No abstract

The 2007 United Kingdom National Institute for Health and Clinical Excellence (NICE) thromboprophylaxis guidelines concerning hip arthroplasty remain contentious in spite of significant evidence. A survey among British Hip Society members was performed to investigate the impact of these guidelines. Information on thromboprophylactic measures before and after guideline publication was gathered for three categories; Total Hip Replacement (THR), hip fracture and high-risk patients (as defined by NICE). The response rate was 185/250 (74%). All responders used thromboprophylaxis, but only 44%, 22% and 7% indicated they were currently acting in accordance with guidance for THR, high risk and hip fracture groups respectively. Only 19%, 14% and 14% had changed their practice since publication of the guidance in THR, high risk and hip fracture groups respectively. The effects of national guidance in influencing thromboprophylactic protocols have therefore been limited. The reasons were not investigated in this survey.

In elderly women with compromised bone quality, extra care is needed to achieve better fitting so as to avoid iatrogenic metaphyseal fractures. Under-sizing or cementing of the prosthesis is recommended when encountering difficulties.

If closed reduction is unsuccessful, open reduction and open medial placement of crossed Kirschner wires can provide reliable results. The small medial incision provides a viewing point for entry of the wire and prevents iatrogenic injury of the ulnar nerve. It is cosmetically more acceptable and can be extended to facilitate open reduction.

IntroductionSimultaneous Monteggia injuries of the elbow and ipsilateral distal radius and ulna fractures are very rare.Case PresentationA unique case of a type I Monteggia fracture equivalent with ipsilateral fracture of the distal radius and ulna (Salter-Harris type II) in a child is reported. We describe the management of this unique fracture and discuss the possible mechanism of injury.ConclusionWe have highlighted a rare combination of injuries. Early recognition and prompt surgical intervention can lead to a satisfactory outcome even in these complex injuries.