Given the rising incidence of obesity in the adult population, it is more than likely that orthopaedic surgeons will be treating more obese patients with lumbar disc pathologies. The relationship between obesity and recurrent herniated nucleus pulposus (HNP) following microdiscectomy remains unclear. To investigate the relationship between obesity and recurrent HNP following lumbar microdiscectomy.Introduction
Objectives
Microdiscectomies and microdecompressions are traditionally defined as procedures performed with a small incision using magnification. There are no studies in the literature comparing the magnification techniques used in these operations. We compared magnifying loupes and microscopes as the senior author was trained with both instruments and was equally comfortable using both. This is a retrospective comparative study involving 51 consecutive patients in group A (loupes) and same number in group B (microscope). The study included all patients who had single level lumbar microdiscectomy or decompression in the period from the 11th of January 2009 to the 6th of April 2010. To avoid any bias, only patients who failed to attend their follow ups were excluded from the study. The senior author operated on all patients. We noted intra-operative and post-operative complications, further interventions, length of surgery and length of hospital stay. We conducted a telephone questionnaire to collect visual analysis score for pre-op and post-op pain and functional status to calculate Macnab's functional status score. 78 patients (75.6%) answered the questionnaire, 39 patients from each group. There was 1 dural leak in group A.1 patient had discitis in the group A and 1 patient had superficial infection in group B. 4 patients in group A and 1 patient in group B had residual pain requiring intervention. The average length of surgery was one hour and five minutes and one hour and eleven minutes, respectively. Mean hospital stay was 1.43 days and 1.78 days, respectively. The data in the group B was skewed due to one patient who stayed for 9 days after surgery. 25 patients (49%) in group A and 36 patients (70.5%) in group B returned to normal pre-prolapse function and physical activity within 3 months.Introduction
Materials/Methods
Minimally invasive plate osteosynthesis (MIPO) is a relatively new surgical technique for the management of distal tibial fractures. Conventional open technique is unfavourable to the fracture biology because of excessive soft tissue stripping and can be associated with significant devastating complications. The aim of this study was to determine the effectiveness of the MIPO technique for distal tibial fracturesIntroduction
Objective
There is conflicting evidence in the literature regarding outcome of patients living in their own home prior to a fracture neck of femur, when using discharge destination and rehabilitation as measures of outcome. We investigated the factors predicting outcome following neck of femur (NOF) fractures, in patients previously living in their own home Medical records of all 292 patients admitted to Royal Derby Hospital between January and October 2010 with a fractured NOF (who lived in their own home prior to admission) were obtained retrospectively. Data included patient demographics; type of surgical intervention; mobility status and level of independence before admission; nature of fracture and patients' ASA grade. Outcome measures including: number of days spent in hospital; number of days spent in rehabilitation; mortality; mobility on discharge; and discharge destination, were also sought. Data was analysed using SPSS Version 18.Introduction
Method
Acetabular bone deficiency presents one of the most challenging problems during revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our medium to long-term experience of 68 consecutive hips in 64 patients who had acetabular revision using impacted cancellous bone grafting with bone cement with a mean follow up of 10.5 ±3.75) years (range 5.1 to 17.7 years). Patients' undergoing acetabular bone grafting during revision hip arthroplasty prior to insertion of a cemented cup between 1993 and 2000 were evaluated. Pre-operative, immediate post-operative, 1 year post-op and final follow-up radiographs were evaluated. The pre-operative bone loss was graded according to the AAOS and Paprosky classifications. The presence of radiolucencies, alignment and incorporation of bone graft were evaluated. The Harris Hip Score (HHS) was used to assess clinical outcome. 13 patients who were unable to attend the department were contacted for a telephone interview. Analysis of the Data was carried out using SPSS17 [SPSS Inc. Chicago, Illinois]Introduction
Methods
To assess whether Patients who are clinically Obese are more likely to require further or revision Surgery following One-Level simple Microdiscectomy compared to Non-obese Patients. Retrospective, single centre and single Surgeon review of Patients' Clinical notes of consecutive Patients who underwent primary One-Level Microdiscectomy between December 2007 and July 2009. Background: Obesity in Surgery has become a topical subject given the increasing proportion of Surgical Patients being Obese. This study provides the largest single centre and single Surgeon comparative cohort. All Patients had undergone One-level simple Primary Microdiscectomy Surgery. Data from the Clinical notes included Patient Demographics, level and side of operation, Length of stay and Re-Operation details. A total number of 71 Patients were eligible for inclusion of which 38 were Female and 33 Male with an average age of 41 years. 25 Patients were Clinically Obese (35%). Average LOS was 1.1 days. 8% of the clinically Obese Patients required further Surgery compared to 8.7% in the Non-obese group. Revision surgery for recurrent discs and Surgery for dural tear repair were the main reasons for return to theatre. Revision rates were comparable between the two Patient groups. LOS was no different for Obese Patients. This study concludes that Obese Patients undergoing One-Level simple Microdiscectomy do not face a significantly higher risk of requiring Revision Surgery in the future.
