Lateral Clavicle Fracture Fixation Using a Superiorly Placed Locking Plate.

Clavicle fractures are common injuries that account for 4% of all fractures, and approximately 21% of clavicle fractures are lateral. Studies have demonstrated that displaced lateral clavicle fractures with disruption of the coracoclavicular ligaments have nonunion rates as high as 28%. Many surgical techniques for fixation of lateral-end clavicle fractures have been proposed.

Bilateral Primary Repair of Simultaneous Bilateral Distal Biceps Rupture.

A case of simultaneous bilateral distal biceps tendon rupture in a recreational gymnast is presented. Achieving bilateral acute primary repair can be challenging as any immobilization will lead to disability and difficulty with self-care and activities of daily living. We have reviewed the evidence of this rare condition and demonstrate that modern rehabilitation techniques, which allow early mobilization, can make simultaneous bilateral primary repair a viable option in such cases.

Surgical skills simulation in trauma and orthopaedic training.

Changing patterns of health care delivery and the rapid evolution of orthopaedic surgical techniques have made it increasingly difficult for trainees to develop expertise in their craft. Working hour restrictions and a drive towards senior led care demands that proficiency be gained in a shorter period of time whilst requiring a greater skill set than that in the past. The resulting conflict between service provision and training has necessitated the development of alternative methods in order to compensate for the reduction in 'hands-on' experience.

Surgical waiting times and patient choice: how much delay do patients really want?

Background: The 18-week target to treatment government initiative was implemented in 2004. In order for this to work, patients need to accept operative dates provided, otherwise the pathway will fail.

Aim: The aim of this prospective study was to identify the earliest time patients would accept surgical intervention following assessment at an outpatient clinic and to identify the reasons why some patients would choose to delay surgery.

Long-term survival of proximal humerus allografts for reconstruction following resection of malignant bone tumours.

We previously reported early favourable results concerning allograft use in proximal humerus reconstruction following malignancy. We now present the long-term follow-up of patients who underwent tumour resection with massive humeral allograft reconstruction. This is a retrospective review of 8 consecutive patients who underwent massive proximal humeral allograft for primary or secondary bone tumours.

Vertical or horizontal orientation of foot radiographs does not affect image interpretation.

This study determined whether the orientation of dorsoplantar and oblique foot radiographs has an effect on radiograph interpretation. A test set of 50 consecutive foot radiographs were selected (25 with fractures, and 25 normal), and duplicated in the horizontal orientation. The images were randomly arranged, numbered 1 through 100, and analysed by six image interpreters.

Locked intramedullary fixation vs plating for displaced and shortened mid-shaft clavicle fractures: a randomized clinical trial.

Background: Recent literature supports surgical intervention for shortened, displaced, mid-shaft clavicle fractures. We present the results of a randomized clinical trial comparing locked intramedullary fixation and plate fixation for short, displaced, mid-shaft clavicle fractures.

Materials And Methods: Local ethical approval was obtained and power analysis and sample size calculations were performed prior to commencement.

Pitfalls in the diagnosis of infection around the shoulder joint--report of three cases.

Infection around the shoulder joint is rare. Clinical suspicion and diagnostic imaging are required for accurate diagnosis. We present three cases that emphasise particular diagnostic challenges when dealing with infection around the shoulder joint.

A modified Weaver-Dunn procedure without need for internal fixation.

The shoulder as the most mobile joint in the body has a complex anatomy providing it with an increased range of motion, at the expense of its stability. The complex of ligaments and tendons around the acromioclavicular joint (ACJ) is prone to injury especially during sporting activity or following falls onto the apex of the shoulder. The original classification of ACJ dislocations having been modified by Rockwood suggests that types III to VI injuries may benefit from surgical intervention.

Bilateral glenohumeral septic arthritis secondary to retroperitoneal abscess.

Glenohumeral septic arthritis is rare and usually a result of Staphylococcus aureus infection. Gram-negative septic arthritis is on the increase and is usually associated with intraabdominal pathology. We present a case of bilateral E.

