Musculoskeletal

Mortality and burden of cervical spine fractures in the elderly: can we do more? (2017)

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Type of publication:
Conference abstract

Author(s):
*Matthew Chan, *Benjamin Chatterton, *David Ford

Citation:
Spine Journal; Mar 2017; vol. 17 (no. 3), S20

Abstract:
BACKGROUND CONTEXT: Cervical spine fractures in the elderly are a significant injury that poses difficult treatment dilemmas. Despite this little has been done to evaluate the mortality and hospital burden. PURPOSE: Evaluate the mortality and hospital burden associated with cervical spine fractures in elderly patients at district general hospitals. STUDY DESIGN/SETTING: 10-year retrospective analysis of patients over the age of 70 presenting with a cervical spine fracture to two district general hospitals. METHODS: The data was collected from documentation on online hospital database systems. Data recorded included patient demographics, injuries sustained including level and mechanism of cervical injury, length of stay and details on inpatient complications, inpatient mortality and one-year mortality. RESULTS: 153 patients were identified with a mean age of 83, and slight female predominance (55%). Mechanical falls (90%) leading to isolated fractures of upper cervical spine, particularly C2 (52%), were the most common site and mechanism of injury. Inpatient mortality was 22.9%, and 1-year mortality was calculated at 35.3%. Inpatient medical complications, particularly chest infections, were common and occurred in 35.9% of patients. Total average length of stay was 18 days, and critical care input was required in 10.5% of patients. CONCLUSIONS: Cervical spine fractures in the elderly cause significant mortality and hospital burden. Medical complications are common, leading to increased morbidity and length of stay. Consideration should be made to develop national guidance akin to hip fractures. This would encourage a multidisciplinary team approach, including early input from medical and physiotherapy teams to ensure more effective treatment and prevention of complications.

Ultrasound guided musculoskeletal interventions: professional opportunities, challenges and the future of injection therapy (2015)

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Type of publication:
Journal article

Author(s):
Sue Innes, Mark Maybury, Alison Hall, *Gordon Lumsden

Citation:
Sonography (2015) 2(4): 84-91

Abstract:
The demand for ultrasound guided injections for musculoskeletal presentations has increased in recent years as practitioners and patients seek verification of needle position. Musculoskeletal management pathways regularly include injection therapy for pain relief and are sometimes indicated as a single intervention but may need to be supported by rehabilitation. Workload in radiology departments has expanded in volume and complexity as radiologists perform new interventional procedures that require medical expertise. Innovative responses are required to meet the demand for ultrasound guided musculoskeletal injections; one option is offering appropriate education to musculoskeletal sonographers, enabling them to extend their current scope of practice. The role of the extended scope physiotherapist in the United Kingdom provides evidence that role diversification can produce excellent patient outcomes whilst preserving financial resources. The professional, legal and clinical requirements of extending service provision to include new clinical staff presents challenges that have to be met with strong leadership and the provision of high quality education in ultrasound guided interventions. There are many indicators that the patient experience is enhanced by guiding musculoskeletal injections, and access to this service has impact on patients’ confidence in their treatment pathway.

Calcaneus osteotomy (2014)

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Type of publication:
Journal article

Author(s):
Tennant J.N., *Carmont M., Phisitkul P.

Citation:
Current Reviews in Musculoskeletal Medicine, 2014, vol./is. 7/4(271-276), 1935-973X;1935-9748 (2014)

Abstract:
Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and contraindications for the procedure, with meticulous surgical technique, should be followed to avoid complications and to achieve optimal outcomes. Multiple options of osteotomies exist, including translational (medializing and lateralizing calcaneal osteotomy, with ability to slide proximally or distally, closing wedge (Dwyer), and rotational type osteotomies (Evans, Z-osteotomy). Future directions for innovation include developments of both implants and surgical techniques.

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Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination (2014)

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Type of publication:
Journal article

Author(s):
Kammar H., *Carmont M.R., Kots E., Laver L., Mann G., Nyska M., Mei-Dan O.

Citation:
Orthopedics, March 2014, vol./is. 37/3(e298-e301), 0147-7447 (March 2014)

Abstract:
Sural nerve injury is a relatively common complication after surgery on the Achilles tendon. Studies to determine the course of the sural nerve have been performed on cadaveric specimens. The purpose of this cross-sectional study was to use ultrasound to determine the relations of the sural nerve in a healthy population. The authors performed ultrasound examination of the posterior triangle of the ankle and Achilles tendon to determine the course of the sural nerve relative to the Achilles tendon in healthy participants. The mean distance between the nerve and the tendon was 21.48, 11.47, 5.8, and 0.81 mm lateral to the Achilles tendon as measured at the insertion and 4, 8, and 11 cm proximally, respectively. Male participants tended to have a nerve that was initially more lateral to the Achilles insertion compared with women. The distance between the sural nerve and the Achilles tendon was found to be lower in older participants, with the nerve passing significantly closer to the tendon at all levels (P

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