Study DesignQualitative studyObjectiveTo explore the perspectives of preclinical spinal cord rese... more Study DesignQualitative studyObjectiveTo explore the perspectives of preclinical spinal cord researchers and clinicians involved in the treatment of spinal cord injury on patient and public involvement (PPI) in preclinical research.SettingPreclinical spinal cord injury research.MethodsSemi-structured interviews were conducted online to collect data that was analysed thematically.FindingsTwenty-two participants (11 clinicians and 11 preclinical researchers) were interviewed. Participants recognised the value of PPI in improving the relevance of preclinical spinal cord research and providing a source of motivation for lab-based research. The perceived distance between preclinical research and the day-to-day experiences of PPI contributors was identified as a major barrier. Inclusive practices and the highly networked and motivated community of people affected by spinal cord injury were noted as facilitators. Building strong partnerships was considered essential for successful PPI.Conc...
BackgroundPatient and public involvement in research (PPI) has many benefits including increasing... more BackgroundPatient and public involvement in research (PPI) has many benefits including increasing relevance and impact. While using PPI in clinical research is now an established practice, the involvement of patients and the public in pre-clinical research, which takes place in a laboratory setting, has been less frequently described and presents specific challenges. This study aimed to explore the perspectives of seriously injured rugby players’ who live with a spinal cord injury on PPI in pre-clinical research.MethodsSemi-structured interviews were conducted via telephone with 11 male seriously injured rugby players living with spinal cord injury on the island of Ireland. A purposive sampling approach was used to identify participants. Selected individuals were invited to take part via gatekeeper in a charitable organisation that supports seriously injured rugby players. Interviews were transcribed verbatim and analysed thematically.FindingsSix themes were identified during analys...
IntroductionIn 2019, research showed that in the six acute adult Dublin hospitals, 1 in 11 patien... more IntroductionIn 2019, research showed that in the six acute adult Dublin hospitals, 1 in 11 patients with fragility hip fracture sustained a second contralateral hip fracture. These have implications of additional patient morbidity and cost to the health service. Relationship of the contralateral femoral neck-shaft angle (NSA) and timing to the second hip fracture have not been established previously. Our study aimed to establish the relationship of the contralateral femur NSA in patient who already sustained a fragility hip fracture and determine if we could predict the timing of the second hip fracture.MethodsA 7 year single institution retrospective cohort study of patients that presented with second fragility hip fracture from 2013-2019 were reviewed. Exclusion criteria are patients who were aged less than 60 years old, high energy injuries, or had a peri-prosthetic fractures. Plain films anteroposterior (AP) pelvis radiographs were reviewed on the National Integrated Medical Ima...
Purpose. To analyse the characteristics of patients who underwent surgery for fractures of the up... more Purpose. To analyse the characteristics of patients who underwent surgery for fractures of the upper thoracic spine (T1–T6) in our institution. The thoracic spine is supported by the rib cage and associated ligaments; therefore, displacement and fracture of the upper thoracic spine in healthy young adults require a great force. The relatively narrow spinal canal around the spinal cord in this area could result in severe neurological deficit should fractures occur. Methods. The treatment course of 32 patients (26 men and 6 women) who underwent surgery for fractures of the upper thoracic spine between February 1995 and March 2001 was retrospectively reviewed. Parameters of injuries and treatment methods were evaluated. Results. Of the 32 patients, 29 were injured in traffic accidents (15 motorcycle and 14 vehicle), 2 in falls, and one by a heavy door falling on his back. 29 patients had spinal fractures at more than one level. 23 patients had complete, 7 had incomplete, and 2 had no n...
We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metast... more We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metastatic disease presenting with gradual weight loss, pretibial swelling and painful weightbearing. Investigations revealed a lesion of the right tibial diaphysis. The radiological and clinical appearance was that of primary osteosarcoma. Biopsy results revealed metastatic transitional cell carcinoma of the tibia. Intramedullary nailing was performed which relieved pain on weightbearing. The patient declined radiotherapy and was started on a palliative care regimen. This case illustrates the importance of histological diagnosis in the treatment of diaphyseal lesions.
Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to r... more Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to repair or regenerate the cartilage defects with varying degrees of success. Three commonly performed techniques include bone marrow stimulation, cartilage repair, and cartilage regeneration. This paper focuses on current level of evidence paying particular attention to cartilage regeneration techniques.
