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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_13 | Pages 61 - 61
1 Mar 2013
Hachem M Hardwick T Pimple M Tavakkolizadeh A Sinha J
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Tightrope fixation is known method for reconstructing acromioclavicular joint and the presence of good bone stock around the two drillholes is the most important determining factor for preventing failure.

Aim

Arthroscopic-assisted tightrope stabilisation involve drilling clavicle and coracoids in a straight line. This leads to eccentric drillholes with inadequate bone around it. Open tightrope fixation involves drilling holes under direct vision, independently and leading to centric hole with adequate bone around it. Our study assesses the hypothesis of tightrope fixation in relation to location of drillholes using CT-scan and cadaveric models for arthroscopic and open technique for ACJ fixation.

Methods

CT-scans of 20 shoulders performed. Special software used to draw straight line from distal end of clavicle to coracoid. Bone volume around coracoid drillhole was calculated. Cadaveric shoulder specimens were dissected. The arthroscopic technique was performed under vision by drilling both clavicle and base of coracoid holes in one direction. Same specimens were used for open technique. Base of coracoid crossectioned and volume calculated.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 41 - 41
1 Jan 2013
Singh A Pimple M Tavakkolizadeh A Sinha J
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Hypothesis

Recurrent shoulder dislocation is associated with bony defect of the glenoid rim, commonly seen along with bankart tear - a soft tissue injury of glenoid labrum. This cadaveric study compares the bone block effect of coracoid transfer using using two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet. We hypothesized that the force needed to dislocate the shoulder would be greater in Congruent Arc technique than the Classical Latarjet, because of increased contact surface area as a result of greater linear dimensions.

Material and methods

We dissected 14 cadaveric shoulders. A bony Bankart lesion was created in form of an inverted pear glenoid. The humeral head was attached to a pulley system that was sequentially loaded until the shoulder dislocated anteriorly. The force needed to dislocate was noted. This was repeated after coracoid transfer with two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 177 - 177
1 May 2011
Pimple M Jones C Rosson J
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The National Institute for Clinical Excellence, UK published guidelines in 2007 encouraging the use of low molecular weight heparin (LMWH) joint replacement surgery. Subsequently, our hospital adopted these guidelines in the treatment of total hip replacements. This study is based on our prospective database of total hip replacements between 2005 and 2009 and compares the complication and mortality rates pre- and post institution of the NICE guidelines.

We analysed prospectively collected data on 686 patients who underwent a primary total hip replacement done by a single surgeon between January 2005 and April 2009. We compared the incidence of mortality, pulmonary embolism, myocardial infarction and intracranial bleeding between the two groups. Prior to the guidelines, all patients were treated for the duration of their admission with 75mg aspirin followed by 4 weeks after discharge. Subsequent to the guidelines, the treatment changed to 40mg of LMWH (Clexane) while an inpatient with aspirin being prescribed for 4 weeks on discharge. Patients unable to tolerate aspirin were treated with low molecular weight heparin. High risk patients (previous pulmonary embolism, previous deep vein thrombosis, family history) were treated with 6 weeks of warfarin. Each patients was reviewed at 8 weeks and 6 months following surgery, and adverse incidents were documented at each review or incident.

Results: 686 patients were identified from the study – 328 pre and 358 post implementation of the NICE guidelines. In the pre-guideline group the mortality was 0.6%, with the incidence of pulmonary embolism being 0.3%, myocardial infarction 0.9% and intracranial bleed 0.3%. Both complications of myocardial infarction occurred early in the post-operative stage and were fatal. The post-guideline group had a mortality rate of 0.2%, with the incidence of pulmonary embolism being 0.2% and intracranial bleeding 0.2%. No myocardial infarctions were noted in this group. The single death was as a result of an intracranial bleed. The was no significant statistical difference in the incidence of mortality, pulmonary embolism, myocardial infarction or intracranial bleeding between the two groups (p value > 0.05, 95% confidence interval). There were no complications in the warfarinised patients of which there were equal numbers in both groups (16).

Conclusion: This study has shown that the change in thromboprophylaxis has not had a significant effect on complication rates in primary total hip replacements and that our mortality rate (0.4%) compares favourably with recent literature. The lack of complications in the war-farinised group probably reflects that high risk patients were identified in the screening process and commenced on warfarin early in the post operative period. Note must be made of the single death due to an intracranial bleed while on low molecular weight heparin.