Long-stem revision prosthesis for salvage of failed fixation of extracapsular proximal femoral fractures.

A retrospective review was made of radiographs and case notes of patients with failed fixation of extracapsular proximal femoral fractures subsequently managed with long-stem revision arthroplasty. Follow-up radiographs, objective scoring, mobility, and complications were assessed. Twenty five hips were managed with long-stem hip arthroplasty in 24 patients with a mean age of 73 years.

Ankle instability.

Acute ankle sprains are common, and if inadequately treated may result in chronic instability. Lateral ankle injuries are most common, with deltoid injuries rare and associated with ankle fractures/dislocation. Medial ankle instability is rare.

Peroneal tendons subluxation.

Subluxation of the peroneal tendons is uncommon. It occurs especially in skiing, soccer, basketball, rugby, ice skating, judo, sprint, water-skiing, mountaineering, and gymnastics. We present an overview of the injury, with the classification commonly used.

Mastectomy scars following breast reconstruction: should routine histologic analysis be performed?

Background: There is some debate in the recent literature regarding the routine submission of mastectomy scars for histologic analysis when performing delayed breast reconstructions. The aim of this study was to review the relevant publications and evaluate the practice of routine histologic examination of mastectomy scars.

Methods: The authors conducted a retrospective review, across three regional plastic and reconstructive surgery units, of 433 patients who had 455 scars routinely sent for histologic examination following delayed breast reconstruction between January of 2000 and December of 2006.

Management of acute and chronic ankle instability.

Acute lateral ankle ligament injuries are common. If left untreated, they can result in chronic instability. Nonsurgical measures, including functional rehabilitation, are the management methods of choice for acute injuries, with surgical intervention reserved for high-demand athletes.

Standardised proformas improve patient handover: Audit of trauma handover practice.

Background: The implementation of the European Working Time Directive has meant the introduction of shift patterns of working for junior doctors. Patient handover between shifts has become a necessary part of practice in order to reduce the risk of medical errors. Data handed over between shifts are used to prioritise clinical jobs outstanding, and to create theatre lists.

Tibial tubercle osteotomy for access during revision knee arthroplasty: Ethibond suture repair technique.

Background: Tibial Tubercle Osteotomy has shown much promise in revision total knee replacement. Methods of repair previously described include screw and wire fixation. Both methods have significant complications.

Recurrent subluxation of the peroneal tendons.

Recurrent peroneal tendon subluxation is an uncommon sports-related injury. The retrofibular groove is formed not by the concavity of the fibula itself, but by a relatively pronounced ridge of collagenous soft tissue blended with the periosteum that extends along the posterolateral lip of the distal fibula. The shape of the groove is primarily determined by this thick fibrocartilagenous periosteal cushion, and not by the bone itself.

Epidemiology of sprains of the lateral ankle ligament complex.

Lateral ankle sprains account for 85% of all ankle sprains. This common injury is most frequently sustained during sporting activity. The ATFL is the weakest of the lateral ankle ligament complex, and is most frequently injured.

Management of recurrent subluxation of the peroneal tendons.

Recurrent peroneal subluxation occurs when an acute injury is misdiagnosed or not adequately managed. The primary pathology is failure of the SPR, the principal restraint to the peroneal tendons. Several surgical techniques have been described.

Peroneal retinaculoplasty with anchors for peroneal tendon subluxation.

Recurrent subluxation of the peroneal tendons is rare but can produce marked functional impairment in athletes. We describe a technique for the reconstruction of the superior peroneal retinaculum using anchors. This procedure is safe and effective in managing instability.

Recurrent subluxation of the peroneal tendons.

Background: Recurrent peroneal tendon subluxation is uncommon.

Hypothesis: The authors tested the null hypothesis that there are no differences between preoperative and postoperative status after anatomical repair of the superior peroneal retinaculum.

Study Design: Case series; Level of evidence, 4.

Nonsurgical management of pancreaticopleural fistula.

Context: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%.

Aim: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit.