Distal humerus fractures in elderly population are often comminuted and presents multiple challenges. When managed with fixation the results are often complicated with stiffness, pain, and reduced function while total elbow replacement is fraught with lifelong restrictions on load bearing which can significantly affect elderly patients who rely assistive devices for ambulation. Elbow hemiarthroplasty however, presents a viable alternative in these cases. This series evaluates the results of the distal humerus hemiarthroplasty in a single centre. Data was collected retrospectively. Comprehensive case reviews were done to collect demographic, intra-operative and post-operative data. Fractures were classified as per AO classification. The primary outcome was functional outcome and range of motion (ROM). The secondary outcomes were complications and patient satisfaction.Objectives
Designs and methods
Recent reports show that spinopelvic mobility influences outcome following total hip arthroplasty. This scoping review investigates the relationship between spinopelvic parameters (SPPs) and symptomatic femoroacetabular impingement (FAI). A systematic search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies investigating the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, acetabular version, biomechanics of dynamic movements and radiological FAI signs.Abstract
Introduction
Methods
Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires.Aims
Methods
Many hospitals do not have a structured process
of consent, the attainment of which can often be rather ‘last-minute’
and somewhat chaotic. This is a surprising state of affairs as spinal
surgery is a high-risk surgical specialty with potential for expensive
litigation claims. More recently, the Montgomery ruling by the United
Kingdom Supreme Court has placed the subject of informed consent
into the spotlight. There is a paucity of practical guidance on how a consent process
can be achieved in a busy clinical setting. The British Association
of Spinal Surgeons (BASS) has convened a working party to address
this need. To our knowledge this is the first example of a national
professional body, representing a single surgical specialty, taking such
a fundamental initiative. In a hard-pressed clinical environment, the ability to achieve
admission reliably on the day of surgery, in patients at ease with
their situation and with little likelihood of late cancellation,
will be of great benefit. It will reduce litigation and improve
the patient experience. Cite this article:
An analysis of significant neuromonitoring changes (NMCs) and evaluation of the efficacy of multimodality neuromonitoring in spinal deformity surgery. A retrospective review of prospectively collected data in 320 consecutive paediatric and adult spinal deformity operations. Patients were sub-grouped according to demographics (age, gender), diagnosis, radiographic findings (Cobb angles, MR abnormalities) and operative features (surgical approach, duration, levels of fixation). Post-operative neurological deficit was documented and defined as either spinal cord or nerve root deficit.Aim:
Method:
Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with percutaneously inserted medial locking plates. Eighteen patients were selected based on the fracture pattern and classified using the AO classification and stabilised with an AO medial tibial locking plate. Time to fracture union, complications and outcomes were assessed with the American Orthopaedic Foot and Ankle Society ankle score at 12 months.Background
Methods
We reviewed the impact of the use of routine perioperative counselling on patients outcomes and experience when undergoing operative deformity correction for adolescent idiopathic scoliosis. Between January 2006 and December 2008, 28 consecutive patients underwent operative deformity correction for adolescent idiopathic scoliosis. 26 of these were seen at the initial presentation to clinic by a voluntary counsellor with experience of a family member having undergone scoliosis correction after they had been identified as being likely to require operative intervention. Most patients were only seen once preoperatively by the counsellor but several were seen on multiple occasions. Most patients were offered the opportunity to meet a post-operative patient who had previously had scoliosis correction surgery. SRS 22 questionnaires were completed pre and post-operatively. All curves were classified using the Lenke classification and pre and post operative Cobb angles were recorded. All patients and their parents were followed up at a mean interval of 3 years with a telephone survey regarding how they felt the input from a counsellor impacted on their experience.Objective
Methods
To audit the routine measurement of Vitamin B12 levels prior to cervical decompressive surgery Retrospective analysis of medical records and pathology results of patients who underwent decompressive cervical surgery for myelopathy over a 6 month period 26 patients were identified from theatre records. 21 out of 26 patients did not have vitamin B12 levels checked prior to their decompressive surgery The reports in the literature of co-existent B12 deficient myelopathy and mechanical compression are a cause for concern. Although the incidence of this is unknown and unlikely to be common, good clinical practice would suggest that we should be routinely monitoring B12 levels in myelopathic patients. We have introduced new standards for routinely checking B12 levels pre-operatively and intend to re-audit the effectiveness of these in six months time.
To establish the current practice of spinal cord monitoring in units carrying out scoliosis surgery in the UK. To illustrate the benefit of routinely monitoring motor evoked potentials (MEPs). Questionaire: Nationwide survey of spinal monitoring modalities used by spinal units carrying out deformity surgery. 10 out of 27 units routinely measure motor evoked potentials (MEPs), the remainder use only sensory potentials (SEPs). There is significant variability in use of monitoring around the UK and we have compared this to the practice elsewhere in the world. We report the case of a thirteen year old girl who underwent posterior instrumentation for correction of an idiopathic scoliosis. Intra-operatively there was a significant reduction in the amplitude of the MEPs without any corresponding change in the SEPs. These changes reversed when the correction was released. The surgery was abandoned and was carried out as a staged procedure, initially anteriorly then posteriorly. There was no loss of motor potentials during either operation and no post operative neurological abnormalities. We propose that the changes noted initially were due to transient ischaemia of the cord which would not have been detected without MEPs and may have led to long term sequelae. This highlights the safety benefit of routinely using MEPs in scoliosis surgery. Nationally there is wide variation in the monitoring of spinal cord function during scoliosis surgery. We feel that monitoring of motor potentials is a vital component in ensuring scoliosis surgery is as safe as possible.
Less blood loss and operative times were found with skip laminectomy. Similar degrees of decompression with both techniques. Significantly improved axial pain scores with skip laminectomy. Significantly improved preservation of range of movement with skip laminectomy.
We are comparing the above two techniques with 25 patients in each group operated by 3 surgeons. The first group had conventional laminoplasty and the second group underwent the skip laminectomy. The groups were comparable in age, sex, pathology and clinical presentation. Both these group had clinical outcome measurements using SF 12 questionnaires, pre and postoperative clinical assessment with standard tools performed by independent surgeon and a specialist spinal physiotherapist. We also routinely performed pre and postoperative MRI scans to assess the adequacy of decompression.
We are comparing the above two techniques with 25 patients in each group operated by 3 surgeons. The first group had conventional laminoplasty and the second group underwent the skip laminectomy. The groups were comparable in age, sex, pathology and clinical presentation. Both these group had clinical outcome measurements using SF 12 questionnaires, pre and postoperative clinical assessment with standard tools performed by independent surgeon and a specialist spinal physiotherapist. We also routinely performed pre and postoperative MRI scans to assess the adequacy of decompression.