We present a 23-year-old man who sustained an isolated fracture of the lateral process of the tal... more We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.
Background: Parents are increasingly turning to the Internet to seek paediatric health informatio... more Background: Parents are increasingly turning to the Internet to seek paediatric health information. Numerous organisations advise that patient educational materials (PEMs) should not surpass the 6th grade reading level. We aimed to assess the readability of online paediatric orthopaedic (PEMs). Methods: A total of 176 articles pertaining to paediatric orthopaedics from the American Academy of Orthopaedic Surgeons (AAOS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP) websites were assessed, using eight readability formulae; the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST and Gunning Fog. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level. The mean RGL of each website's articles were also compared. Results: The cumulative mean RGL was 10.2 (range, 6.6-16.0). No article (0%) was written at a 6th grade reading level and only 7 articles (4.0%) were written at or below the 8th grade reading level. The mean RGL was significantly higher than the 6th (95% CI, 4.0-4.4; P<0.001) and 8th grade reading level (95% CI, 2.0-2.4; P<0.001). The mean RGL of articles on the POSNA website was significantly lower than the AAOS (P<0.001, 95% CI, −1.8 to −1.0) and AAP (P<0.001, 95% CI, −2.9 to −1.1) websites. Conclusions: Paediatric orthopaedic PEMs produced by the AAOS, POSNA and AAP websites have readability scores that exceed recommendations. Given the increasing preference for online health information and the vital role health literacy plays in patient outcomes, significant work is required to address the readability of these materials.
European Journal of Orthopaedic Surgery & Traumatology, 2012
Introduction Fractures of the distal radius are common accounting for approximately one-sixth of ... more Introduction Fractures of the distal radius are common accounting for approximately one-sixth of all fractures treated in the emergency room. This study reviews a series of patients with stable distal radius fractures who have been treated with thermoplastic splint. Methods This study was undertaken between November 2009 and May 2010 in a single orthopaedic fracture outpatient clinic. All patients had undisplaccd or minimally displaced distal radius fractures. Children and open fractures were excluded. Patients had been reviewed in the outpatients with radiographs on 1, 2, 6 and 12 weeks after injury. Skin condition and satisfaction were assessed on splint removal. Radiological parameters of radial inclination, radial length and palmer tilt were measured. Results In total, 26 patients were treated with the splint. The average age of the patients was 45.1 (range, 21-73), and male/female ratio was 12:14. On average, the splint was removed at 5.1 weeks (mode = 6 weeks). The rightto left-side ratio was 11:15. Eleven of those fractures were on the dominant side. There was no significant difference in the radiological outcomes prc-and post-splinting. Nearly all patients had been satisfied with the splint. Two patients had minor cast complications whilst 23 patients were able to shower whilst in splint.
From October 1996 to August 2001, 721 patients with vertebral fractures were admitted to our unit... more From October 1996 to August 2001, 721 patients with vertebral fractures were admitted to our unit. Ten patients suffered from vertebral fractures and concomitant sternal fractures. The clinical notes and plain film radiographs of these patients were studied. The average age of the patients was 37 (20-69) years. Nine had been involved in road traffic accidents. Three patients had fractures of the cervical spine, six of the upper thoracic spine (T1-T6) and one had a lumbar spine fracture. The extra-thoracic fracture group included two patients with neurological compromise and two patients who were neurologically intact. The entire upper thoracic fracture group suffered neurological compromise, with four patients suffering complete neurological deficit. In addition, four of these patients suffered potentially life-threatening intra-thoracic injuries. The relative severity of the neurological compromise and the attendant injuries in the upper thoracic fracture group offers compelling evidence in support of the "fourth column" theory, as expressed by Berg [Berg EE (1993), The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18(13):1916-1919]. Résumé D'octobre 1996 à août 2001, 721 malades avec une fracture vertébrale ont été admis dans notre unité. Dix malades ont souffert de fractures vertébrales et de fractures sternales concomitantes. Les observations et les radiographies de ces malades ont été étudiés. L'âge moyen était de 37 ans (20-69). Neuf avaient été impliqués dans des accidents de la circulation. Trois malades avaient des fractures de la colonne cervicale, six de la colonne thoracique supérieure (T1-T6) et un avait une fracture de la colonne lombaire. Le groupe des fractures extra thoraciques a inclus deux malades avec atteinte neurologique et deux sans atteinte neurologique. Il y a toujours eu une atteinte neurologique dans le groupe des fractures thoraciques supérieures , avec quatre malades qui souffrent d'un déficit neurologique complet. En plus, quatre de ces malades avaient des blessures intra-thoraciques potentiellement mortelles. La sévérité relative de l'atteinte neurologique et les lésions associées dans le groupe des fractures thoraciques supérieures appuient la "théorie de la 4 ecolonne" comme exprimée par Berg (Berg EE (1993). The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18(13):1916-1919).
