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Background: Major blood loss usually occurs in both hip and knee arthroplasty, frequently leading to the need for blood transfusion. This study was performed to determine blood transfusion rates and analyze the factors which affected the need for blood transfusion in patients who underwent primary unilateral total knee and hip arthroplasties at the University Hospital of the West Indies, Jamaica. Method: A prospective study of 118 patients who underwent unilateral total knee and total hip arthroplasties between January 2004 and July 2009 was undertaken. Data collected was analyzed using Microsoft Excel 2008, SPSS version 12 and Stata version 7.0. Results: Of the 118 patients, 90 (70%) were females. Mean ± standard deviation (SD) age was 65.2 ± 11.5 years (range 32 – 85 years). Osteoarthritis accounted for the majority (88%) of arthroplasties. Mean ± SD estimated blood loss for all arthroplasties was 1195.0 ± 855.6 ml (range 100 – 6000 ml). Mean ± SD duration of surgery for all joint arthroplasties was 226.1 ± 63.5 minutes (range 110 – 392 minutes). Mean ± SD preoperative hemoglobin was 12.09 g/dl (range 7.3 – 15.6 g/dl). Average body mass index was 28.9 kg/m 2 (range 17.9 – 68.3 kg/m 2 ). Seventy-five (64%) patients were transfused and of these, 44 patients received allogenic blood only; 20 patients received autologous blood only, and eleven patients received both allogenic and autologous blood. The overall blood transfusion rate was 63%. Conclusion: In our study, the multivariate analysis showed a significant relationship (p = 0.000) only between postoperative transfusion and the estimated blood loss. doi:10.4021/jocmr2009.12.1279

Background Osteogenesis imperfecta, also known as 'brittle bone disease', is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. Methods Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. Results Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. Conclusion Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta.

To evaluate the complications of harvesting autogenous bone from the iliac crest.A retrospective review of patients undergoing iliac crest bone grafting at the University Hospital of the West Indies, during the period 2000-2004, was performed. One hundred and three patients were identified. Thirty-two patients were successfully contacted and 30 completed the questionnaire. There were 18 males (60%) and 12 females (40%). Their ages ranged from 13 years to 80 years (average 45.6 years).Of the 30 patients, 22 (73.3%) had complications. Fourteen (46.6%) patients had temporary pain; five (16.6%) had chronic pain. Two (6.6%) changed position of clothing due to discomfort at the graft site; five (16.6%) experienced difficulty walking, one reported itching of the scar one had altered sensation and one was unhappy with the scar. Fourteen patients (46.6%) had minor complications and eight patients (26.6%) had major complications.Autogenous iliac crest bone grafting is associated with significant complications.

To evaluate the time and type of treatment following extravasation from intravenous infusion and the sequelae of the injuries.The charts of 12 patients who were referred to the Plastic and Orthopaedic Services at the University Hospital of the West Indies were reviewed. The study period was between May 2003 and January 2007. Data were collected on age, gender, site of extravasation, extravasated agent, treatment of the extravasation, necrosis interval, duration of hospital stay for treatment of injury and whether the intravenous line was resited and at what site in relation to the injury.The age of patients ranged from three days to 67 years. The female-to-male ratio was 2:1. In five patients, the intravenous infusion was discontinued immediately after the swelling was noticed. In two patients, the intravenous infusion was stopped after seven hours and in five patients it was discontinued within 12 to 22 hours. The necrosis interval ranged from 12 hours to three weeks. Immediate treatment following extravasation and discontinuation of the infusion included limb elevation in three patients and application of cold compresses in one patient. Eleven patients developed skin necrosis of varying severities. There was no skin necrosis in one patient. Ten patients spent an average of 31 extra days in hospital for treatment of the extravasation injury. Two patients were treated in an out-patient clinic.Extravenous leaks can cause severe tissue injuries. Morbidity is increased by delay in recognition and treatment of the extravasation. A protocol for the treatment of extravasation is recommended.

Congenital pseudarthrosis of the tibia continues to pose one of the most difficult problems in paediatric orthopaedic surgery. The surgical procedures most used for treating congenital pseudarthrosis of the tibia are intramedullary nailing associated with bone grafting, vascularized fibular graft and the Ilizarov external circular fixator. Even when union is achieved, the residual deformities in the affected limb often result in significant disability. These deformities include leg-length discrepancy, angular tibial deformities, ankle mortise valgus and fibular non-union. The Ilizarov method allows simultaneous excision of the pseudarthrosis site, correction of the deformity and lengthening. However, refractures, ankle joint stiffness, fibular non-union with progressive ankle valgus are frequent sequelae with the Ilizarov technique. The surgeon should know when to abandon reconstructive procedures and create a more functional patient with an amputation. The authors discuss the indications and results of the Ilizarov external fixator in two patients with this complex problem. In addition, a critical review of the current literature is undertaken.

