Outcome after conservatively managed intracapsular fractures of the femoral neck

Introduction

In 2012, 2.6% of hip-fracture patients in the UK were treated conservatively. There is little data on outcome for these patients. However, one study demonstrated that though 30-day mortality is higher, mortality over the rest of the year is comparable with that in surgical groups. Therefore, we assessed conservatively managed patients in our unit.

Methods

Patients with intracapsular fractures of the femoral neck treated by conservative means between 2010 and 2012 inclusive were identified. Data were collected: American Society of Anaesthesiologists (ASA) grade, Nottingham Hip Fracture Score (NHFS), mobility, mortality (30 days and one year) and pain levels.

Results

Thirty-two patients formed the study cohort. Mean age was 85.6 years. Median ASA grade was 4. Mortality at 30 days and one year was 31.3% and 56.3%, respectively. There was one case of pneumonia and one of infection. Pressure sores or venous thromboembolism were not documented. Three patients underwent surgery once their health improved. In general, mobility was decreased, but 30.8% of patients could mobilise with two aids or a frame. Only two cases had ongoing problems with pain.

Conclusions

Our data are similar to those published previously. Our patients were likely to have higher mortality data due to selection bias. Thirty-day mortality was significantly higher than the national average, but patients surviving 30 days had a prevalence of mortality similar to those managed by surgical means. Despite mobility decreasing from the pre-admission status, a considerable number of patients were free of pain and could mobilise. These data suggest that conservative management of intracapsular fractures of the femoral neck can produce acceptable results.     

Evaluation of anti–nociceptive activity of methanolic extract of Tecomaria capensis Thunb. (Bignoniaceae) leaves in rats

ObjectiveTo evaluate the anti-nociceptive activity of Tecomaria capensis (T. capensis) leaves extract (TCLE) using different models in rats by acetic acid induced writhing test, (b) tail-flick test (c) tail-clip test.MethodsTCLE (100, 300, 1 000 and 2 000 mg/kg body wt.) was given to rats orally to observe acute toxicity for 14 d. Then test drug TCLE were given at dose of 100, 200 and 500 mg/kg p.o. and standard drug aspirin were given at a dose of 100 mg/kg p.o.ResultsNo mortality was reported even after 14 d. This indicates that the methanol extract is safe up to a single dose of 2 000 mg/kg body weight. TCLE (100, 200 and 500 mg/kg p.o.) significantly inhibited abdominal constrictions (writhing) induced by acetic acid and increased the latency period in the tail flick and tail clip test. TCLE at the dose of 500 mg/kg showed significant anti-nociceptive activity compared to standard aspirin.DiscussionsThe results of this study show that methanol extract of T. capensis possesses anti-nociceptive activity which may be mediated by the central and peripheral mechanisms.     

Effect of cotton padding on the setting properties of plaster slabs

Introduction

Plaster of Paris (PoP) impregnated bandages have been used to maintain the position of bones and joints for over a century. Classically, wool dressing is applied to the limb before the PoP, which can then be moulded to the desired shape. A modification of this practice is to wrap the PoP bandages circumferentially in cotton before wetting and applying to the patient in an attempt to reduce inhalation of plaster dust and reduce mess. However, this may affect the water content of the cast and therefore also its setting properties and strength. This study compared the setting properties of PoP casts when used with and without cotton wrapping.

Methods

Sixty specimens, compliant with the American Society for Testing and Materials standards for three-point bending tests, were prepared, with thirty wrapped in cotton. All were weighed before and after water immersion, and wrapped around a plastic cylinder to mimic limb application. Bending stiffness and yield strength was measured on a servohydraulic materials testing machine at 2, 6, 12, 24, 48 and 72 hours.

Results

The water content of cotton-wrapped plaster was significantly higher (50%) than that of standard plaster. It had significantly lower strength up to 24 hours and significantly lower stiffness up to 72 hours.

Conclusions

The initial decrease in strength and stiffness of the cast wrapped in cotton may comprise the ability of the backslab to hold the joint or bone in an optimal position. Any modification of the standard plaster slab application technique should allow for the potential adverse effects on the plaster setting properties.     

A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery

Introduction

Orthopaedic enhanced recovery after surgery (ERAS) providers are encouraged to estimate the actual benefit of ERAS according to the patient’s opinion by using patient generated data alongside traditional measures such as length of stay. The aim of this paper was to systemically review the literature on the use of patient generated information in orthopaedic ERAS across the whole perioperative pathway.

Methods

Publications were identified using Embase^™, MEDLINE^®, AMED, CINAHL^® (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library and the British Nursing Index. Search terms related to experiences, acceptance, satisfaction or perception of ERAS and quality of life (QoL).

