• Computational modelling of long bone fractures fixed with locking plates - How can the risk of implant failure be reduced?

      Nassiri, M; Macdonald, B; O'Byrne, J M; Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland. (Journal of orthopaedics, 2013-03)
      The Locking Compression Plate (LCP) is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. Knowledge of the fixation stability provided by these new plates is very limited and clarification is still necessary to determine how the mechanical stability and the risk of implant failure can best be controlled.
    • Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials.

      Abdulkarim, Ali; Ellanti, Prasad; Motterlini, Nicola; Fahey, Tom; O'Byrne, John M; Department of Orthopaedics, Cappagh National Orthopaedic Hospital, Finglas, Dublin; Royal College of Surgeons, Dublin, Ireland. (Orthopedic reviews, 2013-02-22)
      The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented versus uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.
    • Total joint arthroplasty in nonagenarians--a retrospective review of complications and resource use.

      Baker, Joseph F; Stoyanov, Veselin; Shafqat, Aseer; Lui, Darren F; Mulhall, Kevin J; Cappagh National Orthopaedic Hospital, Dublin, Ireland. joseph.f.baker@gmail.com (Acta orthopaedica Belgica, 2012-12)
      Increased age brings with it the potential for increased surgical risk. Assessment of specific age cohorts is necessary to plan future service provision and this is the case in hip and knee arthroplasty as the demand for these procedures is anticipated to increase. We retrospectively reviewed the outcomes, including complications, length of stay and blood transfusion rate, in a cohort of 35 nonagenarians undergoing primary or revision total hip and knee arthroplasty. All patients were pre-assessed by anaesthetists before being deemed suitable to undergo surgery in the unit. The mean length of hospital stay was 13.7 +/- 10 days (range 2-56). Thirty-one percent of patients required a blood transfusion. Patients who underwent primary total hip arthroplasty reported improved joint specific functional scores. In this appropriately selected group of nonagenarians, we found no evidence to suggest surgery be withheld on the basis of age alone. However, patients with multiple medical comorbidities warrant appropriate assessment and surgical intervention in an institution with appropriate support. Future planning needs to take into account the predicted increase in demand for arthroplasty surgery in this age group.
    • 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)
    • 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.
    • Dislocation of primary total hip arthroplasty and the risk of redislocation.

      Brennan, Stephen A; Khan, Fahim; Kiernan, Christine; Queally, Joseph M; McQuillan, Janette; Gormley, Isobel C; O'Byrne, John M; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. stevobrennan@hotmail.com (Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2012-09)
      6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).
    • Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

      Moran, Deirdre E; Moynagh, Michael R; Alzanki, Majedah; Chan, Victoria O; Eustace, Stephen J; Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. deirdreradiology@gmail.com (Skeletal radiology, 2012-09)
      Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.
    • 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.
    • 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.
    • Hand dominance in orthopaedic surgeons.

      Lui, Darren F; Baker, Joseph F; Nfila, Gala; Perera, Anthony; Stephens, Michael; Department of Trauma and Orthopaedics, Cappagh, National Orthopaedic Hospital, Finglas, Dublin, Ireland. darrenflui@gmail.com (Acta orthopaedica Belgica, 2012-08)
      Handedness is perhaps the most studied human asymmetry. Laterality is the preference shown for one side and it has been studied in many aspects of medicine. Studies have shown that some orthopaedic procedures had poorer outcomes and identified laterality as a contributing factor. We developed a questionnaire to assess laterality in orthopaedic surgery and compared this to an established scoring system. Sixty-two orthopaedic surgeons surveyed with the validated Waterloo Handedness Questionnaire (WHQ) were compared with the self developed Orthopaedic Handedness Questionnaire (OHQ). Fifty-eight were found to be right hand dominant (RHD) and 4 left hand dominant (LHD). In RHD surgeons, the average WHQ score was 44.9% and OHQ 15%. For LHD surgeons the WHQ score was 30.2% and OHQ 9.4%. This represents a significant amount of time using the non dominant hand but does not necessarily determine satisfactory or successful dexterity transferable to the operating room. Training may be required for the non dominant side.
    • Simian foot at skeletal maturity: long-term case report followup.

      Groarke, Patrick J; Thomason, Katharine; Stephens, Michael M; Cappagh National Orthopaedic Hospital, Foot and Ankle, Finglas, Dublin, 22, Ireland. patrickgroarke007@gmail.com (Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society, 2012-08)
    • 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.
    • 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.
    • 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.
    • Diagnosing the doctors' departure: survey on sources of dissatisfaction among Irish junior doctors.

      Bruce-Brand, R; Broderick, J; Ong, J; O'Byrne, J; Cappagh National Orthopaedic Hospital, Finglas, Dublin 11. robbrucebrand@gmail.com (Irish Medical Journal (IMJ), 2012-01)
      There has been a significant decline in the number of applications for non-consultant hospital doctor (NCHD) posts in Ireland over the last 18 months. We conducted an online, anonymous survey of Irish NCHDs to establish levels of satisfaction, sources of dissatisfaction and the major reasons for junior doctors seeking work abroad. 522 NCHDs took the survey, including 64 (12.3%) currently working outside of the Republic. 219 (45.8%) were slightly dissatisfied and 142 (29.7%) were extremely dissatisfied with practising medicine in Ireland. Major sources of dissatisfaction included the state of the health care system, staffing cover for leave and illness, the dearth of consultant posts and the need to move around Ireland. The most important reason for NCHDs wishing to leave was to seek better training and career opportunities abroad.
    • 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.
    • 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.
    • 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.
    • Degenerative cervical spondylosis: natural history, pathogenesis, and current management strategies.

      Butler, Joseph S; Oner, F Cumhur; Poynton, Ashley R; O'Byrne, John M; Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. (Advances in orthopedics, 2012)
    • 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.