Methicillin resistant Staphylococcus aureus (MRSA) is defined as any strain of Staphylococcus aureus resistant to beta-lactam antibiotics, including the penicillins and cephalosporins. Over the past ten years the UK has seen a dramatic increase in MRSA prevalence in healthcare facilities and the community, with an estimated 30-50% of healthy adults thought to be colonised with MRSA. Surgical patients are among those at highest risk. With potential sequelae including septicaemia, septic shock, septic arthritis, osteomyelitis, meningitis, pneumonia or endocarditis, it is vital that all care facilities have up to date evidence-based guidelines to tackle this problem. The purpose of this review is to highlight the current evidence supporting some of the key perioperative measures which may be implemented in preventing MRSA.

AIMTo determine if complete, split casts and backslabs [plaster of Paris (POP) and fiberglass] generate different intracast pressures and pain.METHODSIncreased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups.RESULTSA significant difference between the various types of casts was noted when the saline volume was greater than 100 mL (P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs (P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL (P = 0.009). Intracast pressures were significantly lower in split casts (P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs (P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mmHg and greater (P = 0.001). Split fiberglass casts had significantly reduced pain levels (P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmHg. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mmHg and lower.CONCLUSIONFibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

Purpose The optimal design for a cemented femoral stem remains a matter of debate. Over time, the shape, surface finish and collar have all been modified in various ways. A clear consensus has not yet emerged regarding the relative merits of even the most basic design features of the stem. We undertook a prospective randomised trial comparing surface finish and the effect of a collar on cemented femoral component subsidence, survivorship and clinical function. Methods One hundred and sixty three primary total hip replacement patients were recruited prospectively and randomised to one of four groups to receive a cemented femoral stem with either a matt or polished finish, and with or without a collar. Results At two years, although there was a trend for increased subsidence in the matt collarless group, this was not statisti- ConclusionsIn the presence of a collar, surface finish did not significantly affect survivorship or function. Between the two collarless groups a polished surface conferred an improved survivorship.

Pubic rami fractures are common. They are associated with significant morbidity and mortality. These fractures are usually classified as stable injuries and traditionally receive limited orthopaedic input. Management typically involves hospital admission and early input from physiotherapists and occupational therapists. Early mobilisation is advocated as a central part of managing these patients, with emphasis on secondary prevention. We report a case diagnosed as minimally displaced inferior pubic ramus fracture in a patient with an ipsilateral total hip replacement (THR). The patient was mobilised early and despite analgesia continued to complain of groin pain. Repeat radiographs showed a fracture of the acetabulum with displacement of the acetabular component of the hip replacement. We advocate early orthopaedic input for all pubic rami fractures, particularly in patients with hip arthroplasty, and thorough investigation including a CT scan of the pelvis to exclude acetabular extension prior to mobilisation.

We report our experience with 143 Durom acetabular components. Our data show a survivorship of 99.2% at 5 years, (95% CI 94.8-99.9), which is not consistent with other reports in the literature of high early failure rates. The true natural history of this component is yet to unfold completely.