Virtual fracture clinics: be vigilant for the ligamentous elbow injury.

The Covid-19 pandemic encouraged remote healthcare and led to dependency on virtual fracture clinics (VFC). VFC are orthopaedic consultant-led clinics where cases are reviewed virtually following referral by emergency department clinicians. Success is contingent on a comprehensive initial history and examination.

The incidence of medial end clavicle fractures is higher than had previously been considered.

Background: Previous X-ray epidemiological studies have estimated the incidence of medial end clavicle fractures to account for 2-3% of all clavicle fractures.

Materials And Methods: At our institution X-rays of every patient attending the Emergency Department are reviewed at a Virtual Fracture Clinic by a Consultant Orthopaedic Surgeon. Patients with a fracture are referred to the Shoulder and Elbow Fracture Clinic.

Mid-term outcomes of surgical management of complex, isolated radial head fractures: a multicentre collaboration.

Objectives: The available literature discussing optimal surgical management of Mason II and III radial head (RH) fractures without concomitant bone or ligamentous injuries is limited. We aim to help determine the appropriate management of these functionally significant injuries.

Design: We present our retrospective cohort study of outcomes of surgically managed isolated, displaced RH fractures SETTING: Study from three trauma centres.

Proximal radioulnar translocations in adults: a tertiary centre study.

We present three cases of proximal radioulnar translocation in adults. Although rare, it is most commonly seen in paediatric cases. There have been three previously documented cases in adults, all requiring surgery and associated with ulnohumeral dislocations.

Not everything is as it seems.

We report a case of a patient operated for shoulder rotator cuff injury under interscalene brachial plexus block and general anesthesia, who developed neurological deficit in the nonoperative upper limb in the immediate postoperative period. As our patient developed neurological deficit on the nonoperative side, it was clear from the beginning that neither the nerve block nor the operative procedure was responsible for it. However, had he developed neurological symptoms on the operative side after having a peripheral nerve block, it would have possibly delayed the timely investigation and diagnosis.

Displaced medial end clavicular fractures treated with an inverted distal clavicle plate contoured through 90 degrees.

Background: This study assessed whether treating medial end clavicular fractures using an inverted distal clavicle locking plate, twisted through 90° around its axis, would allow for a less invasive surgical approach and improve screw trajectory insertion.

Materials And Methods: We searched the databases of the 2 senior authors for patients who had sustained an acute, displaced fracture of the medial end of the clavicle and had undergone operative fixation using an inverted distal clavicle plate contoured through 90°. Through an inferior incision, a contoured locking plate was positioned on the anterior surface of the medial end of the clavicle.

The Provision of Primary and Revision Elbow Replacement Surgery in the NHS.

BESS Surgical Procedure Guidelines (SPGs). The British Elbow and Shoulder Society (BESS) SPGs are a series of evidence and consensus developed by BESS surgeons and physiotherapists to help drive quality improvement and achieve the best possible surgical outcomes for UK patients. This SPG on primary and revision elbow replacement surgery is supported and endorsed by both the British Orthopaedic Association (BOA) and the Getting It Right First Time (GIRFT) Programme.

Arthroscopic Excision of the Sternoclavicular Joint.

Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment.

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

Purpose: Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications.

Sternoclavicular joint osteophytosis: a difficult diagnosis to swallow.

Unexplained dysphagia requires prompt investigation to rule out a possible underlying malignancy. We describe the case of a 60-year-old man who presented to his family practitioner with a 1-year history of increasing dysphagia with associated pain over the front of his chest. He was referred on to an ear, nose and throat specialist where no obvious laryngeal pathology was found at direct laryngoscopy, but an 'indentation' of the right anterior larynx, which increased with external pressure on the sternoclavicular joint (SCJ), was noted.

Accuracy of patient-reported range of elbow motion.

Background: Patient-reported outcome meaures (PROMs) not only provide valuable insights into subjective indices of joint health, but also may provide limited objective information about range of motion (ROM). We sought to evaluate the accuracy of patient-reported range of elbow motion compared to measured ROM.

Methods: Sixty clinic patients were recruited, of whom 26 had elbow pathologies and 34 had pathologies other than at the elbow joint.

The Boyd Interval: A Modification for Use in the Management of Elbow Trauma.

Surgical exposure of the radial head, proximal radius, capitellum, and proximal ulna can be achieved through several different approaches. The most commonly used are: the Kocher, Kaplan, and extensor digitorum communis splitting. Each of these approaches has its own limitations and dangers.

Nonoperative treatment of humeral shaft fractures revisited.

Purpose: The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion.

Methods: Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury.

Early versus delayed operative intervention in displaced clavicle fractures.

Objectives: Recent evidence to suggest that fixation of clavicle fractures yields better outcomes than conservative treatments has led to an increasing trend toward operative management. There is no evidence, however, to compare early fixation with delayed fixation for symptomatic patients before union.

Design: Prospective comparative case series.

Arthroscopic radial head excision in managing elbow trauma.

Purpose: This study describes a case series of 15 patients with radial head fractures who underwent radial head excision using an arthroscopic technique.

Methods: Over a four year period, 15 patients (average age 49.6 years) who had sustained a radial head or radial neck fracture underwent an arthroscopic excision of the radial head.

Does teaching style matter? A randomised trial of group discussion versus lectures in orthopaedic undergraduate teaching.

Objectives: Educational theory suggests that lectures may not be the best way to impart knowledge to students. The aim of this study was to compare the use of didactic lectures with that of interactive discussion sessions in undergraduate teaching of orthopaedics and trauma.

Methods: A total of 77 medical students were assessed in 3 consecutive cohorts.