• Local anaesthetics and chondrotoxicty: What is the evidence?

      Baker, Joseph F; Mulhall, Kevin J; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. joseph.f.baker@gmail.com (Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2012-11)
      Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years.
    • Locking plate fixation for proximal humerus fractures.

      Burke, Neil G; Kennedy, Jim; Green, Connor; Dodds, Michael K; Mullett, Hannan; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. neilburke@yahoo.co.uk (Orthopedics, 2012-02)
      Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.
    • Lumbar Morel-Lavallée effusion.

      Moran, Deirdre E; Napier, Nicholas A; Kavanagh, Eoin C; Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (The spine journal : official journal of the North American Spine Society, 2012-12)
    • The mechanical effect of the existing cement mantle on the in-cement femoral revision.

      Keeling, Parnell; Lennon, Alexander B; Kenny, Patrick J; O'Reilly, Peter; Prendergast, Patrick J; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. parnellkeeling@gmail.com (Clinical biomechanics, 2012-08)
      Cement-in-cement revision hip arthroplasty is an increasingly popular technique to replace a loose femoral stem which retains much of the original cement mantle. However, some concern exists regarding the retention of the existing fatigued and aged cement in such cement-in-cement revisions. This study investigates whether leaving an existing fatigued and aged cement mantle degrades the mechanical performance of a cement-in-cement revision construct.
    • Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

      Chan, VO; Moran, DE; Shine, S; Eustace, SJ; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. vikki_chan12@hotmail.com (Clinical radiology, 2013-10)
      To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury.
    • The meniscofemoral ligaments influence lateral meniscal motion at the human knee joint.

      Poynton, Ashley; Moran, Cathal J; Moran, Ray; O'Brien, Moira; Cappagh National Orthopaedic Hospital, Dublin, Ireland. (2011-03)
      The purpose of this study was to investigate the effect of the meniscofemoral ligaments on lateral meniscal motion during flexion and extension of the human knee joint.
    • MicroRNA function and dysregulation in bone tumors: the evidence to date.

      Nugent, Mary; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (Cancer management and research, 2014)
      Micro ribonucleic acids (miRNAs) are small non-coding RNA segments that have a role in the regulation of normal cellular development and proliferation including normal osteogenesis. They exert their effects through inhibition of specific target genes at the post-transcriptional level. Many miRNAs have altered expression levels in cancer (either increased or decreased depending on the specific miRNA). Altered miRNA expression profiles have been identified in several malignancies including primary bone tumors such as osteosarcoma and Ewing's sarcoma. It is thought that they may function as tumor suppressor genes or oncogenes and hence when dysregulated contribute to the initiation and progression of malignancy. miRNAs are also thought to have a role in the development of bone metastases in other malignancies. In addition, evidence increasingly suggests that miRNAs may play a part in determining the response to chemotherapy in the treatment of osteosarcoma. These molecules are readily detectable in tissues, both fresh and formalin fixed paraffin embedded and, more recently, in blood. Although there are fewer published studies regarding circulating miRNA profiles, they appear to reflect changes in tissue expression. Thus miRNAs may serve as potential indicators of disease presence but more importantly, may have a role in disease characterization or as potential therapeutic targets. This review gives a brief overview of miRNA biochemistry and explores the evidence to date implicating these small molecules in the pathogenesis of bone tumors.
    • Multimodality treatment of a complex series of parallel pathologies in a 16-year-old male that ultimately leads to bilateral hip arthroplasty surgery: A case report.

      Cullen, Emmet; Quinlan, John; Fogarty, Esmond; Keogh, Peter; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (International journal of surgery case reports, 2012)
      Femoral head osteonecrosis is associated with significant sequelae for the patient in the long-term. A combination of factors are thought to contribute to the pathophysiology behind this debilitating disease process.
    • Musculoskeletal oncology training during residency.

      Burke, Neil G; Moran, Cathal J; Hurson, Brian; Dudeney, Sean; O'Toole, Gary C; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. nei1burke@yahoo.co.uk (Journal of orthopaedic surgery, 2011-12)
      To evaluate the efficacy of a musculoskeletal oncology training module during residency.
    • The natural history and clinical syndromes of degenerative cervical spondylosis.

      Kelly, John C; Groarke, Patrick J; Butler, Joseph S; Poynton, Ashley R; O'Byrne, John M; Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, The Royal College of Surgeons in Ireland, Finglas, Dublin 11, Ireland. (Advances in orthopedics, 2012)
      Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy.
    • Neck narrowing in resurfacing hip arthroplasty: a vascular insult?

      Brennan, S A; Khan, F; McQuillan, J; O'Neill, C J; Kenny, P; O'Rourke, S K; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. stevobrennan@hotmail.com (Irish journal of medical science, 2013-06)
      Recent reports show increased failure rates in hip resurfacings that display >10 % neck narrowing. The etiology of neck narrowing remains unknown.
    • Nonoperative modalities to treat symptomatic cervical spondylosis.

