Investigation into the outcomes following fixation of fractured neck of femurs with cannulated hip screws
Authors: Aaron Rooney, Nick Rollitt
Journal: International Journal of Surgery (2013)

s / International Journal of Surgery 11 (2013) 589e685 663 ABSTRACTS digital templating for femoral stem offset and acetabular cup size with the actual size of implants inserted. Methods: The methods of calibration studied were a standard 115% magnification and radio-opaque markers of a known size. All the x-rays were templated retrospectively and blindly. Study 1 looked at the fixed magnification method in 25 consecutive patients. Following the introduction of the radio-opaque marker we considered 24 patients who had a marker in their pre-operative x-ray. This comprised study 2. In study 3 we used the same patients from study 2 and compared the 115%magnification method to the radio-opaque marker results. Results: In study one, 72% of patients had the same offset measured and 72% had the cup size measured accurately. In study two, 55% of patients had the same offset measured and 85% had an accurate cup size measured. In study three, 57% had the same offset measured and 62% had the acetabular cup component measured correctly. Conclusion: Due to the inaccuracies demonstrated in digital templating, we recommend the use of intra-operative trialling as an adjunct when choosing implants in THA. 0399: PATIENT PERSPECTIVE ON REGIONAL ANAESTHESIA OF UPPER LIMB SURGERY Bafiq Nizar, Rinoza Bafiq, James Harty. Cork University Hospital, Cork, Ireland. Aims: Brachial plexus block is the backbone of upper limb regional anaesthesia. The objectives of our study were to evaluate patients' perspective on regional anaesthesia in upper limb surgery and to determine the percentage who preferred it. Method: We randomly selected forty two patients who had a regional anaesthesia for an upper limb elective surgery over a six months period. Data was gathered using a proforma during their hospital stay. Results were analysed using statistical tools. Results: Twenty eight patients disliked regional anaesthesia and four preferred it over general anaesthesia.(66% vs 9.5% p 1⁄4 0.014). Ten patients were indifferent over the type of anaesthesia they received (p 1⁄4 0.024). Twelve patients thought it was distressing and painful and seven considered it as a bad experience. Out of the four who liked regional anaesthesia, two had severe co-morbidities which restricted them to have general anaesthesia, one thought it provided good pain relief and the fourth patient found it shortened the duration of hospital stay. Conclusion: Majority of patients who underwent upper limb surgery did not prefer regional anaesthesia due to the distress and pain caused by the block. However many found it was a satisfactory mode of post-operative analgesia. 0408: INVESTIGATION INTO THE OUTCOMES FOLLOWING FIXATION OF FRACTURED NECK OF FEMURS WITH CANNULATED HIP SCREWS Aaron Rooney, Nick Rollitt. North Middlesex University Hospital, London, UK. Aims: To investigate which patients had received cannulated hip screws for a fractured neck of femur and identify: Which age groups were receiving this treatment. Functional outcomes following the surgery. Number of patients requiring a second operation Methods:Allpatientswere identifiedusing theNationalHipFractureDatabase. Allpatients receivingacannulatedhipscrewfora fracturedneckof femur in the NorthMiddlesexHospital between July 2007 andAugust 2012were identified. The hospital's computerised database was used to access clinical records. Results: 48 patients were identified (21_:27\). The largest group of patients was those aged 80-89 years, 35.4%. Most patients coming from their own home/sheltered accommodation returned there after their operation, 97.7%. The majority of patients had their operation within 36 hours, 68.8%. 