Pufferfish attack on Thursday Island.

In rural Australia animal attacks and bites are an increasingly common phenomenon. The pufferfish is native to the north-eastern coast of Australia and is becoming increasingly tempted closer ashore. We present the first case and review of the literature of a vicious fish bite from this animal in a child in rural Australia.

Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture.

Background: Treatment of complex proximal humeral fractures remains controversial. In cases where adequate open reduction and internal fixation cannot be achieved, hemiarthroplasty has been the traditional treatment; however, clinical results have been mixed. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative, and this study aimed to compare the functional results of RSA versus hemiarthroplasty in patients with acute proximal humeral fracture.

Review of imaging of scaphoid fractures.

Scaphoid fractures are the most common fractures of the carpus, accounting for 79% of all carpal fractures. Early diagnosis of scaphoid fractures is imperative owing to potential complications following the fracture, including non-union, avascular necrosis, carpal instability and osteoarthritis. Plain radiography remains the initial imaging modality to assess scaphoid fractures.

Imaging recognition of morphological variants at the midcarpal joint.

Purpose: To compare the imaging methods for identifying the various morphological variations of the articular surfaces at the midcarpal joint.

Methods: Thirteen cadaveric wrists were examined by plain neutral anteroposterior radiographs; 2-dimensional computed tomography (CT); 3-dimensional CT reconstruction, and 3-tesla magnetic resonance imaging (MRI). Carpal measurements were performed, and the parameters that defined the scaphoid, lunate, hamate, and capitate morphological types were investigated, with dissection being used as the definitive measure of morphology.

Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion.

Purpose: The primary aim of our study was to investigate use of long axis computed tomography (CT) in predicting avascular necrosis of the proximal pole of the scaphoid and subsequent fracture nonunion after internal fixation. In addition, we describe a new technique of measuring the position of a scaphoid fracture and provide data on its reproducibility.

Methods: Thirty-one patients operated on by the senior author for delayed union or nonunion of scaphoid fracture were included.

Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept.

We report 3 cases of translunate fractures with associated perilunate dislocations (or subluxation). We believe the translunate injury reflects a higher-velocity trauma and produces further destabilization of the carpus when compared with the established greater and lesser arc injuries. A modification to Johnson's perilunate injury classification system is proposed: the addition of a translunate arc injury subgroup, which would include all perilunate injuries with translunate fractures.

Arthroscopically assisted treatment of intraosseous ganglions of the lunate.

Intraosseous ganglia (IOGs) of the lunate are a relatively rare, but by no means insignificant, condition because treatment by traditional open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.An arthroscopically assisted minimally invasive technique of debridement and grafting of the lunate IOG is discussed, as well as the history of the condition, indications and contraindications, surgical technique with postoperative rehabilitation, and potential complications.The outcomes of 8 patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently preoperatively and postoperatively by using a modified Green and O'Brien wrist score.

Arthroscopic dorsal capsular release in the wrist: a new technique.

Wrist stiffness is a multifactorial condition that is debilitating for those which it affects. Although good results have been achieved in the past with aggressive physiotherapy and splinting regimens, however, there are some cases that remain refractory to this treatment. In those cases that are caused primarily by arthrofibrosis, arthroscopic surgical release of the capsule is another treatment option.

Treatment of partial distal biceps tendon tears.

Partial rupture of the distal biceps tendon exhibits features similar to that of complete disruption, including acute antecubital pain, weakness of elbow flexion, and forearm supination, and differs only in the fact that the biceps tendon is still palpable in the partial rupture. There are 2 etiologies, first acute traumatic (such as a sudden eccentric contracture) and second, chronic degenerative tendon disease. For accurate diagnosis, a high index of suspicion must be employed.

New advances in wrist arthroscopy.

Wrist arthroscopy is a commonly used procedure that has undergone many modifications and improvements since it was first described. The advent of new portals (both dorsal and volar) means that the wrist joint can be viewed from virtually any perspective ("box concept"). Indications for wrist arthroscopy have continued to expand and include diagnostic and reparative procedures and, more recently, reconstructive, soft-tissue, and bony procedures.

Informed consent: patients listen and read, but what information do they retain?

Aim: To determine the percentage of knowledge retained immediately following an outpatient consultation for total hip and knee joint arthroplasty, and whether any improvement in that knowledge occurred after reading an information leaflet about the operation.

Methods: Patients on the waiting list for joint replacement surgery were given verbal information during the consultation about basic operative details, post-operative programme, and potential complications. A questionnaire was completed asking them to recall these details.