Fractures of the forearm (radius or ulna or both) in children have traditionally been immobilised in plaster of Paris (POP) but synthetic cast materials are becoming more popular. There have been no randomised studies comparing the efficacy of these two materials. The aim of this study was to investigate which cast material is superior for the management of these fractures. We undertook a single-centre prospective randomised trial involving 199 patients with acute fractures of the forearm requiring general anaesthesia for reduction. Patients were randomised by sealed envelope into either a POP or synthetic group and then underwent routine closed reduction and immobilisation in a cast. The patients were reviewed at one and six weeks. A satisfaction questionnaire was completed following the removal of the cast. All clinical complications were recorded and the cast indices were calculated. There was an increase in complications in the POP group. These complications included soft areas of POP requiring revision and loss of reduction with some requiring re-manipulation. There was an increased mean padding index in the fractures that lost reduction. Synthetic casts were preferred by the patients. This study indicates that the clinical outcomes and patient satisfaction are superior using synthetic casts with no reduction in safety.
The direct anterior approach (DAA) for total hip arthroplasty has been increasing in popularity due to potential benefits including less pain, faster recovery, decreased risk of dislocation, and a reduced length of stay. The DAA has been described by many to have a steep learning curve owing to its greater risk of complications when first using the approach. The primary aim of this study was to design and implement a specific surgeon mentor program in an attempt to reduce the learning curve of the DAA. Surgeons completed the surgical education and mentoring program designed to reduce the initial increase in complication rate when first learning the DAA in a public hospital setting. A retrospective review of clinical and radiological outcomes on the first 67 cases was then conducted. Of these, 43 cases were eligible for inclusion. The 43 patients in this study had a mean age of 66.7, BMI of 26.7, and 57% of them were female. Follow-up was between 39 and 49 months, with a mean of 46 months. There were no fractures, dislocations, or blood transfusions. One patient required revision for deep infection. The mean length of stay was 2.81 days. At 6 weeks postoperative, 86% were independently mobile, 9.3% were using a cane, and 4.7% were being weaned off a walker. The radiological assessments found a mean cup abduction of 39.9 ± 5.1 degrees, mean femoral offset of 1.6 ± 5.5 mm, and a total hip offset of 1.3 ± 7 mm greater than the contralateral hip. Patients had a mean leg length discrepancy of −0.9 ± 5.9 mm. In conclusion, a surgeon mentoring program was designed and implemented to reduce the learning curve of the DAA in our center, with satisfactory 3-year clinical and radiological outcomes achieved. This study provides preliminary support for the potential utility of the mentoring program in facilitating other centers in safely introducing the DAA into their practice without an initial increase in complication rate.
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