Reduction under sedation in A&
E by the A&
E doctor (80% of respondents). Apart from X-ray, no investigations are performed (80%). Immobilisation for 3 weeks, followed by physiotherapy (82%). 68 % of respondents would consider stabilisation surgery for first time dislocators (especially professional sportsmen) compared to 35% in 2003. Out of them nearly 90% would perform an arthroscopic stabilization vs. 57.5% in 2003. For recurrent dislocators: 75% would consider stabilisation after a second dislocation. 85% would investigate prior to surgery, choice of investigation being MR arthrogram (52%), compared to 50% in 2003 that would chose to investigate. 77% would choose to perform arthroscopic stabilisation compared to 18% in 2003, the commonest procedure being arthroscopic Bankart repair using biodegradable bone anchors (62% compared to 27% in 2003). Following surgery, immobilisation would be for 3 weeks, full range of motion at 1 to 2 months and return to contact sports at 6 to 12 months.
A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of the Brit-ish Elbow and Shoulder Society. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recurrent traumatic dislocators. The response rate was 83% (n=136) The most likely treatment of a young traumatic shoulder dislocation:
It will be reduced under sedation in A&
E by the A&
E doctor. Apart from x-ray, no investigations will be performed It will be immobilised for 3 weeks, then given course of physiotherapy Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 16% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 3, and the period of immobilisation post operation from nil to 6 weeks. The results reveal a wide variation in practice and no clear consensus on how to best manage these patients. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?
To discover how traumatic anterior shoulder dislocation in the young patient (17–25) is managed by shoulder surgeons in the UK. A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of BESS. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recur- rent traumatic dislocaters. The response rate was 82% (n=135) The most likely treatment of a young traumatic shoulder dislocation:
It will be reduced under sedation in A&
E by the A&
E doctor. Apart from x-ray, no investigations will be performed It will be immobilised for 3 weeks, then given course of physiotherapy Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 18% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 4, and the period of immobilisation post operation from nil to 6 weeks. We now know how shoulder surgeons in the UK are treating this common injury. The results reveal that in Britain, we do not have a consistent approach, raising many discussion points. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?
To investigate whether children with fractures have a low bone mineral density, 109 children (46 female and 63 male) aged 10.5 ± 2.9 years (range 5–16) sustaining either a single fracture (n=60 patients) or multiple fractures (n=49 patients) had Bone Mineral Density measurements [BMD] (Hologic QDR4500A) of L2 to L4. The Z score {(Patient’s BMD – mean aged related BMD)/ standard deviation of that age group)} was calculated using two previously published data from Shropshire children and American children. A z score of zero indicates that the patients’ BMD is exactly on the mean. The proportion above and below zero and was compared using the binomial theorem. Comparison of frequencies between the groups was undertaken using the Chi 2 test. In a scatter plot of z score against age, low z scores were frequent in girls under 8yrs using both reference data. In this group BMD z score was more likely to be below zero (p<
0.05). A low z score was more frequent in boys less than 8 years using American reference data but not Shropshire data. Girls and boys above 8 years did not show any evidence of low BMD. There was no difference in the frequency of low BMD in patients with multiple compared with single fracture. Girls and possibly boys below 8 years who have sustained a fracture show evidence of low BMD. Boys at any age and girls over 8 years did not show any evidence of having low bone density. Further work is needed to establish whether this risk continues into later life. Multiple fractures do not appear to confer additional risk of low bone density.
