Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P < .01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.
INTRODUCTIONThe internet is a convenient source of health information used widely by patients and doctors. Previous studies have found that the written information provided was often inaccurate. There is no literature regarding the accuracy of medical images on the internet. The aim of this study was to assess the accuracy of internet images of injuries to the glenoid labrum following shoulder dislocation. METHODS The Google and Bing search engines were used to find images of Bankart, Perthes and anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. Three independent reviewers assessed the accuracy of image labelling. RESULTS Of images labelled 'Bankart lesion', 30% (9/30) were incorrect while 'Perthes lesion' images were incorrect in 15% of cases (9/60) and 4% of 'ALPSA lesion' images were incorrect (2/46). There was good interobserver reliability (kappa = 0.81). Labelling accuracy was better on educational sites than on commercial sites (6% vs 25% inaccurate, p=0.0013). CONCLUSIONS Caution is recommended when interpreting non-peer reviewed images on the internet.
Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance
Introduction The first lumbar spinal fusion was introduced over 70 years ago and techniques have been evolving since then. Two popular techniques are Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Lumbar Interbody Fusion (PLIF). However, it is still controversial which is better. The aim of this study was to compare the clinical and radiological outcomes of those techniques. Material and Methods We retrospectively reviewed our spinal unit database to identify the patients who underwent TLIF and PLIF over the last 1 year. A hundred and ten patients were identified (54 TLIF, 56 PLIF). Demographics, Visual analogue score for leg and back pain and SF36 scores were analyzed preoperatively, at six weeks, six months and twelve months postopertively. Two independent reviewers assessed the X-rays for fusion at twelve months postoperatively using the Brantigan-Steffee classification. Results With regards to the clinical outcomes, TLIF patients had significantly better outcomes at six weeks with lower visual analogue scores (VAS) and better SF36 scores. The difference between the two groups has significantly reduced after one year. Both TLIF and PLIF patients had excellent lumbar spine fusion on X-rays at one year with good interobserver reliability (Kappa = 0.95) Conclusion Both TLIF and PLIF are excellent techniques for lumbar spinal fusion. There are no significant differences in the clinical and radiological outcomes between the two techniques at one year.
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