Assessing the efficacy of cervical orthoses in restricting spinal motion has historically proved challenging due to a poor understanding of spinal kinematics and the difficulty in accurately measuring spinal motion. This study is the first to use an 8 camera optoelectronic, passive marker, motion analysis system with a novel marker protocol to compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars. Restriction of cervical spine motion was assessed for physiological and functional range of motion (ROM).

Nineteen healthy volunteers (12 female, 7 male) were fitted with collars by an approved physiotherapist. ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro-reflective marker clusters attached to the head and trunk. 3-D kinematic data was collected from uncollared and collared subjects during forward flexion, extension, lateral bending and axial rotation for physiological ROM and during five activities of daily living (ADLs). ROM in the three clinical planes was analysed using the Qualisys Track Manager (Qualisys, Sweden) 6 Degree of Freedom calculation to determine head orientation relative to the trunk.

For physiological ROM, the Aspen and Philadelphia were more effective at restricting flexion/extension than the Vista (p<0.001), Miami-J (p<0.001 and p<0.01) and Miami-J Advanced (p<0.01 and p<0.05). The Aspen was more effective at restricting rotation compared to the Vista (p<0.001) and Miami-J (p<0.05). The Vista was least effective at restricting lateral bending (p<0.001). Through functional ROM, the Vista was less effective than the Aspen (p<0.001) and other collars (p<0.01) at restricting flexion/extension. The Aspen and Miami-J Advanced were more effective at restricting rotation than the Vista (p<0.01 and p<0.05) and Miami-J (p<0.05). All the collars were comparable when restricting lateral bending.

The Aspen is superior to, and the Aspen Vista inferior to, the other collars at restricting cervical spine motion through physiological ROM. Functional ROM observed during ADLs are less than those observed through physiological ROM. The Aspen Vista is inferior to the other collars at restricting motion through functional ROM. The Aspen collar again performs well, particularly at restricting rotation, but is otherwise comparable to the other collars at restricting motion through functional ranges.

Objective

To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes.

There is little evidence from the literature regarding the timing of hip fracture surgery for patients who are on the antiplatelet agent clopidogrel bisulphate (Plavix) (1).

We report the results of a retrospective case control study of 40 patients comparing the timing of surgery for patients taking clopidogrel against a control group of those not taking an antiplatelet agent. Time to surgery, length of stay, transfusion requirements, wound problems and other post operative complications were examined.

Within the study group of patients taking clopidogrel, we also compared those who underwent surgery within four days of stopping the clopidogrel and after four days.

The transfusion requirements were greater in those patients on clopidogrel prior to admission. Wound healing and post operative complications were similar between the two groups. Total length of hospital stay and post operative length of stay were longer in the clopidogrel group.

There was an increase in transfusion requirements and post operative length of stay in patients on clopidogrel undergoing early surgery (within 4 days) compared to the group where surgery was delayed.

We conclude that, in this small study, transfusion requirements and length of stay were greater in patients on clopidogrel. Transfusion requirements and post operative length of stay were also greater if surgery was performed within four days of omitting clopidogrel. Further studies are required to determine optimal timing of surgery following discontinuation of clopidogrel.

Objective: To determine the success of 20 cases treated with TomoFix high tibial medial opening wedge osteotomy.

Study design: Retrospective review of 20 cases with 6 months of follow up including; indications for treatment, surgical technique, results, complications and patient satisfaction.

Background: High Tibial Osteotomy is an established technique for the treatment of unicompartmental osteoarthritis of the varus malaligned knee. Corrections are usually achieved by closed wedge osteotomy from a lateral exposure. This technique has associated risks of; peroneal nerve injuries, instability of the osteotomy and secondary loss of correction. Open wedge osteotomy of the medial side eliminates these risks. TomoFix allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts.

Results: Full weight bearing after 6 weeks. No implant failures, delayed unions, nerve injuries or compartment syndromes. Complications included 1 infection, 1 over correction and 1 with metalwork pain.

Conclusions: TomoFix allows for early mobilisation and avoids loss of correction with reduced risk of nerve injuries and compartment syndrome.

Relevance: The surgical technique needs careful attention. Disorders of normal bone healing and inadequate axial correction may lead to failure of treatment. Early rehabilitation is possible and long term follow up is necessary.

Inadvertent excision of lumps which turn out to be soft tissue sarcomas is still unfortunately quite common. It is known as the “whoops” procedure. Determining whether there is residual disease is key to deciding subsequent management. The value of MRI has been assessed.

All new patients referred to our unit with a potential diagnosis of a “whoops” lesion were routinely reassessed with MR1 6 weeks after the initial operation.

Notwithstanding the result of the scan all patients underwent a further wide excision of the involved area shortly after the MRI. The scans of these patients have been reviewed and classified into positive, equivocal or negative. These results have been compared with the histological assessment of the re- excision specimen to determine the accuracy of MR1 in predicting the presence of residual tumour.

Of 887 patients with newly diagnosed soft tissue sarcomas seen in an 8 year period, 140 (11 %) had previously had a ‘whoops” procedure. Of these 111 had re-evaluation MR1 scans and had also undergone a further re-excision. There was residual tumour in 63 (57%) patients, whilst 48 (43%) had no residual tumour.

The sensitivity of MRI in predicting tumour was 64% but specificity 93%. Positive predictive value was 93% and negative predictive value 67%. Overall accuracy was 77%.

MRI is useful in identifying residual tumour after a whoops procedure but a negative result by no means excludes it. Re-excision remains essential despite the MRI results in most cases to ensure tumour clearance. Preventing the “whoops” procedure is clearly the best option of all!

The quantification of local bone blood flow in man has not previously been possible, despite its importance in the study of normal and pathological bone. We report the use of positron emission tomography, using 15O-labelled water, to measure bone blood flow in patients with closed unilateral fractures of the tibia. We compared fractured and unfractured limbs; alterations in blood flow paralleled those found in animal models. There was increased tibial blood flow at the fracture site as early as 24 hours after fracture, reaching up to 14 times that in the normal limb at two weeks. Blood flow increase was less in displaced than in undisplaced fractures. The muscle to bone ratios of blood flow were similar to those in previous animal work using other techniques. Positron emission tomography will allow study of human bone blood flow in vivo in a wide variety of pathological conditions.