The role of physiotherapy in the treatment of whiplash associated disorders: a prospective study

Objectives  Prospective longitudinal study to evaluate the effect of physiotherapy on whiplash associated disorders (WAD). Materials and methods  A total of 141 patients suffering from grades I–III WAD after a road traffic accident were employed. Validated neck Bournemouth Questionnaire was used in order to look at the effect of treatment on the symptoms. Results  The mean age was 40 (±14) years. The mean length of the treatment was 6 (±3.4) weeks. The mean individual effect size was 0.97 (95% CI 0.8–1.2). A total of 67% of the patients who started their treatment in the first 3 months post-injury improved compared to 48% in those who started physiotherapy after 3 months (P = 0.025). In both groups the applied treatment almost halved the number of patients taken sick leave. Conclusion  Physiotherapy is effective in the treatment of whiplash injury, especially in order to get the patients fit to go back to their previous employment.     

Nail-patella syndrome

Nail patella is one of the familial syndromes commonly asked on the FRCS (Trauma & Orth) exam. This article reviews the latest scientific information available and high-lights the key features.     

Orthopaedic manifestations and management of spondyloepimetaphyseal dysplasia Strudwick type

Spondyloepimetaphyseal dysplasia (SEMD) Strudwick type is a rare autosomal dominant condition arising from defects in COL2A1 the genes responsible for the biosynthesis of procollagen type II. The orthopaedic manifestations of patients can be hypoplastic odontoid peg with atlantoaxial instability, severe kyphosis or lordosis of dorsal and lumbar spines, hip subluxation, coxa vara and early severe hip osteoarthritis, and malalignment of lower limbs like genu valgum or club foot. We report a mother and daughter with SEMD Strudwick Type and describe their orthopaedic problems, surgical management and clinical outcome after 30 years and 7 years of follow-up respectively.     

Hand elevation test for assessment of carpal tunnel syndrome

The Hand Elevation test is a new provocative test for the diagnosis of carpal tunnel syndrome. We have investigated the sensitivity and specificity of this test in 48 patients with a clinical diagnosis of carpal tunnel syndrome and compared it to Tinel's and Phalen's tests. The Hand Elevation test was found to be 88% sensitive and 98% specific. This test is a simple, reproducible provocative test which is easily employed in conjunction with other known tests to assist in the diagnosis of carpal tunnel syndrome.     

A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects

Objective

The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.

Methods

Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace.

Results

The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.

Conclusion

Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.     

Cri du Chat syndrome

Cri du Chat syndrome is a rare genetic condition affecting the short arm of chromosome 5. A range of clinical features, including the characteristic “cat-like” cry and developmental delay, is recognized in children with the syndrome. A higher incidence of certain paediatric orthopaedic conditions such as scoliosis, developmental dysplasia of the hip and pes planus and varus has also been observed.     

Theatre Shoes — A Link in the Common Pathway of Postoperative Wound Infection?

INTRODUCTION

Operating department staff are usually required to wear dedicated theatre shoes whilst in the theatre area but there is little evidence to support the beneficial use of theatre shoes.

PATIENTS AND METHODS

We performed a study to assess the level of bacterial contamination of theatre shoes at the beginning and end of a working day, and compared the results with outdoor footwear.

RESULTS

We found the presence of pathogenic bacterial species responsible for postoperative wound infection on all shoe groups, with outdoor shoes being the most heavily contaminated. Samples taken from theatre shoes at the end of duty were less contaminated than those taken at the beginning of the day with the greatest reduction being in the number of coagulase-negative staphylococcal species grown. Studies have demonstrated that floor bacteria may contribute up to 15% of airborne bacterial colony forming units in operating rooms. The pathogenic bacteria we isolated have also been demonstrated as contaminants in water droplets spilt onto sterile gloves after surgical scrubbing.

CONCLUSIONS

Theatre shoes and floors present a potential source for postoperative infection. A combination of dedicated theatre shoe use and a good floor washing protocol controls the level of shoe contamination by coagulase-negative staphylococci in particular. This finding is significant given the importance of staphylococcal species in postoperative wound infection.     

Assessing the clinical significance of change scores following carpal tunnel surgery

This article presents a prospective longitudinal study to determine the cut-off values for change scores of DASH, Levine, and Kamath questionnaires to distinguish clinical improvement following carpal tunnel surgery. Fifty-four patients (40 female, 14 male), with positive nerve conduction studies, were prospectively followed up. Three questionnaires (DASH, Levine, and Kamath) were posted to patients at four and two weeks prior to their operation and then six weeks following surgery. A patient global impression of change (PGIC) score was completed for patients to rate the overall change in their symptoms. According to the PGIC, 93% of patients improved. The cut-off values for raw change scores that best define clinically significant improvement following carpal tunnel release were 20.9 for DASH, 0.47 for Levine, and 1.97 for the Kamath questionnaire. This study provides a methodological framework for identifying clinically significant changes following treatment. A questionnaire follow-up of patients is now possible using the data provided.

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Résumé  Etude prospective longitudinale dans le but de déterminer les valeurs seuils, les scores DASH, de LEVINE et de KAMATH correspondant à l’amélioration clinique après chirurgie du canal carpien. 54 patients (40 femmes et 14 hommes), ayant un électromyogramme positif ont été suivis de manière prospective. 3 questionnaires (DASH, LEVINE et KAMATH) ont été envoyés aux patients à 4 et 2 semaines avant leur intervention et à 6 semaines après l’intervention. Un score d’impression globale de changement subjectif (PGIC) a été rempli par les patients pour mesurer les changements survenus dans leur symptomatologie. 93% des patients ont été améliorés selon le score PGIC. Les valeurs seuils de changement brut des scores correspondant le mieux à l’amélioration clinique suivant la chirurgie de libération du canal carpien étaient 20.9 pour le DASH, 0.47 pour le LEVINE et 1.97 pour le KAMATH. Cette étude fournit une base méthodologique pour identifier les améliorations cliniques significative après traitement. Le suivi des patients par questionnaire est maintenant possible par l’utilisation des données fournies.

     

The Harris-Galante porous-coated, hemispherical, polyethylene-lined acetabular component in patients under 50 years of age: a 12- to 16-year review

We have reviewed 70 Harris-Galante uncemented acetabular components implanted as hybrid hip replacements with cemented stems between 1991 and 1995 in 53 patients whose mean age was 40 years (19 to 49). The mean follow-up was for 13.6 years (12 to 16) with no loss to follow-up. We assessed the patients both clinically and radiologically. The mean Oxford hip score was 20 (12 to 46) and the mean Harris hip score 81 (37 to 100) at the final review. Radiologically, 27 hips (39%) had femoral osteolysis, 13 (19%) acetabular osteolysis, and 31 (44%) radiolucent lines around the acetabular component. Kaplan-Meier survival curves were constructed for the outcomes of revision of the acetabular component, revision of the component and polyethylene liner, and impending revision for progressive osteolysis. The cumulative survival for revision of the acetabular component was 94% (95% confidence interval 88.4 to 99.7), for the component and liner 84% (95% confidence interval 74.5 to 93.5) and for impending revision 55.3% (95% confidence interval 40.6 to 70) at 16 years. Uncemented acetabular components with polyethylene liners undergo silent lysis and merit regular long-term radiological review.