Revision total elbow replacement.

The range of general and specific adverse event in total elbow arthroplasty is similar in principle and practice to all other revision prosthetic arthroplasty but with three particular challenges: loss of humeral and ulnar bone stock; insufficiency of the extensor 'mechanism'; and the management of the ulnar nerve. Total elbow replacement is presently performed for the management of complex non-reconstructable distal humeral fractures in osteoporotic bone, for post-traumatic arthropathy, and for medically managed inflammatory arthritides in which metaphyseal bone architecture is often preserved while the articular surface is degenerate. In all these conditions the patient often presents for revision total elbow arthroplasty with relevant co-morbidities and relevant musculoskeletal dysfunction (for example: ipsilateral shoulder, wrist, thumb or hand dysfunction).

Inflammatory arthritis and the elbow surgeon.

The treatment of inflammatory arthritis with disease modifying drugs and biological agents had reduced the number of patients needing surgical treatment. Surgical treatment of patients with inflammatory arthritis is challenging not only due to the factors such as bone stock and status of soft tissue but also due to the comorbidities associated with inflammatory arthritis. Multidisciplinary approach to these patients is recommended to deal with the complex poly-articular involvement and systemic physiological impairment especially when planning surgery.

Clinical anatomy and biomechanics of the elbow.

The anatomy of the elbow joint had been studied extensively over the last 2 decades. The increased understanding of the anatomy and contribution of the anatomical structures to the elbow biomechanics had enabled surgeons to improve the results of surgical reconstruction and fracture fixation. This review articles intend to summarise the salient functional and clinical anatomical and relevant biomechanical data that had been published recently.

A dual-site trauma system during COVID-19 pandemic - Our experience in a high-risk area with 60-day mortality report.

Aim: We set up a COVID-free trauma site due to the high rates of COVID-19 infections within our hospital. We aimed to determine the incidence of post-operative COVID-19 infection within the first two weeks post-treatment at the COVID-free site and the postoperative mortality rate. We analysed data for non-hip fracture and fragility hip fracture patients separately.

Trauma and orthopaedic team members' mental health during the COVID-19 pandemic: results of a UK survey.

Aims: Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources.

Bleomycin electrochemotherapy for the management of locally advanced metastatic melanoma: Two notable clinical cases potentially indicating a greater therapeutic role in the era of targeted and immuno-therapy.

Bleomycin electrochemotherapy (ECT) has emerged as a treatment modality for locally advanced metastatic melanoma over the past decade. The phenomenon of reversible electroporation enhances cell permeability when a pulsed electrical current is applied to tissues. This facilitates enhanced cytotoxicity of bleomycin with minimal systemic side effects.

The accuracy of plain radiographs in diagnosing degenerate rotator cuff disease.

Background: A number of radiographic signs have been previously demonstrated to be associated with degenerative rotator cuff tears. An ability to predict the presence of a tear by radiography would permit the early commencement of appropriate treatment and the avoidance of unnecessary invasive investigations. The aim of the present study was to determine the accuracy of using radiographic signs to predict the presence of a cuff tear on arthroscopy.

The congenital undescended scapula syndrome: Sprengel and the cleithrum: a case series and hypothesis.

Background: Sprengel deformity is a rare congenital shoulder girdle anomaly characterized by scapula malposition, periscapular muscle atrophy, and limited shoulder movement. Traditionally, it has been managed by omovertebral bar excision and muscle transplantation procedures guided by age and Cavendish grade. We present a unique observation in humans: a case series with Sprengel deformity possessing a cleithrum, an ancestral remnant of shoulder girdle development found in archaic bony fish.

Bilateral Breast Reconstruction with Abdominal Free Flaps: A Single Centre, Single Surgeon Retrospective Review of 55 Consecutive Patients.

Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003-2014). A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM).

Patterns of healing: a comparison of two proximal tibial osteotomy techniques.

