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Biomedical subjects

D Sunderamoorthy

Publications and source records attributed to D Sunderamoorthy.

6 recordsLinked to original sources
PubMed2006

Secondary prevention of fragility fractures: are we following the guidelines? Closing the audit loop.

INTRODUCTION: The aim of this study was to determine whether orthopaedic surgeons follow the British Orthopaedic Association (BOA) guidelines for secondary prevention of fragility fractures. PATIENTS AND METHODS: A retrospective audit was conducted on patients with neck of femur fractures treated in our hospital between October and November 2003. A re-audit was conducted during the period August to October 2004. RESULTS: There were 27 patients in the initial study period. Twenty-six patients (96%)had full blood count measured with LFT and bone-profile measured in 18 patients (66%). Only nine patients (30%)had treatment for osteoporosis (calcium and vitamin D). Only one patient was referred for DEXA scan. Steps were taken in the form of creating better awareness among the junior doctors and nurse practitioners of the BOA guidelines. In patients above 80 years of age, it was decided to use abbreviated mental score above 7 as a clinical criteria for DEXA referral. A hospital protocol based on BOA guidelines was made. A re-audit was conducted during the period August to October 2004. There were 37 patients. All had their full blood count and renal profile checked (100%). The bone-profile was measured in 28 (75.7%) and LFT in 34 (91.9%) patients. Twenty-four patients (65%) received treatment in the form of calcium + vitamin D (20) and bisphosphonate (4). DEXA-scan referral was not indicated in 14 patients as 4 were already on bisphosphonates and for 10 patients their abbreviated mental score was less than 7. Among the remaining 23 patients, 9 patients (40%) were referred for DEXA scan. This improvement is statistically significant (P = 0.03, chi square test). DISCUSSION AND CONCLUSIONS: The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

Aged↗
PubMed2005

Recurrent elbow dislocation--an uncommon presentation.

A 58 year old female attended our A&E department following a fall in the garden with swelling and bruising of the right arm and the elbow. Anteroposterior and lateral radiographs were interpreted as showing a normal elbow joint. A diagnosis of soft tissue injury to the elbow was made and the patient was discharged with advice. She returned 2 days later, did not have an x ray, and again given advice. Three weeks later she was referred back to A&E by the general practitioner with persistent swelling of the elbow. Further radiographs showed a posterolateral dislocation of the elbow. The elbow was reduced under sedation but was subsequently dislocated at follow up, and was treated by external fixator and transolecranon pin. The fixator was removed at 4 weeks and the elbow was then stable. This case highlights that recurrent elbow dislocations due to significant ligament injuries can present in joint and subsequently dislocate. A high index of suspicion is necessary and appropriate referral to the specialist must be made to avoid the morbidity associated with recurrent dislocation. It also emphasises the need to always assess the patient on his or her own merits despite previously normal investigations.

Elbow Joint↗
PubMed2005

Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation.

A 28 year old fit and healthy Caucasian man had a Bankart's repair of the left shoulder under general anaesthetic for a recurrent dislocation of the shoulder. The operative procedure was uneventful. Following extubation he was tachycardic and saturation dropped in the recovery room. The chest radiograph revealed shadowing in the right lung and he was diagnosed to have right middle lobe collapse. Subsequently the radiograph was reported as right upper lobe consolidation by the radiologist. We wish to report this unusual complication and the difficulty in diagnosis of such a complication occurring following an uneventful anaesthetic.

Adult↗
PubMed2003

An uncommon peripheral nerve injury after penetrating injury of the forearm: the importance of clinical examination.

A 22 year old woman presented to the accident and emergency department with a self inflicted stab wound to the radial side of the volar aspect of the left forearm caused by a pen knife. Her wounds were sutured on the day of injury. Over the course of next three weeks her wounds healed well but she noticed difficulty in using the hand. She therefore attended her general practitioner who suspected a possible nerve injury and referred the patient back to the A&E department. On follow up examination, she was noticed to have a loss of finger and thumb extension and weakness of thumb abduction. Active extension of the wrist (with radial deviation) was intact. There was no sensory deficit. Posterior interosseous nerve (PIN) palsy was diagnosed and the patient was referred to the regional hand surgery unit where she underwent exploration of the wound. A complete transection of the PIN in the supinator canal was found and repaired with good functional outcome. This case reflects the importance of clinical examination in uncommon peripheral nerve injuries and appropriate referral to a specialist department in case of doubtful penetrating wound that pose a threat to an underlying important structure.

Adult↗
PubMed2001

TB or not TB: an unusual sore finger.

A 25 year old Afro-Carribean presented to the accident and emergency department with a painful swelling of the little finger. Radiology revealed periosteal elevation and a bone scan showed a hot spot in the proximal phalanx, suggestive of a tumour or an infection. He gave a history of recurrent chest infections in the past, the chest radiograph revealed apical lesions and loculated pleural effusion. Bronchoscopy washings were positive for acid fast bacillus suggestive of pulmonary tuberculosis with tuberculous dactylitis. A detailed history and high index of suspicion is important as delay in diagnosis can have serious consequences for the patient.

Adult↗