Dr William O'Callaghan

Description:High-pressure injection injuries to the hand are infrequent but potentially catastrophic injuries that have the potential for amputation or severe functional deficits. This is a case report on the management of a 28-year-old machinery operator who sustained a high-pressure grease gun injury to his dominant hand and underwent surgical debridement with a novel hydrosurgery technique. He had no complications and achieved a good functional outcome with a Disabilities of the Arm, Shoulder and Hand score of 1.67 at the 1-year follow-up. We also present a review of the literature and propose the use of hydrosurgery to address the challenges associated with the surgical treatment of these injuries.

Description:Glenoid baseplate positioning for reverse total shoulder arthroplasty (rTSA) is important for stability and longevity, with techniques such as image-derived instrumentation (IDI) developed for improving implant placement accuracy. We performed a single-blinded randomized controlled trial comparing glenoid baseplate insertion accuracy with 3D preoperative planning and IDI jigs vs. 3D preoperative planning and conventional instrumentation. All patients had a preoperative 3D computed tomography to create an IDI; then underwent rTSA according to their randomized method. Repeat computed tomography scans performed at six weeks postoperatively were compared to the preoperative plan to assess for accuracy of implantation. Patient-reported outcome measures and plain radiographs were collected with 2-year follow-up. Forty-seven rTSA patients were included (IDI n = 24, conventional instrumentation n = 23). The IDI group was more likely to have a guidewire placement within 2mm of the preoperative plan in the superior/inferior plane (P = .01); and exhibited a smaller degree of error when the native glenoid retroversion was >10° (P = .047). There was no difference in patient-reported outcome measures or other radiographic parameters between the two groups. IDI is an accurate method for glenoid guidewire and component placement in rTSA, particularly in the superior/inferior plane and in glenoids with native retroversion >10°, when compared to conventional instrumentation.

Description:Proximal femur fractures in geriatric patients are associated with increased morbidity and mortality. This study investigates Brain Natriuretic Peptide immunoassay levels taken at the time of hospital admission in predicting cardiac complications and mortality in geriatric patients with a proximal femur fracture. A single-site prospective cohort study at a large tertiary care, level 1 trauma centre was conducted on all consecutive geriatric patients aged greater than 60 years who sustained a proximal femur fracture. Investigators collected Brain Natriuretic Peptide levels from venous blood samples on admission to the Emergency Department. The main outcome measurements were inpatient cardiovascular complications, and all-cause mortality at 30-day, 90-day, one-year, and nine-years. Over a one-year period, 112 patients were enrolled. The average age was 82.7 years, and the average follow up was 6 years and 6 months (range, 2 days to 9 years). No patients were lost to follow up. There were 44 new or exacerbations of pre-existing cardiac complications requiring management recorded in 30 (26.8%) patients. Mortality at 30 days was 9.8%, 90 days was 16.1%, and one year was 24.1%, with deceased patients having a statistically significant elevated Brain Natriuretic Peptide immunoassay on hospital admission. The Kaplan-Meier graph demonstrated a trend towards increasing Brain Natriuretic Peptide and adverse survivorship risk. The Charlson Comorbidity Index was statistically significant in predicting overall survival probability. Brain Natriuretic Peptide immunoassay on hospital admission may be utilised to identify patients at risk of cardiac complications and mortality to guide further investigations, operative planning, the consent process, and post-operative monitoring.

Description:Objective: The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA. Methods: This paper reports a single surgeon's outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported. Results: Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion, r = 0.926 and 0.856, p < 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common. Conclusions: CAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients. Methods: IV (retrospective case series review).

Description:Pelvic skeletal asymmetry can result in rotational differences and morphologic bony prominence variance between the left and right hemipelvis. When selecting bony reference points for modern computed tomography-based robotic total hip arthroplasty planning, it is unclear which bony landmarks are the most reliable and accurate, especially in the presence of significant pelvic asymmetry. A retrospective study was conducted utilizing a database of computed tomography scans. Multiple bony landmarks in the pelvis and femur were selected for comparison, with the aim of measuring pelvic asymmetry. Specifically, the study measured the average difference in lateral offset between the left and right hemipelvis caused by pelvic asymmetry. Landmarks were also compared to determine the impact of pelvic asymmetry on hip length, femur length, and limb length discrepancies. Furthermore, a scenario was simulated in the software whereby a total hip replacement was inserted, potentially changing the hip length. The impact of pelvic reference point selection on the measurement of this simulated change in hip length was examined. This study population showed widespread pelvic asymmetry. The anatomical landmarks of the opposite side cannot be relied upon for predicting the anatomy of the affected side. The center of rotation axis is more reliable than the inferior obturator foramen axis for hip length discrepancy due to pelvic asymmetry (P < .05). Current computer-assisted surgery THR software reports measurements of global offset and hip length that do not consider pelvic asymmetry. Surgeons are not given confidence ranges to represent the potential impact of asymmetry on the global offset and hip length values. Surgeons following these numbers to guide implant position may incur implant placement error should significant pelvic asymmetry be present in a given patient.