Several low-energy osteotomy techniques are described in the literature, but there is limited evidence comparing them. Our study evaluates the patterns of regenerate formation using two different osteotomy techniques. Two cohorts of patients underwent osteotomy of the tibia using a Gigli saw (n = 15) or De Bastiani corticotomy (n = 12) technique.

Improved access in endonasal rhinoplasty: the cross cartilaginous approach.

Background: The popularity of open rhinoplasty has increased such that it is the first choice of approach for many surgeons undertaking primary rhinoplasty. Despite the benefits of this approach, the drawbacks are often not emphasized. We present a review, with quantitative assessment of 24 rhinoplasty patients using the cross-cartilaginous incision.

Improving transmission rates of electronic discharge summaries to GPs.

Discharge summaries are a vital tool to communicate information from Hospital to Primary Care teams; updating GPs about what happened during an admission, and handing over care detailing any follow up care required. Historically, Discharge Summaries have been posted to hospitals, increasing costs for hospitals, creating administrative work for GP practices receiving the letters, and resulting in some letters being lost or delayed in reaching the GP, with implications for patient safety if follow up requests are not received and acted upon. In an effort to improve patient care, the Clinical Commissioning Group in Surrey drew up a contract with Ashford and St Peter's Foundation Trust, aiming to increase the percentage of discharge summaries sent electronically from the rate of 9% sent within 24 hours, to over 75%.

Improving patient discharge process using electronic medication input tool and on-line guide to arranging follow-ups.

Complete, accurate and timely discharge summaries (TTOs) enable effective communication between hospital teams and GPs. It can prevent adverse events and reduce hospital readmission rates (1). If the discharge summary does not contain important information (e.

Melanoma diagnosed 27 years after a benoxaprofen-induced photosensitivity reaction.

Background: The propionic acid derivative Benoxaprofen was introduced for the treatment of rheumatic disorders in 1980. Its product license was then withdrawn 2 years later due to concerns over serious dermatologic, hepatic and renal side effects. Photosensitivity was the most common side effect with reported incidence of up to 50%.

The value of preoperative and intraoperative electromyography in the management of obstetric brachial plexus injury.

The treatment of obstetric brachial plexus palsy (OBPP) with neuroma-in-continuity is controversial. The recent literature advocates excision of neuroma-in-continuity in OBPP and repair with nerve graft irrespective of its neurophysiological conductivity. This approach risks sacrificing the regenerating axons, and the result has not yet been proven to be superior to neurolysis alone.

Image intensifier-guided injection of corticosteroid and local anesthetic agent for the treatment of recalcitrant plantar fasciitis.

Plantar fasciitis is the most common cause of plantar heel pain. The condition is potentially self-limiting and can respond to conservative treatment, but patients may opt for surgery if the treatments fail. Surgical intervention is associated with potential complications.

A case report and review of soft tissue metastatic squamous cell carcinoma of the upper limb in the absence of a primary tumour.

Soft tissue metastases and distant perineural metastases of an unknown primary are rare presentations of cancer. We present a patient with soft tissue and intraneural metastatic squamous cell carcinoma to the left arm with unknown primary that was treated with wide excision, followed by adjuvant radiotherapy. The patient was followed up for 3 years, and has had no signs of recurrence.

Bilateral well leg compartment syndrome associated with lithotomy (Lloyd Davies) position during gastrointestinal surgery: a case report and review of literature.

Introduction: Well leg compartment syndrome is a rare complication that can occur after prolonged surgery in lithotomy position. We stress the importance to recognize high-risk patients for this complication and finding ways to reduce this risk. We also emphasize high level of suspicion of at risk patients and early recognition of signs and symptoms to enable early diagnosis and treatment.

The mend of the bend-flexor pollicis longus tendon has an additional pulley distal to its point of angulation.

The tendon of flexor pollicis longus angulates at the trapezio-metacarpal joint level. The degree of angulation varies with extent of radial/ulnar deviation (Rack and Ross [1984] J. Physiol.