Patients with spinal cord injuries have been seen to have increased healing of attendant fracture... more Patients with spinal cord injuries have been seen to have increased healing of attendant fractures. While the benefits are obvious, this excessive bone growth also causes unwanted side effects, such as decreased movement around joints, joint fusion and renal tract calculi. However, the cause for this phenomenon remains unclear. This paper evaluates two groups with spinal column fractures – those with neurological compromise (n=10) and those without (n=15), and compares them with a control group with isolated long bone fractures (n=12). Serum was taken from these patients at five specific time intervals post injury (1 day, 5 days, 10 days, 42 days (6 weeks) and 84 days(12 weeks)). These samples were then analysed for levels of Transforming Growth Factor-Beta (TGF-.) using the ELISA technique. This cytokine has been shown to stimulate bone formation after both topical and systemic administration. Results show TGF-.; levels of 142.79±29.51 ng/ml in the neurology group at 84 days post injury. This is higher than any of the other time points within this group (.0.009 vs. all other time points, ANOVA). Furthermore, this level is also higher than the levels recorded in the no neurology (103.51±36.81 ng/ml) and long bone (102.28±47.58 ng/ml) groups at 84 days post injury (p=0.009 and p=0.04 respectively, ANOVA). In conclusion, the results of this work, carried out for the first time in humans, offers strong evidence of the causative role of TGF-.; in the increased bone turnover and attendant complications seen in patients with acute spinal cord injuries.
Introduction: Patient and public involvement (PPI) aims to improve the quality, relevance, and ap... more Introduction: Patient and public involvement (PPI) aims to improve the quality, relevance, and appropriateness of research and ensure that it meets the needs and expectations of those affected by particular conditions to the greatest possible degree. The evidence base for the positive impact of PPI on clinical research continues to grow, but the role of PPI in preclinical research (an umbrella term encompassing ‘basic’, ‘fundamental’, ‘translational’ or ‘lab-based’ research) remains limited. As funding bodies and policymakers continue to increase emphasis on the relevance of PPI to preclinical research, it is timely to map the PPI literature to support preclinical researchers involving the public, patients, or other service users in their research. Therefore, the aim of this scoping review is to explore the literature on patient and public involvement in preclinical research from any discipline. Methods: This scoping review will search the literature in Medline (PubMed), Embase, CIN...
International journal of orthopaedic and trauma nursing, 2018
Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fr... more Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility outcome one week post hip fracture surgery. All hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis RESULTS: Patients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively. Fall location, time to surgery and baseline function predict ind...
To report the incidence of genitourinary (GU) injuries in pelvic and acetabular (P + A) fractures... more To report the incidence of genitourinary (GU) injuries in pelvic and acetabular (P + A) fractures, to investigate associations between P + A fractures and GU injury patterns, and, as a secondary objective, to evaluate prospectively P + A fracture referrals with regard to adherence to the British Orthopaedic Association Standards for Trauma (BOAST) guidelines over a 12-month period. A retrospective review of GU injuries associated with P + A fractures was performed for the period January 2006 to December 2016 in a national pelvic trauma centre in Ireland. Patient demographics, mechanism of injury and details of injuries were recorded. In addition, P + A fracture referrals were prospectively monitored in 2016 and reviewed for adherence to guidelines. The incidence of urological trauma in P + A fractures was 2.4% (n = 28/1 141). The median (range) patient age was 45 (19-85) years and the male to female ratio was 2.1:1. Urethral injuries occurred most frequently (n = 12, 43%), followed ...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 21, 2017
The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-... more The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-on-metal hip implants is low. This study proposes that serial changes in ion-levels are a more accurate marker of arthroplasties at risk. Serial metal ion-levels and implant data of 285 patients with ASR resurfacing or replacement were studied. Patient and implant characteristics were analysed using univariate and multivariate analyses. 111 (39%) had revision surgery. Time since index surgery (p<0.001), acetabular inclination (p<0.001), their interaction (p<0.001) and femoral head size (p = 0.01) were significant variables. Head size (≤51 mm) had lower Co and Cr levels (p = 0.01). Cr/Co showed marginal decrease over time in the unrevised group and no decrease prerevision. Repeated measurement of ion-levels were higher in the revision group suggesting that serial measurements rather than absolute values may have a role to play in predicting implant failure.
Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of sof... more Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of soft tissue coverage often combined with significant displacement and interfragmentary movement add complexity to an already difficult situation for effective infection treatment. External fixation in principle offers a means of achieving fracture stability, while the infection is being eradicated. We present the case of a closed clavicle fracture, initially treated conservatively, that presented 5 weeks later with infection. The fracture was definitively treated with external fixation using a locking plate positioned superficially to the skin, plus negative pressure wound therapy and subsequent secondary closure and antibiotic therapy. This case illustrates a novel method of treatment in this unusual presentation that was well tolerated by the patient and resulted in a good clinical outcome.
Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the... more Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the entertainment-industry. We developed an innovative medical-training simulator on the Oculus™ Gear-VR platform. This novel application was developed utilising internationally recognised Advanced Trauma Life Support (ATLS) principles, requiring decision-making skills for critically-injured virtual-patients. Participants were recruited in June, 2016 at a single-centre trauma-course (ATLS, Leinster, Ireland) and trialled the platform. Simulator performances were correlated with individual expertise and course-performance measures. A post-intervention questionnaire relating to validity-aspects was completed. Eighteen(81.8%) eligible-candidates and eleven(84.6%) course-instructors voluntarily participated. The survey-responders mean-age was 38.9(±11.0) years with 80.8% male predominance. The instructor-group caused significantly less fatal-errors (p &amp;amp;amp;amp;amp;amp;lt; 0.050) and proportions of incorrect-decisions (p &amp;amp;amp;amp;amp;amp;lt; 0.050). The VR-hardware and trauma-application&amp;amp;amp;amp;amp;amp;#39;s mean ratings were 5.09 and 5.04 out of 7 respectively. Participants reported it was an enjoyable method of learning (median-6.0), the learning platform of choice (median-5.0) and a cost-effective training tool (median-5.0). Our research has demonstrated evidence of validity-criteria for a concept application on virtual-reality headsets. We believe that virtual-reality technology is a viable platform for medical-simulation into the future.
Fracture of stems in primary total hip arthroplasty is a known complication and has been attribut... more Fracture of stems in primary total hip arthroplasty is a known complication and has been attributed to varus positioning, excessive weight of the patient, resorption of the femoral calcar and failure of the cement mantle. Fractures in uncemented revision femoral stems are rare and are attributed to reduction in proximal support either in the form of bone loss or an extended trochanteric osteotomy [ETO] against a distally well- fixed stem. Also, undersized stems and high BMI to increase the risk of stem fracture. We report 3 cases of uncemented revision stem fractures. Case 1 is a 77 year old male, Case 2 is a 71- year-old female, case 3 an 82-year-old male. All three patients had significant proximal femoral osteolysis. All three had an extended trochanteric osteotomy for the revision surgery. The hips had remained in-situ for 4, 2 and 5 years respectively prior to fracture. When planning complex revision cases involving long uncemented stems, attention should be given to the above-...
Study DesignQualitative studyObjectiveTo explore the perspectives of preclinical spinal cord rese... more Study DesignQualitative studyObjectiveTo explore the perspectives of preclinical spinal cord researchers and clinicians involved in the treatment of spinal cord injury on patient and public involvement (PPI) in preclinical research.SettingPreclinical spinal cord injury research.MethodsSemi-structured interviews were conducted online to collect data that was analysed thematically.FindingsTwenty-two participants (11 clinicians and 11 preclinical researchers) were interviewed. Participants recognised the value of PPI in improving the relevance of preclinical spinal cord research and providing a source of motivation for lab-based research. The perceived distance between preclinical research and the day-to-day experiences of PPI contributors was identified as a major barrier. Inclusive practices and the highly networked and motivated community of people affected by spinal cord injury were noted as facilitators. Building strong partnerships was considered essential for successful PPI.Conc...