Findings

Of the 596 abstracts found, 8 papers were identified that met the inclusion criteria. A total of 2,208 patients undergoing elective hip and knee arthroplasty were included. Patient satisfaction was reported in 6 papers. Scores were high in all patients and not adversely affected by length of stay. QoL was reported in 2 papers and showed that QoL scores continued to increase up to 12 months following ERAS. Qualitative methods were used in one study, which highlighted problems with support following discharge. There is a paucity of data reporting on patient experience in orthopaedic ERAS. However, ERAS does not compromise patient satisfaction or QoL after elective hip or knee surgery. The measurement of patient experience should be standardised with further research.     

Cystic angiomatosis of bone with massive osteolysis of the cervical spine

The case of a 21/2-year-old boy with diffuse cystic angiomatosis of bone is presented. No evidence of visceral involvement was recorded. The clinical, radiographic and histologic findings during the course of the disease process are discussed. At the age of 15 years the patient died of neurologic alterations developed due to massive osteolysis and collapse of the cervical spine, and severe dyspnoea, secondary to persistent bilateral pleural effusions. Received: 29 August 1997 Revised: 15 January 1998 Accepted: 16 January 1998     

Usability of a virtual reality environment simulating an automated teller machine for assessing and training persons with acquired brain injury

Objective  

This study aimed to examine the usability of a newly designed virtual reality (VR) environment simulating the operation of an automated teller machine (ATM) for assessment and training.     

Extracorporeal Fixation of Displaced Mandibular Condylar Fracture : Viable Option

Background

To present a series of eighteen cases of displaced mandibular condylar fracture managed by extra-corporeal fixation. To evaluate the post operative results in terms of occlusal stability, temporomandibular joint function and radiological findings.

Methods

A series of 18 cases were treated with extra corporeal fixation with mini plate and screws for displaced mandibular condylar fracture. Ramus was exposed through sub mandibular approach. A wire was passed through the angle of mandible to pull the mandible inferiorly. The displaced condyle was retrieved. A suitable bone plate was fixed to the condylar segment and it was repositioned and stabilized with screw with the distal segment. In three cases vertical sub-sigmoid osteotomy was carried out to retrieve the condylar head. After assembling the osteotomised segment and condylar segment, it was repositioned and stabilised in predetermined position. Post operatively the patients were on inter maxillary fixation for a week followed by active physiotherapy.

Result

The follow up period was between 2-11 years. In nine cases occlusion and mandibular function was good. There was no resorption of the condylar head. One case had complete resorption of the condylar head. Other case had fracture of the bone plate.

Conclusion

Extracorporeal fixation is an effective method for management of displaced and dislocated condylar fracture.Key Words: Extracorporeal fixation, Condylar fracture     

High density lipoprotein cholesterol and total cholesterol in children with asthma and allergic rhinitis

Serum high density lipoprotein cholesterol and total cholesterol were studied in 15 children with allergic rhinitis, 45 asymptomatic asthmatic children and 16 children with acute asthmatic attacks. The latter were also studied in their asymptomatic phase. Two control groups of children with minor anatomical defects and those with acute pneumonia with respiratory distress were also studied. The serum concentrations of high density lipoprotein cholesterol were significantly higher (p less than 0.001) and those of total cholesterol lower (p less than 0.001) in children with respiratory allergy when compared to controls. The concentration of high density lipoprotein cholesterol increased and that of total cholesterol decreased during acute asthma.     

Randomized double-blind placebo-controlled trial of bestatin in patients with resected stage I squamous-cell lung carcinoma

BACKGROUND: Bestatin is a potent aminopeptidase inhibitor that has immunostimulant and antitumor activity. We conducted a prospective randomized, double-blind, placebo-controlled trial to determine whether postoperative adjuvant treatment with bestatin could prolong the survival of patients with completely resected stage I squamous-cell lung carcinoma. METHODS: Patients with confirmed, resected stage I squamous-cell lung carcinoma were randomly assigned to receive either bestatin (30 mg) or placebo daily by mouth for 2 years. We assessed whether bestatin treatment was associated with overall survival and 5-year cancer-free survival and assessed its safety. All statistical tests were two-sided. RESULTS: From July 8, 1992, through March 30, 1995, 402 patients were entered in the study, 202 in the bestatin group and 198 in the placebo group. The median follow-up for surviving patients was 76 months (range = 58-92 months). The 5-year overall survival was 81% in the bestatin group and 74% in the placebo group for a difference of 7% (95% confidence interval [CI] = -1.4% to 15.0%). The 5-year cancer-free survival was 71% in the bestatin group and 62% in the placebo group for a difference of 9% (95% CI = -0.7% to 17.8%). Overall survival (P =.033, log-rank test) and cancer-free survival (P =.017, log-rank test) were statistically significantly different by Kaplan-Meier analysis. Few adverse events were observed in either group. CONCLUSIONS: Survival was statistically significantly better for patients with completely resected stage I squamous-cell lung carcinoma who were treated with bestatin as a postoperative adjuvant therapy than for those who received a placebo. This result requires confirmation in other phase III trials.