Aims The Exeter V40 cemented polished tapered stem system has demonstrated excellent long-term outcomes. This paper presents a systematic review of the existing literature and reports on a large case series comparing implant fractures between the Exeter V40 series; 125 mm and conventional length stem systems. Methods A systematic literature search was performed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In parallel, we performed a retrospective single centre study of Exeter V40 femoral stem prosthetic fractures between April 2003 and June 2020. Results There are 25 reported cases of such prosthetic fractures confined to small case series and case reports within the literature. We report an additional 19 cases to the literature (mean age 66.3 years (SD 11.7); 12 (63%) females; BMI 32.9 kg/m2 (SD 5.9)). The mean time from index procedure to fracture was 7.8 years (SD 3.6; 2.5 to 16.3). Exeter V40 stem fracture incidence was 0.15% and 1.21% for primary and revision arthroplasty, respectively. Incidence was significantly higher in revision arthroplasty (p < 0.001) and 125 mm length stems compared to ≥ 150 mm length stems (1.25% vs 0.13%, respectively; p < 0.001). When comparing different stem length cohorts, 125 mm short-stems were associated with stem-body fractures (92% vs 29%; p = 0.0095), earlier time to fracture (6.2 years vs 11.0 years; p = 0.0018), younger patient age at time of fracture (62.7 years vs 72.6 years; p = 0.037), and female sex (75% vs 43%; p = 0.326). Conclusion This complication remains rare, although we report a significantly higher incidence at up to 17 years follow-up than in the literature. Short 125 mm length Exeter V40 stems undoubtedly have a role in restoring anatomy and biomechanics in smaller femoral geometries, although the surgeon has to appreciate the higher risk of stem fracture and the associated predisposing factors which may necessitate particular attention to surgical technique and planning. Cite this article: Bone Jt Open 2021;2(6):443–456.
IntroductionDerotation osteotomies are commonly performed in paediatric orthopaedic and limb reconstruction practice. The purpose of this study was to determine whether the use of a digital inclinometer significantly improves the accuracy in attaining the desired correction.Materials & MethodsWe designed an electronic survey regarding derotation femoral osteotomy (DFO) including methods of intra-operative angular correction assessment and acceptable margins of error for correction. This was distributed to 28 paediatric orthopaedic surgeons in our region. A DFO model was created, using an anatomic sawbone with foam covering. 8 orthopaedic surgeons each performed two 30-degree DFOs, one using K-wires and visual estimation (VE), and the other using a Digital Inclinometer (DI). Two radiologists reported pre and post procedure rotational profile CT scans to assess the achieved rotational correction.ResultsThere was a 68% response rate to the survey. The most popular methods of estimating intra-operative correction were reported to be K-wires and rotation marks on bone. The majority of respondents reported that a 6–10 degree margin of error was acceptable for a 30-degree derotation. This was therefore set as the upper limit for acceptable error margin in the simulation study. The mean error in rotation in the VE group of simulated DFO was 19.7 degrees, with error>5 degrees and error>10 degrees in 7 (88%) and 6 (75%) cases respectively. Mean error in DI group was 3.1 degrees, with error>5 degrees in 1 case (13%).ConclusionsOur results show that the compared to conventional techniques, the use of an inclinometer significantly improves the accuracy of femoral de-rotation and significantly reduces the incidence of unacceptable errors in correction. We would suggest that digital inclinometers be used to assess intra-operative correction during derotation osteotomies.
given intramuscularly in a dose of 50 mg per square meter of bodysurface area. Clinical observation, ultrasound examination were performed and serum chorionic gonadotropin was measured until the level was less than 15 IU/L. The patient required multiple-dose protocol. Time to resolution was 21 days. Conclusion. Small size of ectopic pregnancy after ART and a chance of its atypical localization may often complicate laparoscopic treatment of this condition and, therefore, emphasize the value of ultrasound diagnosis and medical management option.
Poster abstractsrespectively. There was no major complication, however, 4 cases required intensive therapy unit care and blood transfusion, with total blood loss over 3 litres. Two of these cases had successful laparoscopic management. Average hospital stay was 2 days. Conclusions: Our study showed that 6% non-tubal ectopic pregnancies accounted for all ectopic pregnancies in the unit. Experience at ultrasound diagnosis and laparoscopic technique can lead to earlier diagnosis and few operative failures needing laparotomy. In spite of potential morbidity, laparoscopic surgery should be considered for women requiring surgery where laparoscopic expertise available. Medical management should be considered where appropriate. P05.04Is the embryonic growth rate in the first trimester influenced by cigarette smoking? (TVS). All women were asked whether they were a smoker or nonsmoker and this was recorded at the first visit. All women with a viable singleton pregnancy in the 1 st trimester who had at least two CRL measurements were included in the final analysis. The embryonic growth rate was measured in mm/day calculated using the following formula: (CRL mm @ 2 nd scan -CRL mm @ 1 st scan)/(gestational age @ 1 st scan -gestational age @ 2 nd scan). Pvalues were calculated using Welch t-test for the difference between the mean embryonic growth rates in smokers vs. non-smokers. Results: 779 consecutive women presented to the EPU and were subsequently found to have a live intrauterine pregnancy. 467 women underwent a single scan, 186 had two scans, 38 had three scans and 7 had more than three scans. A total of 184 women had complete data including smoker information and embryonic growth rate. 21.5% of women were smokers. The mean embryonic growth rate in the non-smoker and smoker groups were 1.19 mm/day and 0.96 mm/day, respectively (P-value = 0.003). Conclusions: First trimester embryonic growth velocity is slower in women who smoke compared to non-smokers. This is the first study to demonstrate that early aberrant embryonic growth patterns could be related to cigarette smoking. P05.05Efficacy and safety of single dose methotrexate treatment for ectopic pregnancy and pregnancy of unknown location and progesterone as a predictor of success
Figure 1Axial CT image showing normal calibre abdominal aorta (arrow 1) with surrounding soft tissue mass representing retroperitoneal fi brosis (arrow 2).
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