BackgroundPatient and public involvement in research (PPI) has many benefits including increasing... more BackgroundPatient and public involvement in research (PPI) has many benefits including increasing relevance and impact. While using PPI in clinical research is now an established practice, the involvement of patients and the public in pre-clinical research, which takes place in a laboratory setting, has been less frequently described and presents specific challenges. This study aimed to explore the perspectives of seriously injured rugby players’ who live with a spinal cord injury on PPI in pre-clinical research.MethodsSemi-structured interviews were conducted via telephone with 11 male seriously injured rugby players living with spinal cord injury on the island of Ireland. A purposive sampling approach was used to identify participants. Selected individuals were invited to take part via gatekeeper in a charitable organisation that supports seriously injured rugby players. Interviews were transcribed verbatim and analysed thematically.FindingsSix themes were identified during analys...
IntroductionIn 2019, research showed that in the six acute adult Dublin hospitals, 1 in 11 patien... more IntroductionIn 2019, research showed that in the six acute adult Dublin hospitals, 1 in 11 patients with fragility hip fracture sustained a second contralateral hip fracture. These have implications of additional patient morbidity and cost to the health service. Relationship of the contralateral femoral neck-shaft angle (NSA) and timing to the second hip fracture have not been established previously. Our study aimed to establish the relationship of the contralateral femur NSA in patient who already sustained a fragility hip fracture and determine if we could predict the timing of the second hip fracture.MethodsA 7 year single institution retrospective cohort study of patients that presented with second fragility hip fracture from 2013-2019 were reviewed. Exclusion criteria are patients who were aged less than 60 years old, high energy injuries, or had a peri-prosthetic fractures. Plain films anteroposterior (AP) pelvis radiographs were reviewed on the National Integrated Medical Ima...
Purpose. To analyse the characteristics of patients who underwent surgery for fractures of the up... more Purpose. To analyse the characteristics of patients who underwent surgery for fractures of the upper thoracic spine (T1–T6) in our institution. The thoracic spine is supported by the rib cage and associated ligaments; therefore, displacement and fracture of the upper thoracic spine in healthy young adults require a great force. The relatively narrow spinal canal around the spinal cord in this area could result in severe neurological deficit should fractures occur. Methods. The treatment course of 32 patients (26 men and 6 women) who underwent surgery for fractures of the upper thoracic spine between February 1995 and March 2001 was retrospectively reviewed. Parameters of injuries and treatment methods were evaluated. Results. Of the 32 patients, 29 were injured in traffic accidents (15 motorcycle and 14 vehicle), 2 in falls, and one by a heavy door falling on his back. 29 patients had spinal fractures at more than one level. 23 patients had complete, 7 had incomplete, and 2 had no n...
We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metast... more We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metastatic disease presenting with gradual weight loss, pretibial swelling and painful weightbearing. Investigations revealed a lesion of the right tibial diaphysis. The radiological and clinical appearance was that of primary osteosarcoma. Biopsy results revealed metastatic transitional cell carcinoma of the tibia. Intramedullary nailing was performed which relieved pain on weightbearing. The patient declined radiotherapy and was started on a palliative care regimen. This case illustrates the importance of histological diagnosis in the treatment of diaphyseal lesions.
Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to r... more Articular cartilage (AC) injury is a common disorder. Numerous techniques have been employed to repair or regenerate the cartilage defects with varying degrees of success. Three commonly performed techniques include bone marrow stimulation, cartilage repair, and cartilage regeneration. This paper focuses on current level of evidence paying particular attention to cartilage regeneration techniques.
We present a 23-year-old man who sustained an isolated fracture of the lateral process of the tal... more We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.
