BACKGROUND: Methylprednisolone is the only neuroprotective therapy advocated in acute non-penetrating spinal cord injury. Trials indicate improved neurological outcome following early administration of a high dose regime. The National Spinal Injuries Unit (NSIU) has promoted this regime by a simple laminated poster sent to all Irish A&E departments. AIM: To assess the use of methylprednisolone in patients with spinal cord injuries. METHODS: A retrospective audit of patient data for all patients admitted with traumatic neurological impairment over a 12-month period. RESULTS: One hundred ninety-six patients were admitted during the study period, 28 (14%) received intravenous methylprednisolone of which six had clear records documenting compliance. One patient received both dexamethasone and methylprednisolone in high doses and three had incorrect bolus dosages administered. Six patients received methylprednisolone infusion longer than the protocol, while five patients were given infusions shorter than recommended. Three patients were admitted to the unit that could have received the steroid regime at the point of transfer. CONCLUSIONS: There was poor documentation of prescription orders and timing of administration. Only six patients had clear documentation allowing confirmation of adherence to the protocol of the National Acute Spinal Cord Injury Study (NASCIS) III trial.

Acute Disease↗

PubMedDate not supplied

Management of the collapsing spine for patients with Duchenne muscular dystrophy.

Instrumented fusion of the collapsing spine has gained widespread acceptance for patients with Duchenne Muscular Dystrophy but controversy still exists on the issue of extending the surgical fusion to sacrum in these patients. This retrospective study reviews the long-term outcome of a group of patients with spinal deformity associated with Duchenne Muscular Dystrophy who were managed with long spinal fusion to L5 and ongoing wheelchair seating attention. The clinical notes and radiographs of 19 consecutive patients were reviewed. Fifteen patients attended for clinical and radiological assessment at a mean of 28 months post operatively. The surgery for these patients involved a mean anaesthetic time of 3.5 h and a mean transfusion requirement of 5 units of red cell concentrate. At long-term follow-up 15 patients continued to sit in a well-balanced position. Surgical fusion of the spine to L5 combined with ongoing attention to seating is associated with good long-term functional results in these patients.

Adolescent↗

PubMedDate not supplied

Trends in RTA related spinal injuries: the post penalty points era.

BACKGROUND: On October 31st 2002 a system of cumulative penalty points for road traffic offences was introduced. Early evidence suggested a reduction in road traffic accident (RTA) related morbidity. AIMS: To evaluate the persistence of the initial reduction in RTA related spinal injuries following penalty points introduction. METHODS: Retrospective review of all acute spinal trauma admissions to the NSIU between November 1st 1998 and October 31st 2004 (n = 966). Patient demographics and injury aetiology were assessed. Follow-up questionnaires evaluated RTA circumstances. RESULTS: RTA related spinal injuries accounted for 39.3% of NSIU admissions. These injuries were significantly more common in males aged 16-24, drivers (70.8%), on routine journeys (77.5%) and rural roads (48.8%). The highest proportion of accidents occurred during weekends (64.3% from Fri-Sun) and from midnight to 6am (29.3%). CONCLUSIONS: The initial reduction in RTA related spinal injuries has not been sustained. Young male drivers are the greatest at risk group.

Accidents, Traffic↗

PubMedDate not supplied

Evaluation of the syndesmotic screw in low Weber C ankle fractures.

OBJECTIVE: To determine the functional and radiographic outcome of low Weber C ankle fractures and to evaluate the contribution of the syndesmotic screw in their outcome. DESIGN: Prospective evaluation of a consecutive series. SETTING: Level I trauma center. PATIENTS: Forty-five patients divided into two groups matched for age, sex, and severity of injury. Twenty-six patients were treated with open reduction, internal fixation, and a supplemental syndesmotic screw, and nineteen patients were treated without a syndesmotic screw. Minimum time to follow-up was three years. METHODS: A subjective, objective, and radiographic ankle scoring system was used. Logistical regression analysis was performed to determine whether the presence or absence of a syndesmotic screw was a predictor of a poor outcome. The likelihood ratio test was used to evaluate the significance of each variable in both univariate and multivariate analyses. RESULTS: There was no statistically significant difference between either group, either using subjective outcome criteria (p = 0.86) or in ankle range of motion (p = 0.94). Logistical regression analysis indicated that fracture dislocation could be used as a predictor of a poor outcome for either group. Inadequate reduction and advancing age were also found to be significant predictors of a poorer outcome regardless of the use of a syndesmotic screw (p = 0.003, p = 0.004). CONCLUSIONS: Judicious fixation of Weber C type injuries within five centimeters of the ankle joint, with or without a syndesmotic screw, gives similar results. Obligatory fixation of these fractures with syndesmotic screws appears to have no benefit and creates the need for an additional procedure.

Adolescent↗

PubMedDate not supplied

One-session surgery for bilateral correction of lower limb deformities in spastic diplegia.

Fifty-seven patients with spastic diplegia underwent one-stage bilateral proximal soft tissue release for correction of lower limb deformities. The indications for surgery were improvement of gait and posture and facilitation of toilet care. Significant improvement in ambulatory status followed operation, and most parents were pleased.

Cerebral Palsy↗

PubMedDate not supplied

The subcostal nerve (ouch!): anatomical awareness in Salter's innominate osteotomy.

The identification of the lateral cutaneous branch of the subcostal nerve supplying the anterior gluteal region while using the modified Smith-Petersen approach in performing Salter's innominate osteotomy has not been described previously. Following cadaveric dissection in six specimens and after performing routine Salter's innominate osteotomy using the modified Smith-Petersen approach in five patients, we found consistently that the lateral cutaneous branch of the subcostal nerve crossed the iliac crest between 2 and 5 cm posterior to the anterior superior iliac spine. This important accidental finding has led us to take care in identifying and protecting this nerve from any undue injury that could cause blunting of sensation in the anterior gluteal region.

Buttocks↗

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Acute dislocation of the patella in children. The natural history.

On the basis of a survey of 55 cases, we can predict that one child in 6 with acute dislocation of the patella will develop recurrent dislocation. Two in 6 children have minor symptoms and the remainder are asymptomatic. The majority of patients show the radiological signs of patellofemoral dysplasia.

Child↗

PubMedDate not supplied

Incidental neck symptoms in high energy trauma victims.

We conducted a prospective study into the incidence of neck symptoms in victims of high energy trauma. Thirty consecutive patients were questioned regarding neck and jaw pain and stiffness initially and at six weeks. Despite suffering extensive skeletal injuries as a result of road traffic accidents, only two patients had such symptoms. We conclude that the incidence of 'whip lash' is surprisingly low in victims of high energy trauma.

Accidents, Traffic↗