83.3% of patients had not had a further operation at the time of our study. One patient had their screws removed because of pain. Six patients (12.5%) required a conversion to a total hip replacement. Conclusions: Our conversion rates compare favourably to those reported in the literature. Great consideration has to be given to the choice of patient undergoing this procedure due to the relatively high risk of requiring a second operation 0413: FOREFOOT SURGERY AS A DAY CASE: COMPLIANCE OF SAME DAY DISCHARGE AND PATIENT SATISFACTION Sarah Al-Himdani, Abubakar Mustafa, Anand Pillai. University Hospital of South Manchester, Manchester, UK. Aim: To evaluate the compliance with same day discharge, post operative pain and patient's satisfaction following forefoot surgery as day case. Method: Prospective study of 35 patients who underwent various day case forefoot surgerybetweenAugust toOctober2012.Procedureswereperformed under general or spinal anaesthesia, by a single surgeon and ankle block was used. A standard discharge protocol was followed. Patient satisfaction was assessed using a standardised questionnaire in a 2 week follow up clinic. Results: The study comprised of 6males (18%) and 29 (82%) females, with a mean age of 54 (25-79) years. The surgical procedures included 1st ray surgery, excision of Morton's neuroma and lesser toes correction. 62% patient had surgery in morning operative list, 38% in the afternoon. 72% hadmore than one procedure. Nine patients (26%) required overnight stay. The most common reason was post-operative nausea and vomiting (4 patients, 11%) and pain (2 patients, 5%). Post-operative pain control was adequate in 97%. Overall patient satisfaction was 95%. Conclusion: Forefoot surgery is safe and practical procedure for day surgery with an excellent patient satisfaction rate. Correct patient selection and appropriate anaesthetic protocol to address PONV will improve efficacy of discharge. 0430: A CROSS SECTIONAL REVIEW OF THE INCIDENCE OF PHANTOM LIMB SENSATION IN A COHORT OF AMPUTEES AND THE EFFECT OF VISCERAL STIMULATION (MICTURITION/DEFECATION) ON SENSATION INTENSITY Michael Rafferty, Thomas Bennett-Britton, Rhodri Phillip. Defence Medical Rehabilitation Unit, Epsom, Surrey, UK. Aim: To assess the prevalence of phantom limb pain and the effect of visceral stimulation in a cohort of military amputees. A literature review identified just one case study in 2001(1), Methods: A cohort of 75 patients with a background of limb amputation completed a questionnaire including a pain visual analogue scale (VAS). Patients recorded the presence and intensity of phantom limb sensation. Secondary outcomes were alteration in sensation associated with a need to micturate, micturition, needing to open bowels and opening bowels. Results: Participants reported phantom limb sensation prevalence of 86% with a mean VAS of 2.66 (SD 2.1). 81% of patients reported a change in the severity of phantom limb sensation with visceral stimuli. The mean change in VAS alteration of phantom limb sensation due to visceral stimulation was 1.32 for bladder stimulation and 1.06 for bowel stimulation (p-value 0.027).65% of patients reported improvement over time. Only 36% reported an improvement of symptoms with neuropathic medications. Conclusion: Phantom limb sensation and the effect of visceral stimulation is a greater problem faced by amputees than previously described. The use of pharmacological agents has no benefit to the majority of those questioned; however 65% of patients report improvement over time. 0451: THE LATARJET PROCEDURE: A RELIABLE AND SAFE PROCEDURE FOR ANTERIOR SHOULDER DISLOCATIONS WITH ANTERIOR BONY GLENOID DEFICIENCY Joshua Henry , Lennard Funk . University of Manchester, Manchester, UK; Wrightington, Wigan and Leigh NHS Trust, Greater Manchester, UK. Aims: The Latarjet procedure was developed to prevent further dislocations through transplantation of the coracoid, creating a reinforcing tendinous sling and repairing the inferior ligamentous complex. This study aimed to assess the overall success of the Latarjet procedure in terms of recurrence of anterior instability and improving shoulder function in the presence of bony glenoid deficiency. Patients and Methods: All patients that had undergone the Latarjet procedure between March 2011 and May 2012 were included. Indication for surgery was anterionferior bony glenoid deficiency. All procedures were performed by the senior author. The Oxford Shoulder Instability score, Oxford Shoulder score, Constant Shoulder score, Disabilities of the Arm Shoulder and Hand score and pain and satisfaction assessed outcome. Results: There were 58 patients with a mean age of 25.68 years (range 18.17-44.05) and an average follow up period of 22 months. Recurrence of anterior instability was reported in one patient after a traumatic injury. Shoulder function and pain showed significant improvement in all outcome measures (p 95% of patients that were active sportsmen were able to return to sport.