Connor Green

Mid-Western Regional Orthopaedic Hospital, Croom, Luimneach, Munster, Ireland

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Publications (12)11.82 Total impact

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    ABSTRACT: Simultaneous bilateral neck of femur fracture is rare. There have been few reports of such a condition in the literature. This uncommon pattern of injury has been associated with high-energy trauma, underlying bone disease, and seizure disorders. We describe our experience of such a condition involving an elderly patient with significant cardiovascular comorbidity. The operative approach involved single-stage repair of both the involved joints. Bilateral uncemented hemi-arthroplasty was performed using a single tray of sterile surgical instruments and 2 sterile drapes. We report a satisfactory outcome. Uncemented arthroplasty should be considered in such a case so as to minimize the risk of a possible bone cement implantation syndrome.
    Geriatric orthopaedic surgery & rehabilitation. 09/2013; 4(3):71-73.
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    ABSTRACT: Total hip arthroplasty is associated with significant postoperative pain. A psoas compartment block is superior to other regional techniques in analgesia post THA. However, traditional methods of delivery are associated with serious complications. We present a technique of a surgeon delivered lumbar plexus block through injection at the portion of the iliopsoas seen intraoperatively. We randomised fifty-three consecutive patients into two groups. The group that received the block had an increased period prior to requesting supplementary analgesia and lower overall pain scores. There were no adverse effects. We have demonstrated the analgesic efficacy of Psoas Compartment Block performed during surgical access for total hip arthroplasty. This technique should be considered in the analgesic regimen for total hip arthroplasty.
    The Journal of arthroplasty 08/2013; · 1.79 Impact Factor
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    ABSTRACT: Cadaveric dissection remains an important part of undergraduate medical education in anatomy. In a concerted effort to rise the number of doctors in practice in Ireland the amount of medical school placements has been increased steadily since 1995. This poses a problem as the number of cadavers has remained unchanged despite an overall increase in the population Ireland over the last twenty years. The medical profession plays a central part in raising public awareness of living and post-mortem organ donation. Previous studies have examined the attitudes of medical students to whole body donation, however to our knowledge this is the first study that evaluates the attitudes of medical professionals. We assess the opinions of junior and senior doctors at the time of their dissection experience and in their current practice. We show that their attitudes have changed as their clinical experience grows.
    The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 08/2013; · 1.97 Impact Factor
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    ABSTRACT: Although the vast majority of injuries suffered while cycling are minor, acute spinal injuries have been reported. We describe three cases of acute spinal injury occurring while cycling. All three patients reported being thrown over the handlebars, while travelling downhill at speed. Two of the cases resulted in profound neurological deficit. These cases show that there is a spectrum of spinal injury due to bicycle accidents, ranging from no neurological deficit to profound insult, and from high cervical injury to mid-thoracic spinal injury. In cases of bicycle accidents, increased awareness of the possibility of such spinal injury is advisable.
    Acta orthopaedica Belgica 06/2012; 78(3):409-13. · 0.63 Impact Factor
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    ABSTRACT: Pregnancy presents unique challenges to both the Orthopaedic surgeon, and the patient. Uniquely there exists not one, but two patients necessitating consideration in each decision process. Physiological changes serve to contribute to the presentation of a number of orthopaedic conditions unique to pregnancy, as well as impacting upon the management of trauma involving the pregnant patient. While elective orthopaedic procedures can generally be postponed until after delivery, trauma usually demands more urgent intervention. A planned and reasoned approach to managing such trauma scenarios is beneficial. In this review article we firstly discuss some of the physiological changes in pregnancy that make the patient susceptible to orthopaedic disease or injury. Secondly, we look at the management of orthopaedic trauma in the pregnant patient. An overview of some of the orthopaedic conditions encountered during pregnancy is presented.
    Orthopaedics and Trauma. 06/2012; 26(3):212–219.
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    ABSTRACT: It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing. 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient. The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups. The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate.
    Journal of tissue viability 06/2012; 21(3):84-7. · 1.18 Impact Factor
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    ABSTRACT: Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.