Background: Parents are increasingly turning to the Internet to seek paediatric health informatio... more Background: Parents are increasingly turning to the Internet to seek paediatric health information. Numerous organisations advise that patient educational materials (PEMs) should not surpass the 6th grade reading level. We aimed to assess the readability of online paediatric orthopaedic (PEMs). Methods: A total of 176 articles pertaining to paediatric orthopaedics from the American Academy of Orthopaedic Surgeons (AAOS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP) websites were assessed, using eight readability formulae; the Flesch-Kincaid Reading Grade Level, the Flesch Reading Ease Score, Raygor Estimate, SMOG, Coleman-Liau, Fry, FORCAST and Gunning Fog. The mean reading grade level (RGL) of each article was compared to the 6th and 8th grade reading level. The mean RGL of each website's articles were also compared. Results: The cumulative mean RGL was 10.2 (range, 6.6-16.0). No article (0%) was written at a 6th grade reading level and only 7 articles (4.0%) were written at or below the 8th grade reading level. The mean RGL was significantly higher than the 6th (95% CI, 4.0-4.4; P<0.001) and 8th grade reading level (95% CI, 2.0-2.4; P<0.001). The mean RGL of articles on the POSNA website was significantly lower than the AAOS (P<0.001, 95% CI, −1.8 to −1.0) and AAP (P<0.001, 95% CI, −2.9 to −1.1) websites. Conclusions: Paediatric orthopaedic PEMs produced by the AAOS, POSNA and AAP websites have readability scores that exceed recommendations. Given the increasing preference for online health information and the vital role health literacy plays in patient outcomes, significant work is required to address the readability of these materials.
European Journal of Orthopaedic Surgery & Traumatology, 2012
Introduction Fractures of the distal radius are common accounting for approximately one-sixth of ... more Introduction Fractures of the distal radius are common accounting for approximately one-sixth of all fractures treated in the emergency room. This study reviews a series of patients with stable distal radius fractures who have been treated with thermoplastic splint. Methods This study was undertaken between November 2009 and May 2010 in a single orthopaedic fracture outpatient clinic. All patients had undisplaccd or minimally displaced distal radius fractures. Children and open fractures were excluded. Patients had been reviewed in the outpatients with radiographs on 1, 2, 6 and 12 weeks after injury. Skin condition and satisfaction were assessed on splint removal. Radiological parameters of radial inclination, radial length and palmer tilt were measured. Results In total, 26 patients were treated with the splint. The average age of the patients was 45.1 (range, 21-73), and male/female ratio was 12:14. On average, the splint was removed at 5.1 weeks (mode = 6 weeks). The rightto left-side ratio was 11:15. Eleven of those fractures were on the dominant side. There was no significant difference in the radiological outcomes prc-and post-splinting. Nearly all patients had been satisfied with the splint. Two patients had minor cast complications whilst 23 patients were able to shower whilst in splint.
From October 1996 to August 2001, 721 patients with vertebral fractures were admitted to our unit... more From October 1996 to August 2001, 721 patients with vertebral fractures were admitted to our unit. Ten patients suffered from vertebral fractures and concomitant sternal fractures. The clinical notes and plain film radiographs of these patients were studied. The average age of the patients was 37 (20-69) years. Nine had been involved in road traffic accidents. Three patients had fractures of the cervical spine, six of the upper thoracic spine (T1-T6) and one had a lumbar spine fracture. The extra-thoracic fracture group included two patients with neurological compromise and two patients who were neurologically intact. The entire upper thoracic fracture group suffered neurological compromise, with four patients suffering complete neurological deficit. In addition, four of these patients suffered potentially life-threatening intra-thoracic injuries. The relative severity of the neurological compromise and the attendant injuries in the upper thoracic fracture group offers compelling evidence in support of the "fourth column" theory, as expressed by Berg [Berg EE (1993), The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18(13):1916-1919]. Résumé D'octobre 1996 à août 2001, 721 malades avec une fracture vertébrale ont été admis dans notre unité. Dix malades ont souffert de fractures vertébrales et de fractures sternales concomitantes. Les observations et les radiographies de ces malades ont été étudiés. L'âge moyen était de 37 ans (20-69). Neuf avaient été impliqués dans des accidents de la circulation. Trois malades avaient des fractures de la colonne cervicale, six de la colonne thoracique supérieure (T1-T6) et un avait une fracture de la colonne lombaire. Le groupe des fractures extra thoraciques a inclus deux malades avec atteinte neurologique et deux sans atteinte neurologique. Il y a toujours eu une atteinte neurologique dans le groupe des fractures thoraciques supérieures , avec quatre malades qui souffrent d'un déficit neurologique complet. En plus, quatre de ces malades avaient des blessures intra-thoraciques potentiellement mortelles. La sévérité relative de l'atteinte neurologique et les lésions associées dans le groupe des fractures thoraciques supérieures appuient la "théorie de la 4 ecolonne" comme exprimée par Berg (Berg EE (1993). The sternal-rib complex. A possible fourth column in thoracic spine fractures. Spine 18(13):1916-1919).
Patients with spinal cord injuries have been seen to have increased healing of attendant fracture... more Patients with spinal cord injuries have been seen to have increased healing of attendant fractures. While the benefits are obvious, this excessive bone growth also causes unwanted side effects, such as decreased movement around joints, joint fusion and renal tract calculi. However, the cause for this phenomenon remains unclear. This paper evaluates two groups with spinal column fractures – those with neurological compromise (n=10) and those without (n=15), and compares them with a control group with isolated long bone fractures (n=12). Serum was taken from these patients at five specific time intervals post injury (1 day, 5 days, 10 days, 42 days (6 weeks) and 84 days(12 weeks)). These samples were then analysed for levels of Transforming Growth Factor-Beta (TGF-.) using the ELISA technique. This cytokine has been shown to stimulate bone formation after both topical and systemic administration. Results show TGF-.; levels of 142.79±29.51 ng/ml in the neurology group at 84 days post injury. This is higher than any of the other time points within this group (.0.009 vs. all other time points, ANOVA). Furthermore, this level is also higher than the levels recorded in the no neurology (103.51±36.81 ng/ml) and long bone (102.28±47.58 ng/ml) groups at 84 days post injury (p=0.009 and p=0.04 respectively, ANOVA). In conclusion, the results of this work, carried out for the first time in humans, offers strong evidence of the causative role of TGF-.; in the increased bone turnover and attendant complications seen in patients with acute spinal cord injuries.
Introduction: Patient and public involvement (PPI) aims to improve the quality, relevance, and ap... more Introduction: Patient and public involvement (PPI) aims to improve the quality, relevance, and appropriateness of research and ensure that it meets the needs and expectations of those affected by particular conditions to the greatest possible degree. The evidence base for the positive impact of PPI on clinical research continues to grow, but the role of PPI in preclinical research (an umbrella term encompassing ‘basic’, ‘fundamental’, ‘translational’ or ‘lab-based’ research) remains limited. As funding bodies and policymakers continue to increase emphasis on the relevance of PPI to preclinical research, it is timely to map the PPI literature to support preclinical researchers involving the public, patients, or other service users in their research. Therefore, the aim of this scoping review is to explore the literature on patient and public involvement in preclinical research from any discipline. Methods: This scoping review will search the literature in Medline (PubMed), Embase, CIN...
International journal of orthopaedic and trauma nursing, 2018
Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fr... more Better patient outcomes and more efficient healthcare could be achieved by predicting post hip fracture function at an early stage. This study aimed to identify independent predictors of mobility outcome one week post hip fracture surgery. All hip fracture inpatients (n=77) were included in this 6 month prospective observational cohort study. Predictor variables were obtained on the first postoperative day and included premorbid function using the New Mobility Score (NMS). Mobility outcome measures one week postoperatively included the Cumulated Ambulatory Score (CAS). Data were analysed with SPSS using binary multiple logistic regression analysis RESULTS: Patients who fell outdoors (OR 3.848; 95% CI, 1.053-14.061), had no delay to surgery (OR 5.472; 95% CI, 1.073-27.907) and had high pre-fracture function (OR3.366; 95% CI, 1.042-10.879) were predicted to achieve independent mobility (CAS = 6) one week postoperatively. Fall location, time to surgery and baseline function predict ind...
