Management of Scapula Fractures at a Level 1 Trauma Centre in the United Kingdom.

Background Scapular fractures, an uncommon injury that can be brought on by a high-energy mechanism because of its proximity to the pectoral and shoulder muscles, are frequently linked to fatal injuries. This study aimed to compare surgical versus conservative treatment of scapular fractures and the results of treated patients. Methods The traumatic scapular fracture patients in this cross-sectional study (n = 391) were treated at a major trauma centre (level 1) in the United Kingdom between 2012 and 2018.

Arthroscopic reduction internal fixation for displaced radial head fractures: a systematic review of the outcomes and complications.

Background: Arthroscopic reduction internal fixation (ARIF) is gaining popularity for displaced radial head fractures. However, it has yet to be widely performed. ARIF offers a complete view of the articular surfaces of the radial head, capitulum, and coronoid and diagnoses and treats other associated injuries.

When can anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity be safely reduced in the emergency department?

Following dislocation of the glenohumeral joint with an isolated greater tuberosity fracture, closed reduction in the emergency department can lead to fracture propagation or iatrogenic fractures. This article assesses the evidence regarding when anterior dislocations of the shoulder with an isolated fracture of the greater tuberosity can be safely reduced in the emergency department, as there is currently no clear guidance on this. A total of eight articles described 172 cases which underwent closed reduction, which resulted in 22 cases of iatrogenic fractures.

Distal humerus hemiarthroplasty for trauma: a systematic review of the outcomes and complications.

Background: In patients with distal humerus fractures that are unreconstructible, total elbow arthroplasty is an established alternative to open reduction-internal fixation. Distal humerus hemiarthroplasty is a further alternative to avoid the significant lifestyle limitations associated with total elbow arthroplasty. Distal humerus hemiarthroplasty is an increasingly popular treatment option for unreconstructible distal humeral fractures not amenable to reconstruction.

Customizable pre-printed consent forms: a solution in light of the Montgomery ruling.

Introduction: This article presents an audit cycle supported quality improvement project addressing best practice in the consent process for lower limb arthroplasty which takes into account the new standard in surgical consent and the importance of material risks.

Methods: 50 consecutive total hip and total knee replacement consent forms over a 3-month period were reviewed for legibility and completeness. Following the introduction of a new, pre-printed but customizable consent form the review process was repeated.

Are standard antero-posterior and 20° caudal radiographs a true assessment of mid-shaft clavicular fracture displacement?

Aims: Decision-making in management of clavicle fractures is often based on the degree of displacement and shortening present on plain radiographs. We aimed to evaluate whether plain radiographs provide an accurate representation of the true displacement present, which can be difficult to image in orthogonal planes.

Methods: Consecutive high-energy trauma patients with midshaft clavicular fractures requiring further CT imaging of the thorax/abdomen for other associated injuries between 2009 and 2012 were evaluated.

The Peri-operative Management of the Rheumatoid Patient Undergoing Total Knee Arthroplasty: A Review of Literature.

Rheumatoid arthritis is the commonest inflammatory arthropathy, and affects synovium, cartilage and bone. Despite recent improvements with disease modifying biological agents, progressive joint destruction may continue eventually leading to the need for joint arthroplasty. The knee joint is involved in 90% of patients with rheumatoid arthritis, and total knee arthroplasty is being performed in many patients to alleviate pain and recover function.

Complications Encountered with Total Hip Arthroplasty in Rheumatoid Patients.

Rheumatoid arthritis affects around 1% of the global population with a predilection for Western societies. The treatment of the rheumatoid hip has gone through significant changes in recent years. Although osteotomies and synovectomies were previously commonplace, advances in arthroplasty technique and technology has seen these former procedures being performed less commonly.

V-Y vertebral body osteotomy for the treatment of fixed sagittal plane spinal deformity.

Background Context: Fixed sagittal plane imbalance (FSI) has traditionally been corrected by either opening or closing wedge osteotomies or vertebral column resections. These methods involve multiple vertebrae and have been associated with limited degrees of correction and/or neurovascular compromise.

Purpose: We describe a new V-Y vertebral osteotomy (VYO) that involves a single vertebra, allowing for correction of all three columns in a safer fashion.

Intraoperative nerve monitoring during total shoulder arthroplasty surgery.

Background: Nerve injury is an acknowledged complication of total shoulder arthroplasty (TSA). Although the incidence of postoperative neurological deficit has been reported to be between 1% and 16%, the true incidence of nerve damage is considered to be higher. The present study aimed to identify the rate of intraoperative nerve injury during total shoulder arthroplasty and to determine potential risk factors.

Developing an electronic teaching and training portfolio.

Technological advances, in particular the rise of the internet, have led to dramatic changes in medical education. The recent global financial crisis and issues with medical staffing have meant that training programs and universities are increasingly exploring electronic means to provide efficient and cost effective education techniques. In this article, we explore methods by which orthopedic trainees can develop their educational portfolio through electronic resources and similarly, how training or residency programs can utilize these advances in technology to both increase efficiency and enhance their teaching reputation.

Cauda equina syndrome following sacral fractures: a report of three cases.

We report 3 patients with cauda equina syndrome (CES) secondary to a sacral fracture. The difficulty in early diagnosis of CES and the lack of evidence and guidance on treatment are highlighted. When there is a sacral fracture, CES should be suspected.

The perioperative management of skeletal metastases.

Bone metastasis is a common problem affecting a significant proportion of patients with metastatic cancer. Bone metastasis can present in a number of ways and the patients may need surgical stabilisation of their lesions. There are many important considerations in the care of these patients that need to be borne in mind including their increased anesthetic risks and potential risk of complications.