Hip Hemiarthroplasty is one of the commonest orthopaedic operation done in UK with recent NHFD data from 2017 report showing that 43% of the 77000 patients who presented to hospital had hemiarthroplasty. Literature suggests dislocation rate of 0.8% – 6.1% for Hip Hemiarthroplasty. Dislocation of hemiarthroplasty may lead to significant morbidity and mortality. To investigate if acetabular dysplasia has a significant association with hemiarthroplasty dislocation.Background
Aim
Creating cement keyholes (i.e. drilling simple holes in cancellous bone to allow cement filling) is a practice used in multiple scenarios in orthopaedic surgery to ensure improved fixation between the bone-cement interface and as such between bone and prosthesis. It is most commonly used in hip arthroplasty to secure fixation of the cup to the acetabulum by drilling keyholes in acetabulum. However very little research has been conducted into what the dimensions of such cement keyholes should be. The following laboratory based research was performed to provide insight into the optimum dimensions of cement keyholes. The investigator designed a novel arrangement to enable testing of keyholes. Beechwood block models were then made to this design testing keyholes of varying diameters and depths. These were cemented with acrylic bone cement and then loaded to failure. A finite system analysis was also performed. Results show that stresses are concentrated at the base of the keyhole. As such increasing diameter of keyhole infers greater strength, but there is no relationship between depth and strength. This has been further confirmed with finite element analysis. We suggest the width of cement keyholes bears more importance than the depth and propose drilling wide but shallow keyholes.
The Dawn Hip - An Effective Strategy to Improve the Management of Traumatic Hip Fractures Traumatic hip fractures are managed with nationwide standards, and are regularly audited and published. A previous audit last year at the William Harvey revealed 66% of hip fractures were operated within 48 hours, compared to the national average of 75%. We implemented a strategy to improve this target by introducing the ‘Dawn Hip’ - a hip fracture operation which is prepared for surgery at 8am on the Emergency (CEPOD) list. Over a two month period after the introduction of the ‘Dawn hip’, the number of hip operations and start time on the CEPOD list were audited. Performance data were extrapolated from the National Hip Fracture Database (NHFD) and compared nationally.Introduction
Methods
Neglected traumatic dislocation of hip in children is very rare and most of the studies are too small to draw a conclusion. There is no consensus on timing for closed VS open reductions and post reduction care. The aim of our prospective study was to analyse and characterise the short term treatment outcome of treating 20 such cases in children (<12 years). All had posterior dislocation without any associated fractures (Thompson & Epstein type 1) sustained during typical childhood play activities and/or a fall from a height less than 10 feet. All attended the hospital between 1-52 weeks of injury. Closed reductions under GA were performed in 12 cases which were less than 3 weeks old, followed by hip immobilisation for 3 weeks and PWB mobilisation for 3 weeks. 8 hips (> 3 weeks old) had open reductions as none of them could be reduced by skeletal tractions and were allowed for FWB mobilisation after 9 weeks. Functional result (Garrett et al) at 2 years follow-up showed a complete range of motion in 18 children while the remaining two had 80% of normal hip movements with no deformity. All the hips showed varying degrees of avascular necrosis, with preservation of joint space on radiographs (Ficat & Arlet stage 1-3). There were no redislocations. We suggest that closed (for <3 weeks old dislocation) and open (for >3 weeks old dislocations) reductions are satisfactory treatment for traumatic neglected hip dislocations in children
We present an objective method for predicting the redisplacement of paediatric forearm and wrist fractures. Novel radiographic measurements were defined and their value assessed for clinical decision making. In Phase I of the study we defined the Cast Index (a/b) is the ratio of cast width in lateral view (a) and the width of the cast in AP view (b). Padding Index (x/y) isthe ratio of padding thickness in the plane of maximum deformity correction (x) and the greatest interosseous distance (y) in AP view. The sum of cast index and padding index was defined as the Canterbury Index. In Phase I, 142 children's radiographs were analysed and a statistically significant difference was identified between redisplacement and initial complete off-ending of the bones, cast index > 0.8 and padding index of > 0.3. There was no significant association with age, fracture location, seniority of surgeon or angulation. In Phase II, radiographs of 5 randomly selected cases were presented to 40 surgeons (20 consultants & 20 registrars). Following an eyeball assessment they were asked to measure the cast index and padding index (after instruction). With eyeballing the consultants predicted 33% and registrars 25% of the cases that redisplaced. After learning to measure the indices the accuracy increased to 72% for consultants and 81% for registrars (p<0.001). We conclude that the cast index, padding index and Canterbury Index are validated tools to assess plaster cast quality and can be used to predict redisplacement of paediatric forearm fractures after manipulation. They can easily be taught to orthopaedic surgeons and are more accurate than eyeballing radiographs in the clinical setting. Redisplacement can be predicted if cast index > 0.8, padding index > 0.3 and Canterbury Index > 1.1.