      Hirpara, Kieran Michael; Butler, Joseph S; Dolan, Roisin T; O'Byrne, John M; Poynton, Ashley R; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (2012)
      Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.
    • Post operative complications in a dedicated elective orthopaedic hospital: transfers requiring specialist critical care support

      Dawson, P; Daly, A; Lui, D; Butler, JS; Cashman, J (Irish Medical Journal, 2015-05)
      We aim to report our experience with out of hospital transfers for postoperative complications in a stand-alone elective orthopaedic hospital. We aim to describe the cohort of patients transferred, the rate of transfer and assess the risk factors for transfer. Patients were identified who were transferred out of the hospital to another acute hospital for management of non-routine medical problems. Patient data was collected relating to age, BMI, ASA, type of surgery, nature of the complication, timing and the outcome of transfer. In 2012, 2,853 inpatient surgical procedures were carried out, 51 patients (1.8%) developed a postoperative complication that required out of hospital transfer. Mean age of patients transferred was 67 (12-86) years, mean age of the overall case mix 58 years (0-96) (p=0.01). 37.7% of the overall case mix of surgeries was made up of primary hip and knee arthroplasty procedures, these patients made up 63.7% of patients transferred out (p=0.001). Mean BMI recorded was 31.7 (22-48) compared to the mean BMI of the total arthroplasty case mix of 28.8 (20-44) (p=0.02). 59% of all patients at our institution were ASA category II or III. 76% of patients transferred were ASA category II or III (p=0.005). We can conclude that patients requiring transfer are typically older. Arthroplasty patients are more likely to require transfer than patients undergoing other orthopaedic procedures. Among the arthroplasty cohort transferred patients will typically have a higher BMI than average. Patients with ASA category II or III make up nearly three quarters of those patients transferred. The mean age of patients transferred is typically older by 9 years.
    • Postoperative infection in the foot and ankle.

      Chan, Victoria O; Morrison, William B; Kavanagh, Eoin C; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. vikki_chan12@hotmail.com (Seminars in musculoskeletal radiology, 2012-07)
      Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.
    • Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

      Chan, V O; Moran, D E; Mwangi, I; Eustace, S J; Department of Radiology, Cappagh National Orthopaedic Hospital, Dublin, Ireland. vikki_chan12@hotmail.com (Skeletal radiology, 2013-08)
      To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment.
    • Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

      Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M; Foot and Ankle Orthopaedic Fellow, Cappagh National Orthopaedic Hospital, Dublin, Ireland. (The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2014-07)
      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.
    • A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

      Burke, Neil G; Green, Connor; McHugh, Gavin; McGolderick, Niall; Kilcoyne, Carol; Kenny, Patrick; Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland. nei1burke@yahoo.co.uk (Journal of tissue viability, 2012-08)
      It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing.
    • Quality of life in individuals with chronic foot conditions: a cross sectional observational study.

      Groarke, Patrick; Galvin, Rose; Kelly, John; Stephens, Michael M; National Orthopaedic Hospital, Cappagh, Finglas, Dublin 9, Ireland. patrick groarke@yahoo.co.uk (Foot, 2012-06)
      Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery.
    • Radiation safety knowledge and practices among Irish orthopaedic trainees.

      Nugent, M; Carmody, O; Dudeney, S; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland, nugentmary@gmail.com. (Irish journal of medical science, 2014-04-23)
      Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees.
    • The role of osteoblasts in peri-prosthetic osteolysis.

      O'Neill, S C; Queally, J M; Devitt, B M; Doran, P P; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (The bone & joint journal, 2013-08)
      Peri-prosthetic osteolysis and subsequent aseptic loosening is the most common reason for revising total hip replacements. Wear particles originating from the prosthetic components interact with multiple cell types in the peri-prosthetic region resulting in an inflammatory process that ultimately leads to peri-prosthetic bone loss. These cells include macrophages, osteoclasts, osteoblasts and fibroblasts. The majority of research in peri-prosthetic osteolysis has concentrated on the role played by osteoclasts and macrophages. The purpose of this review is to assess the role of the osteoblast in peri-prosthetic osteolysis. In peri-prosthetic osteolysis, wear particles may affect osteoblasts and contribute to the osteolytic process by two mechanisms. First, particles and metallic ions have been shown to inhibit the osteoblast in terms of its ability to secrete mineralised bone matrix, by reducing calcium deposition, alkaline phosphatase activity and its ability to proliferate. Secondly, particles and metallic ions have been shown to stimulate osteoblasts to produce pro inflammatory mediators in vitro. In vivo, these mediators have the potential to attract pro-inflammatory cells to the peri-prosthetic area and stimulate osteoclasts to absorb bone. Further research is needed to fully define the role of the osteoblast in peri-prosthetic osteolysis and to explore its potential role as a therapeutic target in this condition.