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Background: This study aimed to: (1) Determine the ability to achieve the surgeons' desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used. Methods: A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA. A digital inclinometer and 3-point pelvic support were used with the PA. With the PA, intraoperative cup inclination at impaction was recorded. Radiographic inclination/anteversion (RI/RA) was measured from intraoperative radiographs (AA-only) and from postoperative radiographs for all cases. Optimum inclination/anteversion was defined as 40°/20° (±10°). The difference between intra- and postoperative orientations allowed for determination of the difference in pelvic position at impaction. Results: Optimum RI and RA were achieved in 91.3% (n = 365) and 92% (n = 368) of cases respectively. Optimum cup orientation was detected in 84% of cases (n = 336). There was equivalent ability to achieve cup orientation between approaches (AA: 82.5% vs. PA: 85.5%; p = 0.41). The use of an inclinometer in the PA was associated with a smaller variability of inclination at implantation (10° vs. 14°) and counteracted the greater difference in pelvic position (4.4° vs. 2.1°) seen with the PA. Conclusions: Over 80% of cases can have optimum orientation without navigation, using simple, cheap contemporary measures. Such measures eliminate differences between approaches, related to patient position. Narrower implantation angles will further reduce variability in cup orientation achieved. [ABSTRACT FROM AUTHOR]

Spinopelvic mobility affects outcome after THA. Whether the sacro‐femoral‐pubic (SFP) angle, measured on AP radiographs, can be reliably used to estimate pelvic tilt (PT) in hip osteoarthritis patients is unknown. This study aimed to (1) validate the use of the SFP angle in the calculation of PT from AP radiographs, and (2) identify individual patient factors affecting the estimation of PT. A cohort of 100 patients awaiting THA for end‐stage hip osteoarthritis was prospectively studied. AP and lateral radiographs, taken in the standing and relaxed‐seated positions were evaluated for spinopelvic measurements (SFP, PT, and pelvic incidence [PI]). To validate the SFP angle, estimated PT values using the formula [PT = 75°‐SFP] were compared to the true, measured values from the lateral radiographs. Despite good agreement for the estimated and true PT (16.2 ± 5.9° vs. 15.5 ± 8.6°; p =.315), a significantly poorer agreement could be found between the two methods at high or low values of PT. Patient‐specific PI correlated with the difference between the two measurement methods (Pearson's r = −0.644; p <.001). However, the change in SFP angle equaled approximately the change in pelvic tilt (∆PT = 2°−∆SFP; Pearson's r = −0.934; p <.001). Absolute values for the sagittal PT should not be estimated from AP pelvic radiographs in patients awaiting total hip arthroplasty. However, the relative change in PT between different positions equals approximately the change in SFP angle. This may allow functional cup orientation after THA to be determined between different postures from an AP radiograph of the pelvis. The SFP angle has moderate accuracy in determining a patient's pelvic tilt; however, it can accurately determine a patient's change in pelvic tilt in different positions. [ABSTRACT FROM AUTHOR]

Let's Talk About Mouth Cancer is a Scottish charity set up by a group of healthcare professionals with the aim of improving the prognosis of a patient diagnosed with mouth cancer. This article will present the charity's award winning oral health campaigns and the various methods used to empower patients with skills and knowledge to catch mouth cancer early. The social media platforms used in the campaign and the demographic engaged will be discussed, along with the knowledge of mouth cancer signs, symptoms, risk factors and current practice of self-examination in Scotland. [ABSTRACT FROM AUTHOR]

Abstract: Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. [Copyright &y& Elsevier]

Background: Isolated avascular necrosis of the metacarpal head, also known as Dietrich's disease, is a rare entity with few cases reported previously in the literature. It has been associated with steroid use, lupus, and trauma. We describe the clinical presentation, pathogenesis, and treatment options associated with this uncommon condition., Case Report: A 36-year-old man presented with a 1-year history of a painful right middle finger metacarpophalangeal joint (MCPJ). There was no preceding history of trauma. Routine blood investigations and plain-film imaging were unremarkable. Magnetic resonance imaging (MRI) revealed a focus of osteonecrosis in the middle finger MCPJ consistent with Dietrich's disease. Given the patient's excellent functional status, conservative therapy was been successfully undertaken., Conclusions: Dietrich's disease, although a rare entity, must be considered in the differential diagnosis of painful MCPJ, where routine blood investigations and plain-film imaging studies are unremarkable.

Compartment syndrome is a well described limb-threatening and potentially life-threatening condition. Compartment syndromes of the upper and lower limbs are well documented in the literature. The gluteal region, however, is often not considered as a compartment despite having three osseofascial boundaries. We report a case of gluteal compartment syndrome which resulted from a bone marrow biopsy. The patient was anticoagulated at the time. The outcome was residual right sided foot drop due to sciatic nerve palsy. This case describes an unusual presentation of a rare condition. Gluteal compartment syndrome is a potential complication of bone marrow biopsy.

Although the vast majority of injuries suffered while cycling are minor, acute spinal injuries have been reported. We describe three cases of acute spinal injury occurring while cycling. All three patients reported being thrown over the handlebars, while travelling downhill at speed. Two of the cases resulted in profound neurological deficit. These cases show that there is a spectrum of spinal injury due to bicycle accidents, ranging from no neurological deficit to profound insult, and from high cervical injury to mid-thoracic spinal injury. In cases of bicycle accidents, increased awareness of the possibility of such spinal injury is advisable.