No abstract

Purpose The purpose of the study was to quantify patient exposure to ionising radiation during fluoroscopic-assisted arthroscopic surgery of the hip, establish a risk profile of this exposure, and reassure patients of radiation safety during the procedure. Methods We retrospectively analysed the dose area products for 50 consecutive patients undergoing arthroscopic hip surgery by an experienced hip arthroscopic surgeon. The effective dose and organ dose were derived using a Monte Carlo program. Results The mean total fluoroscopy time was 1.10 minutes and the mean dose area product value was 297.2 cGycm 2 . We calculated the entrance skin dose to be 52 mGy to the area where the beam was targeted (81 cm 2 ). The mean effective dose for intra-operative fluoroscopy was 0.33 mSv, with a SD of 0.90 Sv. Conclusion This study confirms that fluoroscopic-assisted arthroscopic surgery of the hip is safe with a low maximum radiation dose and supports its continued use in preference to alternative imaging modalities.

Introduction: Appropriate alerting of patients with trauma and informative handover are necessary to allow a smooth transition of care between the prehospital and hospital teams. Aim: To identify current practice and areas that need to be improved to facilitate the transition from prehospital care to emergency department resuscitation. Methods: A questionnaire postal study of 100 emergency departments and all 32 ambulance service trusts in England and Wales. Results: Emergency departments returned 34 (34%) completed questionnaires, and ambulance trusts returned 16 (50%) completed questionnaires. In all, 56.8% of emergency department responders stated that trauma alert information was relayed through ambulance control, 48.5% stated that alert messages were standardised and 18.5% felt that ambulance crews used the trauma severity scoring system during alerting. 64.7% stated that handover was broadcast to the trauma team and 9.1% routinely received digital photographic images. All ambulance service responders included injury mechanism in their alerting criteria and 53.3% used a standard handover structure with 86.7% familiar with the mnemonic ASHICE (Age, Sex, History, Injuries, Condition, Expected time of arrival) for rapid information transmission. Discussion: Greater cooperation between regional emergency departments and ambulance services is necessary to refine the alerting and handover process, producing a pathway through which vital information is collected by trained personnel and communicated without distortion to the resuscitation room, where it may be utilised to inform life-saving decisions.

Subtalar dislocation is a significant injury characterised by late complications, including subtalar arthritis. We describe a rare case of irreducible posterior subtalar dislocation due to incarceration of a fracture of the anterior process of the calcaneum in the subtalar joint, and discuss appropriate management.

Introduction: A continuous process of trauma centre evaluation is essential to ensure the development and progression of trauma care at regional, national and international levels. Evaluation may be by comparison between pooled datasets or by direct benchmarking between centres. This study attempts to benchmark mortality at two trauma centres standardising this for multiple case-mix factors, which includes the prevalence of individual background pre-existing diseases within the study population.