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1.  Fatal fat embolism after above knee amputation in a child 
Orthopedic Reviews  2010;2(1):e8.
We report a fatal pulmonary fat embolism syndrome arising consequent to an above knee amputation in a child. Pre-existing poor respiratory reserves, as a result of severe scoliosis, may have contributed to the fatal outcome.
doi:10.4081/or.2010.e8
PMCID: PMC3143953  PMID: 21808703
fat embolism syndrome.
2.  Non-union following bilateral simultaneos Ganz trochanteric osteotomy 
Orthopedic Reviews  2010;2(1):e1.
Between January 2003 and December 2004, 13 patients underwent bilateral resurfacing arthroplasty via a Ganz trochanteric osteotomy. This bilateral group was mobilised fully weight-bearing with crutches. During the same period 139 Ganz trochanteric osteotomies were performed for unilateral hip resurfacing. These patients were mobilised with crutches, weight-bearing up to 10 kg on the operated leg. Nine osteotomies (32%) in the bilateral group subsequently developed a symptomatic non-union requiring revision of fixation. This compares with 10 patients (7%) in the unilateral group. Applying the Fisher's exact test, the difference reached significance (P=0.0004). In two patients a second revision was required to achieve union. In one patient, revision of trochanteric fixation precipitated a deep infection. Protected weight-bearing following a Ganz trochanteric osteotomy is important to the success of the procedure. Simultaneous bilateral hip arthroplasty through a Ganz approach should be avoided. If it is undertaken, we recommend that patients should be non weight-bearing for 6 weeks following surgery. Non-union following a Ganz trochanteric osteotomy for arthroplasty carries a significant morbidity.
doi:10.4081/or.2010.e1
PMCID: PMC3143954  PMID: 21808692
ganz trochanteric flip osteotomy; bilateral; simultaneous; non-union; resurfacing.
3.  Outcome Scores Collected by Touchscreen: Medical Audit as it Should be in the 21st Century? 
INTRODUCTION
Collecting outcome scores in paper form is fraught with difficulty. We have assessed the feasibility of, and patient's attitude towards, entering scores using a touchscreen.
PATIENTS AND METHODS
A touchscreen was installed in the orthopaedic out-patient clinic. If relevant, patients were asked to complete either an Oswestry Disability Index (ODI) or Oxford Shoulder Score (OSS) using the screen. Patients were given written instructions and their hospital number by the receptionist who had no further input. Scores were completed with two identifiers. A paper questionnaire was used to assess computer experience and attitude towards the touchscreen.
RESULTS
A total of 1348 patients, average age 50 years, successfully completed a score in the first 12 months. One-third were over 60 years. Overall, 91% correctly entered their hospital number and date of birth, falling to 84% in patients over 70 years. All patients were identifiable. The average time to complete the scores was 4.7 min rising with age. Of 170 patients completing the paper assessment of the touchscreen, one-third had little or no experience of computers and a third were over 60 years. Of patients, 93% were willing to repeat the score using the touchscreen to monitor progress. Two-thirds found it easier to use than expected. Only 10% would prefer a paper score. These results were maintained among patients over 60 years. Only two were unable to complete the score and 80% of those potentially eligible did so. The remainder were called to clinic before the touchscreen was free.
CONCLUSIONS
Orthopaedic outcome scores can be collected in very large volumes using a touchscreen. Data are then in an immediately usable form. The method is acceptable to patients, independent of age and computer experience. Even in the oldest patients, the accuracy is higher than for paper versions of the score. Combined with operative data, this simple method has the potential to provide a very powerful audit tool indeed.
doi:10.1308/003588407X205422
PMCID: PMC2121277  PMID: 17959007
Outcomes Assessment; Audit; Computers

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