The Ilizarov method allows the surgeon to perform extended lengthening of both congenital and acquired short limbs. The technique can be difficult, time consuming and is associated with many complications. Generally, the number of complications and failures of lengthenings increases in proportion to the length of the distraction and the severity of the preoperative problems. The rate of major complications decreases substantially as the experience of the surgeon increases.

Congenital pseudarthrosis of the tibia continues to pose one of the most difficult problems in paediatric orthopaedic surgery. The surgical procedures most used for treating congenital pseudarthrosis of the tibia are intramedullary nailing associated with bone grafting, vascularized fibular graft and the Ilizarov external circular fixator. Even when union is achieved, the residual deformities in the affected limb often result in significant disability. These deformities include leg-length discrepancy, angular tibial deformities, ankle mortise valgus and fibular non-union. The Ilizarov method allows simultaneous excision of the pseudarthrosis site, correction of the deformity and lengthening. However, refractures, ankle joint stiffness, fibular non-union with progressive ankle valgus are frequent sequelae with the Ilizarov technique. The surgeon should know when to abandon reconstructive procedures and create a more functional patient with an amputation. The authors discuss the indications and results of the Ilizarov external fixator in two patients with this complex problem. In addition, a critical review of the current literature is undertaken.

Objective To review the results of the management of infected non-union of long bones using the Illizarov fixator. Methods Eight patients with non-union of long bones associated with current or prior infection were treated between 1998 and 2006. Seven patients were treated between 2004 and 2006. There were seven males and one female with an average age of 32 years (range 17-53 years). Four non-unions were located in the tibia, two were present in the humerus, one was present in the femur and one was intraarticular. Five non-unions were treated with acute compression, two were treated with bone transport and the frame was used in a static mode in one. Results There was one excellent, three good, one fair and three poor results. Conclusion The Illizarov technique is an important treatment method for surgeons performing posttraumatic reconstructive surgery. Non-union, infection, shortening and deformity are all addressed simultaneously.

The accuracy of joint line tenderness in the diagnosis of meniscal tears was assessed in 129 knees. Arthroscopy was performed in each case to establish the diagnosis. The diagnosis was correct in 100 knees (77.5%) and incorrect in 29 (22.5%). A preoperative diagnosis of a medial meniscal tear was made in 63 knees and confirmed in 46 (73%) at arthroscopy. There were 46 true-positive, 17 false-positive, four false-negative and 62 true-negative results for the medial side. A lateral meniscal tear was suspected in 45 knees and confirmed in 39 (86.7%). Thus, 39 true-positive, six false-positive, two false-negative, and 82 true-negative interpretations were found. In this study, joint line tenderness as a test for lateral meniscal tears was accurate (93%), sensitive (95%), and specific (93%), but for medial tears the rates were lower.

Chondro-epiphyseal separation of the distal humerus is a rare injury, and when it occurs in the newborn, it may be difficult to diagnose and is easily mistaken for a dislocation of the elbow. The unimpressive clinical appearance of such an injury of the elbow in an infant, as well as the absence of ossific nuclei of the distal humerus in the newborn, are responsible for the dilemma in making the diagnosis. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the non-ossified epiphysis about the elbow of infants to demonstrate dislocations, fractures, and physeal separations. Closed reduction with or without percutaneous Kirschner wire fixation is the treatment of choice for these injuries. In this article, we report on a case of complete epiphyseal separation in a neonate and discuss the problems arising in its diagnosis.

A retrospective review of 141 displaced supracondylar fractures in children at the Bustamante Children's Hospital and the University Hospital of the West Indies from 1994 to 1999 revealed ten ulnar nerve palsies. Of the 141 supracondylar fractures, 27 were treated with open reduction and internal fixation, while 114 had closed reduction and percutaneous pinning. All fractures were fixed with crossed Kirschner wires. Of the ten cases, the ulnar nerve was explored in two cases; the medial pin was removed in two cases, while the other six cases were observed. Follow-up ranged from three to 18 months. Full nerve recovery occurred in all cases except one in which there was partial return of function. Recommendations are made regarding the management of these injuries.