York Hospital

Summary A 4‐month‐old warmblood colt presented with an acute onset change in gait and mentation. Neurological examination identified marked cervical stiffness with bilaterally reduced lateral flexion, pain on palpation of the mid‐caudal cervical region and mild positional strabismus when the head was elevated. Radiography and ultrasonography of the C4–C5 articular process joint, respectively, revealed a large radiolucent defect within the left caudal articular process of C4 and distension of the synovial recesses containing hyperechoic, heterogeneous fluid. Ultrasound‐guided synoviocentesis yielded a purulent sample with a white cell count of 131 × 10 9 /L (reference range: <2 WBC/μL) confirming the presence of septic arthritis. Computed tomography was used to evaluate concurrent osteitis of the C4 caudal articular process. Arthroscopic lavage of the affected joint was performed under general anaesthesia, followed by peri‐ and postoperative antimicrobial therapy. The foal recovered uneventfully, showing no residual neurological or musculoskeletal deficits up to 15 months postsurgery. This report describes successful surgical management and clinical resolution of cervical articular process joint sepsis in a foal, achieved through timely diagnosis and intervention.

Core outcome sets reduce selective reporting bias and increase homogeneity by providing a predefined set of outcomes that should always be reported. The Harmonising Outcome Measures for Eczema (HOME) initiative has developed a core outcome set (COS) for randomized control trials (RCTs) of eczema intervention. We assessed the COS uptake in systematic reviews in order to appreciate changes in the research landscape. In systematic reviews, the uptake of the COS reduces research waste and facilitates updating reviews. We found positive improvements in COS implementation, although the COS is yet to be uniformly implemented in systematic reviews.

Accidental ingestion of foreign bodies frequently necessitates emergency department visits, with many cases requiring surgical consultation. Although most ingested items pass through the gastrointestinal tract uneventfully, orthodontic components, such as wires, present a specific risk due to their shape and material properties. This report describes a rare case of a 13-year-old male adolescent whose initial presentation suggested ingestion of a chicken bone. He was later found to have an orthodontic archwire impacted in the esophagus, which was successfully removed via rigid esophagoscopy. This case highlightsthe need to considerorthodontic devices as potential foreign bodies in adolescents, emphasizing that such objects may be ingested inadvertently. Prompt imaging and intervention are critical to prevent complications, such as obstruction or perforation, ensuring patient safety and optimal clinical outcomes.

IntroductionA total hip replacement is a common procedure performed by trauma and orthopaedic surgeons. Successful outcomes in arthroplasty surgery have significantly contributed to more hip replacement procedures being performed annually. This has also increased the incidence of femoral periprosthetic fractures, leading to more revision hip replacement procedures being performed.MethodsThis is a retrospective cohort study carried out at a district general hospital in the United Kingdom. Theatre records were reviewed from 2018 to 2022 to identify patients with a femoral periprosthetic fracture. Following the data collection, the patients were split into two groups. The first group analysed the patient outcomes through the type of surgical intervention they had, and the second group analysed the patients according to the timing of surgical intervention.ResultsThere were 88 patients included in the study, out of which 49 had revision surgery and 39 had fixation for the femoral periprosthetic fracture. No statistically significant difference was observed in 30-day mortality and one-year mortality for the patients having revision or fixation surgery. Similarly, the results were not found to be significant in 30-day mortality and one-year mortality for the patients having surgery within 36 hours or after 36 hours of diagnosis.ConclusionOverall, the findings of this study are in keeping with the literature. Input from the specialist arthroplasty team is often required for the management of femoral periprosthetic fractures. There is no significant impact on mortality with a delay in surgical intervention for femoral periprosthetic fractures, unlike hip fractures. Medical optimisation and careful planning lead to better patient outcomes for this group of patients.