The availability and usage of portable image intensifiers has revolutionised routine orthopaedic practice. Extensive use of fluoroscopy however may result into significant radiation exposure to operating staff. An accumulated dose of 65 microSv per procedure over long exposure has been reported to increase the risk of thyroid cancer. The present prospective study aimed at measuring the scattered dose to the thyroid using an Unfors EDD dosimeter during DHS/IMHS for fractures of the neck of the femur and IM nailing for long bone fractures. In 32 procedures, the dose of 65 microSv was exceeded 13 times; 8 times during DHS/IMHS and 5 times during IMN. The average thyroid dose was 142 microSv during IMN and 55 microSv during DHS. Only 9 of the total 223 (4%) theatre personnel were using a thyroid shield in spite of its availability. These results suggest that the thyroid is frequently exposed to potentially harmful radiation during these procedures. Strict inclusion of a thyroid shield as a part of routine radiation protection is recommended.
AimTo use Patient Reported Outcome Measures (PROMs) to determine the effectiveness of lumbar spinal surgery at a single UK institution.MethodsConsecutive patients who underwent lumbar spinal surgery (discectomies or decompressions) from 1 January 2011 to 13 March 2013 at a UK District General Hospital were assessed. The procedures were performed or supervised by a senior Consultant Orthopaedic spinal surgeon. All patients completed PROM questionnaires before and three months following surgery. These included Visual Analogue Scores (VAS), SF-12, Oswestry Disability Index (ODI) and Roland Morris Low Back Pain Questionnaire (RMQ).ResultsA total of 230 patients had surgery. Of these, 189 (82%) completed both pre- and post-operative questionnaires. All PROMs showed improvement: VAS for constant back pain improved from 4.1 to 2.1 and exacerbations of back pain from 5.8 to 2.4. VAS for constant leg pain improved from 6.3 to 1.7 and for exacerbations of leg pain from 8.2 to 1.8. Mean ODI from 47 to 21; RMQ from13...
Cyclists are prone to a number of sport-related musculoskeletal injuries, mainly of the lower limb. Nerve compression injuries are relatively rare, though in the hand ulnar nerve compression is well described. We describe a case of bilateral median nerve compression caused by cycling.
This aim of this study is to evaluate the efficacy of the Plant Tan plate, a new implant introduced for comminuted proximal humerus fractures. This paper presents the results of 10 patients who underwent the procedure over a two year period.Methods : Two and three part proximal humeral fractures continue to be a difficult problem and accurate fixation is necessary for optimum functional outcome.Ten patient had plant Tan plate fixation for proximal humerus fractures from January 2002 till January 2004. Details including patient demographics, the type of fracture, the bone quality, significant co morbid factors, the surgical approach union rate and complications were noted. Outcome was assessed using the Constant score and comparing with the opposite side and the Oxford shoulder questionnaire.Results : After an average follow up of 6 months, 80% of the patients were satisfied with the result of surgery at the time of the most recent examination. The union rate was 85 %. The significant complications were in...
Aims & Objectives: The Children’s Air Ambulance (TCAA) are a national charity that operate 2 dedicated helicopters which are available for neonatal and paediatric transport. They have 10 clinical partner teams (CPT) based in different geographical regions around England. Every team undertakes the annual aviation environmental training course (AETC) in partnership with the pilots and air desk team. Methods: Each CPT has different levels of experience which prompted the TCAA education group to develop a national training day, aiming to develop collaborative education between CPT’s, witness top tips and share good practice amongst colleagues. The goal was for all teams to adopt this training programme in 2020 providing a standardised approach. A faculty of 4 was established. Results: The multidisciplinary training day was held at TCAA headquarters at Coventry airport. The TCAA pilots were an essential part of the training day being in a unique position of observing practices from all CPT’s providing an insight into frequently occurring issues to incorporate into the day. The participants were able to immerse themselves in the flight environment, responding to evolving clinical and aviation situations: strategies for supporting an anxious parent, and performing an emergency evacuation. Conclusions: Debriefing and evaluations demonstrated the day had been a success and each team agreed they would use this training programme in the coming year. An additional benefit to the day was the opportunity for the teams to enhance their professional relationships. Thank you to the staff from TCAA for their hospitality and CPTs for their participation.
A 31 year old woman presented with a crusting lesion on the scar of her BCG vaccination. Histological examination showed it to be a basal cell carcinoma, which only rarely arises in vaccination scars, and is particularly unusual in BCG vaccination scars.
Objectives & Background With 1.9 million neurons lost every minute a stroke is untreated1, rapid assessment and management is a time critical medical emergency, and is reliant on robust Emergency Department (ED) systems. Rapid access to CT imaging is an immediate priority to allow exclusion of patients with haemorrhagic stroke, an absolute contraindication to thrombolysis. Our QI project aimed to reduce the time from arrival in ED to CT scan for patients presenting with potentially thrombolysable stroke. Methods Using a combination of live and simulated stroke scenarios, we process-mapped the care of potentially thrombolysable patients through the ED at Forth Valley Royal Hospital. We identified ‘unnecessary’ delays from non-value adding activity and following consultation with the Scottish Ambulance Service, Radiology & Neurology, created a new pre-alert procedure and streamlined protocol for this patient group which facilitated rapid assessment, stabilization and early access to CT imaging. We used a multi-modal approach to deliver change which included weekly clinical governance meetings, teaching for medical & nursing staff, in-situ simulation to educate and stress the system, regular safety brief announcements and the development of a ‘Stroke Awareness Week' at our hospital. Results Door to CT time was reduced by 40%, from 30 minutes (median 23) to 18 minutes (median 13), comparing 4 month sample periods before and after changes. During our QI project, Door-to-Needle (DTN) time has reduced from a mean of 81 minutes (in 2015) to a mean of 64 minutes (2016YTD). Conclusion Early thrombolysis has been shown to improve outcomes in patients with ischaemic stroke.2 Reducing ‘Door-to-CT' scan time in the ED is an important step in enabling a reduction in the overall DTN time. This can be achieved by stream-lining key processes in the patient journey through the ED. A multi-modal approach ensured this change was introduced safely and effectively whilst re-enforcing a core change to standard working practice. Further work on process mapping and the delivery of thrombolysis is the next obvious step in further reduction in DTN time. Figure 1 Quality Improvement Run Chart 'Door-to-CT' time with change processes highlighted
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