![]() The change in practice has been closely audited over the six weeks of COVID-19 pandemic emergency hospital working pattern. Reducing the movement of patients within the hospital was vital to decrease possible nosocomial transmission of COVID-19 and prompted an emergent change in practice to stop the routine check radiographs following hip hemiarthroplasty. The driver for change in practice has been the lessons learned through the coronavirus pandemic and how to create a ‘new normal’ working pattern in the aftermath. Routine practice in most centres across the UK, is to obtain a check radiograph after the procedure in order to evaluate the hip prior to discharge as there is a small risk of peri-prosthetic fracture, component malposition and implant dislocation 2 -5. In line with NICE guidance 1 and BOA BOAST guidelines hemiarthroplasty and total hip replacement are used to treat patients with this condition allowing patients to be mobilised post operatively, either on day of or day after surgery. Gloucestershire hospitals NHS trust manages 760 acute fractured neck of femur patients on average each year with 60% being intracapsular fractures. The duration of therapy is empirical.Andrew Jones a, Harriet Lewis b and Peter Kempshall cĪST7 Trauma and Orthopaedics, Gloucestershire Hospitals NHS Foundation TrustīCT2 Trauma and Orthopaedics, Gloucestershire Hospitals NHS Foundation TrustĬConsultant Orthopaedic Surgeon, Gloucestershire Hospitals NHS Foundation TrustĬorresponding author e-mail: Ī fractured neck of femur continued to be a very common presentation to orthopaedic departments across the country during the coronavirus pandemic. ![]() Initial antibiotic therapy must be affective against penicillin-resistant gram-positive cocci. Infected and non-infected synovial effusion is indistinguishable on MR imaging. However false positive MR diagnosis may be made in case there is non-specific bone marrow oedema. Mr will however show the marrow oedema when the results of CT and scintigraphy are equivocal. Cortical destruction may not be easily appreciable on MRI. The inflamed tissue shows a high STIR signal. Associated osteomyelitis is seen as an area of low T1W and high T2W signal within the bone marrow and the subchondral bone. When the margin of the synovium is irregular and the adjacent soft tissue also enhances, infective arthritis should be considered. Inflamed synovium enhances after gadolinium. MRI is also useful when the diagnosis is uncertain on other investigations. Ignore at your peril! MRI is helpful in documenting complications such as fistulas, abscesses, or osteitis. Widening of the joint space is a warning sign of increased joint pressure. Translucent zones do not always mean that growth plate or capital epiphysis is destroyed. A normal radiograph does not give any idea of the capital epiphysis, growth plate or the triradiate cartilage. ![]() The initial x-rays do not always predict outcome. The causative organism in septic arthritis is usually Staph. Hence, puncture with aspiration and examination of the joint fluid (microscopy, culture and WBC) is mandatory whenever infection is suspected. WBC and temperature are normal in one-third cases. The laboratory data may remain normal, and the initial radiographs difficult to interpret or unhelpful. The symptoms can be mistaken for rheumatoid or other arthritides. Often the only symptom is a child not using a limb. It is sometimes difficult to establish diagnosis especially in new-borns. This will prevent growth anomalies and limitation of motion. Acute septic arthritis is an orthopaedic emergency and requires immediate recognition and effective treatment. Other factors that are of importance include infecting organism, associated osteomyelitis and adequacy of treatment. Most authors agree that neonates and infants are more likely to have a poor outcome. The single most important factor in determining outcome is the delay in instituting treatment. However, the sequelae are seen to this day. The importance of acute septic arthritis was first recognised by Smith in 1874.the mortality is not as high as in the pre-antibiotic era.
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