Adjustable loop femoral cortical suspension devices for anterior cruciate ligament reconstruction: a systematic review

Background: Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. Purpose: To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. Study Design: Systematic review. Methods: This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. Results: Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. Clinical Significance: This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. Conclusion: We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices

Acute double flexor tendon ruptures following injection of collagenase clostridium histolyticum (Xiapex) for Dupuytren's contracture.

We report a case of acute (24 h) double flexor tendon rupture of the little finger after a single injection of collagenase clostridium histolyticum into a palmar Dupuytren's contracture cord which caused metacarpophalangeal joint contracture. Tendon surgery was performed 48 h postinjury with primary repair and standard rehabilitation but it resulted in poor active flexion due to adhesions. Previous papers have suggested that a needle inserted into the flexor tendon can be detected prior to the injection of collagenase by asking the patient to actively move the finger, but our test on an awake patient showed that when a 27-gauge needle was inserted into the flexor tendons through a thick palmar cord, the syringe did not move significantly when the patient moved the finger, and therefore this test does not minimise the risk of iatrogenic tendon injury when using collagenase (Xiapex) for Dupuytren's contracture.This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text from PMC

Do patients want copies of their GP letters? - our experience with 7250 patients

A prospective study was performed to investigate whether patients would actively request a copy of their GP letters following an outpatient consultation. The study was performed at two sites and involved 7250 Trauma & Orthopaedic patients, and of these only 0.3% of patients requested a copy of their letter by actively filling in a stamped envelope. The estimated cost of sending a copy of the letter to all the patients seen in the NHS Outpatients was 13 million pounds in England alone. We suggest that rather than sending patients’ copies of all their correspondence as a routine, there are more secure and cost effective ways to inform patients and allow free access to all information recorded in their medical notes

Special issue on increasing flexibility in wireless software defined radio systems

After making constant significant advancements in the field of Wireless Software Defined Radios (SDRs), it is now clear that the related technologies are maturing. It is well known that SDRs are inherently flexible by nature. Still, there is a constant push for efforts to keep increasing the flexibility of Wireless Software Defined Radios. This need for increase in flexibility is not just limited to radios in the civil market but also in the tactical market due to increase in coalition forces working together in sensitive areas of the world. Among various ways to increase this flexibility, some of them are using open standards and architectures, improved techniques in digital signal processing and development of more efficient embedded systems. Thus, this Special Issue of the Springer Journal of Signal Processing Systems focuses on the before mentioned areas of advanced SDRs technologies which help in building more efficient and flexible SDRs

Medical management of overactive bladder

Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. OAB syndrome has an incidence reported from six European countries ranging between 12-17%, while in the United States; a study conducted by the National Overactive Bladder Evaluation program found the incidence at 17%. In Asia, the prevalence of OAB is reported at 53.1%. In about 75%, OAB symptoms are due to idiopathic detrusor activity; neurological disease, bladder outflow obstruction (BOO) intrinsic bladder pathology and other chronic pelvic floor disorders are implicated in the others. OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat

Emphysematous pyelonephritis.

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma. The clinical course of EPN can be severe and life-threatening if not recognized and treated promptly. Most of the information has been from case reports, a few large series have also been reported. Using an evidence-based approach, this review describes the pathogenesis, classification, complications, and management of EPN. Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The cause for mortality in EPN is primarily due to septic complications. Up to 95% of the cases with EPN have underlying uncontrolled diabetes mellitus. The risk of developing EPN secondary to a urinary tract obstruction is about 25-40%. There are three classifications of EPN based on radiological findings. Acute renal failure, microscopic or macroscopic haematuria, severe proteinuria are other positive findings in EPN. Escherichia coli is the most common causative pathogen with the organism isolated on urine or pus cultures in nearly 70% of the reported cases. A plain radiograph shows an abnormal gas shadow in the renal bed raising the suspicion whereas an ultrasound scan or computed tomography (CT) will confirm the presence of intra-renal gas thus supporting the diagnosis of EPN. Gas may extend beyond the site of inflammation to the sub capsular, perinephric and pararenal spaces. In some cases, gas was found to be extending into the scrotal sac and spermatic cord. Subsequent case studies have shown patients being successfully treated with PCD when used in addition to medical management, with significant reduction in the morality rates. PCD should be performed on patients who have localized areas of gas and functioning renal tissue is present. The treatment strategies include MM alone, PCD plus MM, MM plus emergency nephrectomy, and PCD plus MM plus emergency nephrectomy. In small proportion of patients managed with MM and PCD, subsequent nephrectomy will be required and in these patients the reported mortality is 6.6% Nephrectomy in patients with EPN can be simple, radical or laparoscopic

Adherence to national guidelines on the management of open tibial fractures: a decade on.

This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text from the publisher's site