggia type I fracture equivalent with ipsilateral fracture of the distal radius and ulna in a child: a case report.

Introduction: Simultaneous Monteggia injuries of the elbow and ipsilateral distal radius and ulna fractures are very rare.

Case Presentation: A unique case of a type I Monteggia fracture equivalent with ipsilateral fracture of the distal radius and ulna (Salter-Harris type II) in a child is reported. We describe the management of this unique fracture and discuss the possible mechanism of injury.

Association of intra-operative metaphyseal fractures with prosthesis size during hemiarthroplasty of the hip.

Purpose: To study the possible causes of intra-operative metaphyseal fractures in elderly patients undergoing hemiarthroplasty for displaced intracapsular femoral neck fracture.

Methods: 36 men and 228 women aged 61 to 89 years with 273 displaced femoral neck fractures underwent hemiarthroplasty using a hydroxyapatite ceramic-coated Furlong bipolar prosthesis. Anteroposterior and lateral radiographs were taken immediately after surgery to evaluate the presence and type of any intra-operative fractures (classified according to the Vancouver system) and their effect on stem stability or osseointegration.

Use of botulinum toxin in small-angle heterotropia and decompensating heterophoria: a review of the literature.

Botulinum toxin has been used extensively in strabismus management. However, less is published regarding its use in small-angled manifest deviations or decompensating heterophorias, where an alternative to surgery is required. The aim of this review is to look at the use and effectiveness of botulinum toxin in managing small-angled manifest deviations, both constant and intermittent, and decompensating heterophorias.

Staged bilateral hip or knee arthroplasties.

Purpose: To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties.

Methods: From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures.

Stratus optical coherence tomogram III: a novel, reliable and accurate way to measure corneal thickness.

The commercially available optical coherence tomogram (Stratus OCT III) designed for posterior segment imaging can be used for central corneal thickness (CCT) measurement. The aim of the study was to determine the accuracy and reliability of CCT measurements using Stratus OCT III versus ultrasound pachymetry. CCT using Stratus OCT III (CCT oct) was taken and averaged.

Situs inversus abdominus and malrotation in an adult with Ladd's band formation leading to intestinal ischaemia.

Situs inversus abdominus with rotational anomaly of the intestines is an extremely rare condition. Although intestinal malrotation has been recognized as a cause of obstruction in infants and children and may be complicated by intestinal ischaemia, it is very rare in adults. When it occurs in the adult patient, it may present acutely as bowel obstruction or intestinal ischaemia or chronically as vague intermittent abdominal pain.

Open medial placement of Kirschner wires for supracondylar humeral fractures in children.

Purpose: To assess the efficacy of our protocol for treatment of displaced Gartland type-3 supracondylar fractures of the humerus in children.

Methods: Records of 43 children with displaced Gartland type-3 supracondylar fractures of the humerus admitted from October 1997 to October 2003 were reviewed. Patients were treated within 12 hours of admission by closed reduction (n=33) or open reduction (n=10).

Diabetes mellitus and pregnancy.

Diabetes mellitus is the most common medical complication of pregnancy and it carries a significant risk to the foetus and the mother. Congenital malformations and perinatal morbidity remain common compared with the offspring of non diabetic pregnancies. Diabetic mothers are at risk of progression of microvascular diabetic complications as well as early pregnancy loss, pre-eclampsia, polyhydramnios and premature labour.

Familial Dandy-Walker syndrome: a case report supporting an autosomal inheritance.

Introduction: We report an isolated pedigree in which a consanguineous couple had twin sons with Dandy-Walker malformation (DWM). The mother is similarly affected with the disorder.

Discussion: DWM is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities.

Medial approach for fixation of displaced supracondylar fractures of the humerus in children.

This study aimed at evaluating our protocol for displaced Gartland Type 3 supracondylar fractures of the humerus in children. Forty-eight children had 49 fractures during the study period, from 1997 to 2002; they were included in the study. Their mean age was 7.

Cleft mitral valve in association with anomalous left coronary artery arising from pulmonary artery.

An anomalous origin of the left coronary artery from the pulmonary artery is commonly associated with mitral valve insufficiency. Usually this is secondary to left ventricular dysfunction or papillary muscle ischemia. We describe the association of an anomalous left coronary artery from the pulmonary artery with structural abnormalities of the mitral valve (cleft mitral leaflet) in 2 children, both of whom were being investigated for primary mitral valve disease.

Chronic fatigue syndrome or myalgic encephalomyelitis in children and adolescents.

Chronic fatigue syndrome or myalgic encephalomyelitis in children and adolescents is still poorly understood. The provisional diagnostic criteria and the concept are depicted here. The treatment modalities and prognosis for the disease are yet inconsistent.

Orthopaedic intervention in early rheumatoid arthritis. Occurrence and predictive factors in an inception cohort of 1064 patients followed for 5 years.

Objectives: To assess the occurrence of and predictive factors for orthopaedic surgery in an inception cohort of rheumatoid arthritis (RA) patients recruited and followed prospectively for 5 yr in nine regions in England.

Methods: Standard clinical, laboratory and radiological assessments and all interventions were recorded at baseline and yearly in RA patients (less than 2 yrs symptoms) prior to the use of disease-modifying drugs.

Results: One thousand and sixty-four patients completed 5 yr of follow-up.

Surgeon-controlled ultrasound-guided core biopsies in the breast--a prospective study and a new use for surgeons in the clinic.

Aims: This study was to assess the accuracy of a surgeon performing ultrasound-guided core biopsies of the breast.

Methods: A prospective audit was carried out of 555 patients who underwent an ultrasound-guided core biopsy for a discrete solid mass [under 30 mm maximum diameter] by a single surgeon. The surgeon controlled the core biopsy needle and an ultrasonographer or radiologist provided the imaging with ultrasound.

Use of the Ilizarov technique to improve limb function following hemipelvectomy.

Aims: Limb salvage surgery combined with tumour resection has become established in the management of pelvic tumours. However, subsequent reconstructive options for maintenance of quality of life lead to varied outcomes. We present a hitherto undescribed use of the Ilizarov technique as a second stage adjunct, for the optimisation of function, after first stage tumour resection and arthrodesis.