This study was carried out to determine the incidence of shoulder injuries in the ipsilateral shoulder of patients who attended our unit with fractures of the humeral diaphysis.

This was a prospective study. 22 patients with fractures of the humeral diaphysis had an early (within 10 days of injury) MRI scan of the shoulder. The contralateral shoulder was also scanned as an internal control. There were 10 male and 12 female patients. The average age was 45 years. 20 were treated non-operatively, and 2 had retrograde intra-medullary nailing of the humerus. 6 patients in our study had a symmetrical MRI scan. The remaining 16 patients had some acute abnormality evident in the ipsilateral shoulder. 11 patients had a significant subacromial bursitis. 2 of these patients had a tear of the supraspinatus tendon. 1 patient had an undisplaced fracture of the coracoid process. The remaining 4 patients had significant AC joint inflammation, 3 being acute, the 4th being acute-on-chronic.

This study shows a high incidence of asymmetrical MRI scans, indicating a definite shoulder injury sustained at the time of the fracture of the humeral diaphysis. We therefore surmise that shoulder pain and dysfunction post antegrade intra-medullary nailing of the humerus may not be due to iatrogenic causes, but may in fact result from concomitant ipsilateral shoulder injury. To our knowledge, this is the first study demonstrating such an association.

The conservative management if isolated humeral shaft fractures is a long, drawn out, painful process for the patient. For the clinician, it involves multiple clinic attendances and repeated radiographic assessment and brace alteration.

The primary reason for conservative management is the excellent results, but a very definite secondary consideration is the high incidence of shoulder pathology after I.M. nailing. This is thought to be due to rotator cuff pathology at the time of surgery. We question the validity of this second argument.

Ten consecutive humeral shaft fractures attending our unit had an MRI of both shoulders carried out during the initial stages of their injury. Two of the ten had retrograde nailing and the remainder was managed conservatively. While there was no patient with an occult coracoid fracture in association with the shaft fracture. We found eight out of ten to have significant signal changes in the subacromial space on the side of the fracture only.

We conclude that there is a significant occult injury to the shoulder at the time of humeral shaft fracture and this may in fact represent a cause for the high incidence of shoulder pain post fracture.

Introduction: Operative fixation is the mainstay of treatment for displaced ankle fractures. Results however can be variable, with patients complaining of residual pain and stiffness of the ankle joint. In addition, metalwork can be problematic giving rise to symptoms in up to 25% of patients. We undertook a retrospective study to evaluate outcome in terms of functional and radiological criteria in a cohort of patients.

Aim: To assess outcome in a cohort of patients following operative treatment of ankle fractures.

Materials and Methods: Patients with suitable injuries sustained were identified from the hospital HIPE database. Data was collated from hospital records including demographic details, mechanism of injury, details of the initial injury and surgical treatment. Patients were invited to attend for clinical and radiological examination of the injured ankle. Patients completed the SF12, the Olerud ankle score and a visual analogue pain scale (VAS) on arrival at the clinic. The range of motion of both the injured and uninjured ankle were examined. Finally, the patient’s injured ankle was evaluated on plain X-rays using Cedell’s scoring system. Comparison was made with initial roentgens at the time of injury.

Results: From 106 patients treated over a four-year period, 63 were successfully followed up. Mean time of follow up was 3.5 years. Older patients had a poorer recovery, as had those with more severely displaced fractures. Pain was not a major problem for patients with 58 complaining of no pain, or pain only after prolonged exercise. 43% of patients complained of occasional swelling of the affected limb. The majority of patients (89%) had returned to their previous occupations at the time of follow up. 16% of patients (10) had their metalwork removed post operatively. In seven cases, this was due to skin problems or pain adjacent to the metalwork.

Conclusion: Older age at presentation, and severity of initial injury appear to have a significant effect on long-term outcome, which may be attributable to poorer osteosynthetic ability in an elderly osteoporotic patient. Our study underlines the importance of accurate anatomical reduction of ankle fractures in order to minimise subsequent arthrosis.