BackgroundThe common modality of treatment of metacarpal fractures is nonsurgical. There are, however, a subset of patients and fracture types that require surgical correction, but surgery comes with its own problems like stiffness and scarring. Therefore, surgical operations must be minimally invasive barring complications of anaesthesia and the procedure. Therefore, we conducted this study to assess patient outcomes following treatment with percutaneous intramedullary screw fixation via the wide-awake local anaesthesia no tourniquet (WALANT) approach for unstable metacarpal fractures. MethodologyWe retrospectively analysed the records of 21 patients who received metacarpal fixations with headless compression screws at two district general hospitals in the United Kingdom from 2018 to 2020. We used wide-awake anaesthesia with 10 mL (1% lidocaine and 1 mL 8.4% sodium bicarbonate as a buffer) infiltrated around the superficial tissues on the dorsal aspect of the metacarpal bone, including the periosteum. The Jahss manoeuvre was used to reduce the fracture under the guidance of a mini C-arm. All patients had 3-mm Medartis cannulated compression screws (Medartis AG, Basel, Switzerland) (self-tapping) inserted retroactively using a 5-mm skin incision. The range of movement of the metacarpophalangeal joint was checked intraoperatively and shown to the patient for optimal postoperative rehabilitation. Patients underwent a two-week follow-up wound check and examination for pain (using the visual analogue scale (VAS)) or stiffness requiring physiotherapy. We used the Manchester-modified (M2) disability of the arm, shoulder, and hand (DASH) score to scrutinize the fracture union and the functional outcome of the hand. We also assessed the time to return to work. ResultsThe study included 18 men and two women with a mean age of 22.6 years (range, 18 to 40). The fifth (n=16), fourth (n=4), and second metacarpals (n=1) were involved, and we saw transverse (n=10) and short oblique (n=11) fractures. Fractures healed in five weeks (range, four to six weeks). The mean M2 DASH score was 0.8 (range, 0 to 6), and mean total active motion was 240° (range, 230° to 260°). At the final follow-up, the mean extensor lag for the metacarpophalangeal joint was 5° (range, 0° to 15°), 7° for the proximal interphalangeal joint (range, 0° to 15°), and no lag at the distal interphalangeal joint. The average VAS score at the end of two weeks was 8/10 (range, 7 to 9). The average time for the return to daily activities was 2.56 weeks. We found no intraoperative complications in any of the patients. All patients went home on the same day postoperatively and gave feedback that their experience with WALANT was good to excellent. All patients had a good range of motion at the two-week follow-up, and the mean time to return to normal work was two to three weeks. The M2 DASH score measured was satisfactory. ConclusionsThis retrospective study assessed patient outcomes following treatment with percutaneous intramedullary screw fixation via the WALANT appr...
Introduction The process of informed consent is vital, not only to good clinical practice and patient care, but also to avoid negligence and malpractice claims. Elective hip and knee arthroplasty numbers are increasing globally, and the British Orthopaedic Association (BOA) has endorsed standards for obtaining written consent for these procedures. Many centres in the United Kingdom and globally, use handwritten consent forms to document informed consent, leaving open the potential for missing out important procedure and risk-related information. Our study aimed to assess whether information on handwritten consent forms was compliant with BOA standards for elective arthroplasty of the hip and knee. Methods We retrospectively reviewed 70 handwritten consent forms, across theatre lists of 12 arthroplasty consultants at our elective arthroplasty centre. These included 35 forms each for hip and knee arthroplasty respectively. We compared the information on these forms to the standards prescribed by the BOA. We assessed compliance of the forms with common, less common and rare risks of hip and knee replacement, as described by the BOA. We also noted the designation of the person filling out the form (consultant, registrar or nurse practitioner) and whether this affected information on the form. We assessed the forms for legibility issues, and whether the setting (clinic/pre-operative ward) affected information on the form. Results None of the 70 forms reviewed achieved full compliance with BOA standards. When assessed for common risks of hip and knee arthroplasty, the number of compliant forms was 25.7% and 42.8%, respectively. None of the forms mentioned all rare risks of either hip or knee arthroplasty. We identified legibility issues in 12 of 70 (17.1%) forms. There was no significant difference in information written on forms filled out by consultants, registrars or nurse practitioners, or between forms filled out in the clinic versus those on the pre-operative ward. Conclusion Handwritten forms lack compliance with prescribed standards for written informed consent in elective hip and knee arthroplasty. Ideally, a pre-written consent form should be used, but with the option of adding information individually tailored to the patients’ background. This ensures that good clinical practice is optimally followed, and reduces the potential risk of any litigation.
<p class="abstract"><strong>Background:</strong> Knee being a major weight bearing joint, arthritis of the knee is a common problem. Over time various conservative measures have been used to alleviate the arthritic pain, but complete pain relief has rarely been achieved. Total Knee Arthroplasty has an established place in the treatment of knee arthritis and is an effective surgical modality that provides immediate pain relief and enhances quality of life. Though most patients were satisfied by the immediate outcome of the surgery, further detailed interrogation revealed concern and inability to perform activities they previously used to do, thus arising the need for an objective method to measure the true outcome.</p><p class="abstract"><strong>Methods:</strong> There are very few established objective scoring methods to evaluate the outcome following a Total Knee Arthroplasty. In our study, we have used the ‘Functional Knee Score’ for the 30 patients with arthritis who underwent TKA using the midvastus approach under tourniquet cover.<strong></strong></p><p class="abstract"><strong>Results:</strong> The majority of the patients were from the age group of 61-70 years which accounts for 36.7% of patients in our study. The mean functional new knee society score preoperatively was 39.90 standard deviation of 3.055 which improved to 80.77 with standard deviation of 6.263 postoperatively, p<0.001.</p><p class="abstract"><strong>Conclusions:</strong> Using knee society functional score, 10 patients had excellent results, 16 had a good result, 4 patients a had fair result.</p>
Spinal tuberculosis is the most common form of extrapulmonnary tuberculosis. It can be managed conservatively as well as by operative intervention. The surgery involves decompression of the focus of infection and stabilisation of the spine. Various approaches have been devised to perform decompression and instrumentation of the spine. This study compares the efficacy and complications of three approaches: Anterior and Posterior, Anterolateral and Only Posterior approach. It is a retrospective study involving 30 patients from October 2013 to October 2015. In our study, we found that the posterior approach was a safer approach with lesser complications and almost equal efficacy as compared to other two approaches. Though there was equally significant improvement in the post-operative neurology in all the three approaches, the posterior approach was associated with lesser morbidity and required relatively lesser time.
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