How accurately does a simulation glove reflect function compared to rheumatoid arthritis sufferers?

INTRODUCTION

This study assessed the ability of gloves to simulate rheumatoid arthritis of the hand.

SUBJECTS AND METHODS

Assessments were made in the dominant hand of 24 healthy volunteers with no glove, glove A (simulating stiffness only) and glove B (simulating stiffness and pain). Results were compared to data held on 23 rheumatoid arthritis patients. Sollerman score was used as a standardised measure of hand function and time taken to complete testing was recorded. Grip strength was also measured in volunteers.

RESULTS

Both gloves simulate a reduction in power and prolong time taken to complete Sollerman hand-function testing. The gloves are less able to simulate a matched reduction in function when compared to rheumatoid arthritis sufferers. Sollerman score is 9.7% less in rheumatoid arthritis hands than a healthy volunteer using the glove.

CONCLUSIONS

The glove could, therefore, be used to guide future design of tools and aides that accommodate for hand disorders. More work on the usefulness of such disease simulation in the design of tools for such patients is needed.

How accurately does a simulation glove reflect function compared to rheumatoid arthritis sufferers?

INTRODUCTION

This study assessed the ability of gloves to simulate rheumatoid arthritis of the hand.

SUBJECTS AND METHODS

Assessments were made in the dominant hand of 24 healthy volunteers with no glove, glove A (simulating stiffness only) and glove B (simulating stiffness and pain). Results were compared to data held on 23 rheumatoid arthritis patients. Sollerman score was used as a standardised measure of hand function and time taken to complete testing was recorded. Grip strength was also measured in volunteers.

RESULTS

Both gloves simulate a reduction in power and prolong time taken to complete Sollerman hand-function testing. The gloves are less able to simulate a matched reduction in function when compared to rheumatoid arthritis sufferers. Sollerman score is 9.7% less in rheumatoid arthritis hands than a healthy volunteer using the glove.

CONCLUSIONS

The glove could, therefore, be used to guide future design of tools and aides that accommodate for hand disorders. More work on the usefulness of such disease simulation in the design of tools for such patients is needed.

Managing osteoporosis in patients with fragility fractures: did the British Orthopaedic Association guidelines have any impact?

INTRODUCTION

The incidence of fragility fractures could double in the next 50 years. Effective treatments for osteoporosis exist and the British Orthopaedic Association (BOA) has guidelines governing how to manage underlying osteoporosis in patients with fragility fractures. This study assessed how well two trauma units treat underlying osteoporosis and whether the BOA guidelines made any impact.

PATIENTS AND METHODS

Case notes of patients with a fracture of their proximal femur admitted during January and February in 2003, 2004 and 2005 were reviewed. The results were analysed for differences between site and year.

RESULTS

A total of 602 case notes were reviewed. There was a significant difference in the number of patients discharged on osteoporosis medication between the two sites (27% at LRI, 8% at KGH; P < 0.001), but not between 2003 and 2005 (22% and 16%; P = 0.16). Of the patients started on treatment, 83% were started on calcium and/or vitamin D(3) supplements.

CONCLUSIONS

The number of patients who had their underlying osteoporosis addressed was low and the type of treatment sub-optimal. This suggests the BOA guidelines have not made an impact and further work is required to improve the management of these patients.

Brief exposure of 0.05% chlorhexidine does not impair non-osteoarthritic human cartilage metabolism

Jet lavage with chlorhexidine 0.05% is an effective means of wound decontamination with 99% of bacteria removed or killed after 1min. Reports of chondrolysis following exposure to concentrations of >0.05% or prolonged exposure to chlorhexidine have curtailed its use in orthopaedic practice. Using radiolabelled sulphur uptake to measure cartilage metabolism, we quantitatively assessed the in-vitro effect of osteoarthritic and non-osteoarthritic human cartilage exposure to chlorhexidine 0.05% for 1min and 1h. The metabolism of non-osteoarthritic cartilage was not significantly affected by a 1min exposure to chlorhexidine 0.05% whereas that of osteoarthritic cartilage was markedly impaired. Prolonged exposure for 1h markedly affected both types of cartilage. These results are encouraging in that 0.05% chlorhexidine may have a role in the decontamination of contaminated open joint injuries in patients with no signs of osteoarthritis. Until there is further understanding of the mechanism underlying reported incidents of chondrolysis following its use, however, it cannot be recommended for the irrigation of 'clean' articular cartilage.