Changing operating lists on the day of surgery: a service evaluation

This study aims to explore how often the operating list is changed on the day of surgery and the reasons why this may occur. The purpose was to analyse the wider potential impact that changing the list on the day of surgery may have on patient safety, patient satisfaction and theatre efficiency. Survey data was collected across a multi-specialty elective operating department. The findings demonstrated that a significant change in operating lists occurred in 37.3% of sessions, for a variety of potentially avoidable reasons. We concluded that improved organisation and communication before the planned session could reduce the occurrence of changes, thereby increasing patient safety, theatre efficiency and potentially reducing incidents.

Should all acromioclavicular joint injections be performed under image guidance?

INTRODUCTION

Steroid and local anaesthetic injection to the acromioclavicular joint (ACJ) is a very common diagnostic and therapeutic procedure, which is often performed in the outpatient department. However, it can be difficult to localize this joint because of its small size, presence of osteophytes and variable morphology in the population. We performed a study to determine whether the use of an image intensifier (X-ray guidance), in theatre, improves the accuracy of this injection.

METHODS

This was a prospective study carried out between March 2014 and March 2015. The injections were performed by two senior orthopaedic surgeons. First, we clinically palpated the ACJ and marked the area over this point as A. Then, with the use of a needle and an image intensifier in a single plane, we identified the actual location of the ACJ and marked this point as B. We measured the distance between A and B in millimetres (mm) and determined the accuracy of the injections. Further analysis taking into account the ACJ capsular attachments was also performed.

RESULTS

In total, 45 patients and 50 injections were included in the study; five patients had repeated injections at different times. We found that only 12 injections (24%) were palpated to be correct with no discrepancies between A and B (95% confidence interval: 14-37%). For the remaining 38 injections (76%), the use of an image intensifier had significantly improved the accuracy of ACJ location ( p < 0.05). Taking the capsular attachments of the ACJ into consideration reduced the number of inaccurate injections to 27 (54%).

CONCLUSION

We recommend the use of an image intensifier (or ultrasound guidance) to accurately determine the location of the ACJ for steroid and local anaesthetic injections. This prevents an injection into the wrong place, which can lead to wrong diagnosis and/or suboptimal treatment.

Arthroscopic treatment of metacarpophalangeal arthropathy in haemochromatosis

A 37-year-old sports teacher suffering from idiopathic haemochromatosis with arthropathy of the MP joints has been treated and followed-up by us for 4 years. Three out of four affected MP joints were treated with arthroscopic operations; one of these had been treated elsewhere previously by arthrotomy. This article presents a brief review of the condition and its treatment by arthroscopic surgery with detailed technique. We believe that MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results. No specific instruments are needed apart from a standard small joint arthroscopy set.

[In "achillodynia" also consider a rare cause--a case report of schwannoma of the tibial nerve]

'Achillodynia' is a quite well-known pattern of complaints in sports medicine but is also known to occur among the general population. It is a complex of signs and symptoms with the principal sign of pain in the region of the Achilles tendon that can have a wide variety of causes; on-target therapy requires exact clarification of the underlying cause. Sonography has been successfully used in recent years as one of the diagnostic tools in this regard. This enables also the diagnosis of rare causes, such as tumours of peripheral nerves. The present article is a case report on a woman patient suspected to be suffering from achillodynia caused by a schwannoma of the tibial nerve.