    Orthopedics 01/2012; 35(2):e250-4. · 1.05 Impact Factor
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    ABSTRACT: Reverse-geometry shoulder replacement requires fixation of a baseplate (called a metaglene) to the glenoid, to which a convex glenosphere is attached. Most systems use screws to achieve this fixation. The suprascapular nerve passes close to the glenoid and is known to be at risk of injury when devices and sutures are inserted into the glenoid. We investigate the risk posed to the suprascapular nerve by placement of metaglene fixation screws. Ten cadaveric shoulder specimens were used. A metaglene was inserted and fixed by use of 4 screws. The suprascapular nerve was dissected and its branches identified. The screw tips and their proximity to the nerve and branches were identified and recorded. The superior and posterior screws posed the most risk to the suprascapular nerve. The nerve was engaged by the posterior screw on 4 occasions and was within 5 mm of the nerve or a branch of it in 5 others. The superior screw was extraosseous on 4 occasions, making contact with the nerve in 3 of those 4 specimens and being within 2 mm of it in the fourth specimen. Metaglene fixation with screws poses a significant risk to the suprascapular nerve. Caution should be used when inserting the posterior and superior screws in particular. Short locking screws may allow adequate fixation while minimizing the risk of neurologic injury.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 05/2011; 20(8):1323-7. · 1.93 Impact Factor
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    ABSTRACT: Based on a positive personal experience, the authors advocate the use of a wound protector/retractor such as the Alexis system in total hip arthroplasty, to avoid intra-operative bacterial contamination from the skin, while avoiding damage to the skin and other soft tissues.
    Acta orthopaedica Belgica 04/2011; 77(2):258-9. · 0.63 Impact Factor
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    ABSTRACT: Total hip replacement produces significant postoperative pain. Psoas compartment block is the most effective block of the lumbar plexus in terms of pain relief and reduced blood loss. It is a proven regional technique for analgesia and anaesthesia during and after total hip replacement conferring a number of benefits to the patient. However, traditional techniques used to produce this block require increased theatre time and are associated with a number of serious complications. We present a surgeon-delivered technique for producing a lumbar plexus block using direct injection into the iliopsoas muscle when it is visible intraoperatively. This study shows a cadaveric model using methylene blue and radiopaque contrast produces injectate spread in a fashion which would produce a successful lumbar plexus block. This novel technique for lumbar plexus block affords the benefits of psoas compartment block with reduced complications and reduced administration time.
    Clinical Anatomy 03/2011; 24(6):763-7. · 1.16 Impact Factor
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    ABSTRACT: Three-dimensional data is required to have advanced knowledge of foot and ankle kinematics and morphology. However, studies have been difficult to compare due to a lack of a common coordinate system. Therefore, we present a means to define a coordinate frame in the foot and ankle and its clinical application. We carried out ten CT scans in anatomically normal feet and segmented them in a general purpose segmentation program for grey value images. 3D binary formatted stereolithography files were then create and imported to a shape analysis program for biomechanics which was used to define a coordinate frame and carry out morphological analysis of the forefoot. The coordinate frame had axes standard deviations of 2.36 which are comparable to axes variability of other joint coordinate systems. We showed a strong correlation between the lengths of the metatarsals within and between the columns of the foot and also among the lesser metatarsal lengths. We present a reproducible method for construction of a coordinate system for the foot and ankle with low axes variability. To conduct meaningful comparison between multiple subjects the coordinate system must be constant. This system enables such comparison and therefore will aid morphological data collection and improve preoperative planning accuracy.
    Foot & Ankle International 02/2011; 32(2):193-9. · 1.47 Impact Factor
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    ABSTRACT: Hip pain is a common complaint with many causes. Pathology in the hip can present with pain referred to sites other than the hip and pain in the hip may result from pathology elsewhere. An accurate history and examination is paramount. Chronic painful conditions of the hip summarised in this paper can be classified into three main groups: intra-articular, extra-articular and hip mimickers. The intra-articular conditions include osteoarthritis, rheumatoid arthritis, femoroacetabular impingement, labral tears and snapping hip secondary to loose bodies, synovial chondromatosis or labral tears. Extra-articular conditions include snapping hip, iliopsoas bursitis, piriformis syndrome and greater trochanteric pain syndrome. Hip mimickers include myofascial pain syndrome, osteitis pubis, sacroiliac joint pain and nerve entrapment syndromes.
    Orthopaedics and Trauma. 01/2011; 25(3):223-229.