To report the incidence of genitourinary (GU) injuries in pelvic and acetabular (P + A) fractures... more To report the incidence of genitourinary (GU) injuries in pelvic and acetabular (P + A) fractures, to investigate associations between P + A fractures and GU injury patterns, and, as a secondary objective, to evaluate prospectively P + A fracture referrals with regard to adherence to the British Orthopaedic Association Standards for Trauma (BOAST) guidelines over a 12-month period. A retrospective review of GU injuries associated with P + A fractures was performed for the period January 2006 to December 2016 in a national pelvic trauma centre in Ireland. Patient demographics, mechanism of injury and details of injuries were recorded. In addition, P + A fracture referrals were prospectively monitored in 2016 and reviewed for adherence to guidelines. The incidence of urological trauma in P + A fractures was 2.4% (n = 28/1 141). The median (range) patient age was 45 (19-85) years and the male to female ratio was 2.1:1. Urethral injuries occurred most frequently (n = 12, 43%), followed ...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, Jan 21, 2017
The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-... more The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-on-metal hip implants is low. This study proposes that serial changes in ion-levels are a more accurate marker of arthroplasties at risk. Serial metal ion-levels and implant data of 285 patients with ASR resurfacing or replacement were studied. Patient and implant characteristics were analysed using univariate and multivariate analyses. 111 (39%) had revision surgery. Time since index surgery (p<0.001), acetabular inclination (p<0.001), their interaction (p<0.001) and femoral head size (p = 0.01) were significant variables. Head size (≤51 mm) had lower Co and Cr levels (p = 0.01). Cr/Co showed marginal decrease over time in the unrevised group and no decrease prerevision. Repeated measurement of ion-levels were higher in the revision group suggesting that serial measurements rather than absolute values may have a role to play in predicting implant failure.
Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of sof... more Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of soft tissue coverage often combined with significant displacement and interfragmentary movement add complexity to an already difficult situation for effective infection treatment. External fixation in principle offers a means of achieving fracture stability, while the infection is being eradicated. We present the case of a closed clavicle fracture, initially treated conservatively, that presented 5 weeks later with infection. The fracture was definitively treated with external fixation using a locking plate positioned superficially to the skin, plus negative pressure wound therapy and subsequent secondary closure and antibiotic therapy. This case illustrates a novel method of treatment in this unusual presentation that was well tolerated by the patient and resulted in a good clinical outcome.
Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the... more Consumer-available virtual-reality technology was launched in 2016 with strong foundations in the entertainment-industry. We developed an innovative medical-training simulator on the Oculus™ Gear-VR platform. This novel application was developed utilising internationally recognised Advanced Trauma Life Support (ATLS) principles, requiring decision-making skills for critically-injured virtual-patients. Participants were recruited in June, 2016 at a single-centre trauma-course (ATLS, Leinster, Ireland) and trialled the platform. Simulator performances were correlated with individual expertise and course-performance measures. A post-intervention questionnaire relating to validity-aspects was completed. Eighteen(81.8%) eligible-candidates and eleven(84.6%) course-instructors voluntarily participated. The survey-responders mean-age was 38.9(±11.0) years with 80.8% male predominance. The instructor-group caused significantly less fatal-errors (p &amp;amp;amp;amp;amp;amp;lt; 0.050) and proportions of incorrect-decisions (p &amp;amp;amp;amp;amp;amp;lt; 0.050). The VR-hardware and trauma-application&amp;amp;amp;amp;amp;amp;#39;s mean ratings were 5.09 and 5.04 out of 7 respectively. Participants reported it was an enjoyable method of learning (median-6.0), the learning platform of choice (median-5.0) and a cost-effective training tool (median-5.0). Our research has demonstrated evidence of validity-criteria for a concept application on virtual-reality headsets. We believe that virtual-reality technology is a viable platform for medical-simulation into the future.
Fracture of stems in primary total hip arthroplasty is a known complication and has been attribut... more Fracture of stems in primary total hip arthroplasty is a known complication and has been attributed to varus positioning, excessive weight of the patient, resorption of the femoral calcar and failure of the cement mantle. Fractures in uncemented revision femoral stems are rare and are attributed to reduction in proximal support either in the form of bone loss or an extended trochanteric osteotomy [ETO] against a distally well- fixed stem. Also, undersized stems and high BMI to increase the risk of stem fracture. We report 3 cases of uncemented revision stem fractures. Case 1 is a 77 year old male, Case 2 is a 71- year-old female, case 3 an 82-year-old male. All three patients had significant proximal femoral osteolysis. All three had an extended trochanteric osteotomy for the revision surgery. The hips had remained in-situ for 4, 2 and 5 years respectively prior to fracture. When planning complex revision cases involving long uncemented stems, attention should be given to the above-...
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