The glenohumeral joint is the most frequently dislocated articulation, but possibly due to the lower prevalence of posterior shoulder dislocations, approximately 50% to 79% of posterior glenohumeral dislocations are missed at initial presentation. The aim of this study was to systematically evaluate the most recent evidence involving the aetiology of posterior glenohumeral dislocations, as well as the diagnosis and treatment. A systematic search was conducted using PubMed (MEDLINE), Web of Science, Embase, and Cochrane (January 1997 to September 2017), with references from articles also evaluated. Studies reporting patients who experienced an acute posterior glenohumeral joint subluxation and/or dislocation, as well as the aetiology of posterior glenohumeral dislocations, were included.Aims
Materials and Methods
Results: For the patients with the shoulder triad, outcome was excellent to satisfactory in all, with frontal and vertical elevation greater than 90°, nearly normal rotations, and acceptable force and range of motion for daily, occupational and sports activities. The patients with dead shoulder syndrome were a more heterogeneous population. Clinical outcome was less satisfactory although there was a real improvement in range of motion. Occasional pain was reported and some of the patients were satisfied. Conclusion: Combined lesions of the shoulder create a difficult diagnostic and therapeutic situation. As when occurring alone, it is important to recognize injury early in order to adapt treatment to achieve functional improvement.
To determine the bony outcomes of patients treated at our Institution after sustaining femur fracture and arterial injury, due to gunshot, in the ipsilateral limb, studied over a four-year period. The database at the Department of Vascular Surgery at our Institution was searched for cases that had sustained both arterial injury and femur fracture of the ipsilateral leg. Their case notes and X-rays were reviewed for the following:
Time line from injury to discharge Procedure performed Duration of external fixation Complications (infection, iatrogenic vascular injury, amputation, bony union achieved) Incidence of fasciotomy During the period from 2002 to the end of 2005 there were 12 patients who qualified to be included in the audit group. Three of the 12 (25%) had to undergo a primary amputation upon arrival. The other nine cases underwent surgery. One of these received an intra-medullary device, another skeletal traction and the rest external fixation following the vascular surgery. Five of the 7 external fixation devices were converted to an intramedullary device in due course. All nine cases went on to union. There were no reported cases of iatrogenic vascular repair disruption. Of the 12, only three cases reported any infection. One case developed severe osteomyelitis of the femur. Primary vascular repair with temporary external fixation that was later converted into an intramedullary device (within 14 days) provided satisfactory results.
The retrospective analysis of 131 patients suffering from a fracture of the ring of the axis is reported. The injury was classified into three types according to radiological displacement and stability.
Tibial eminence fractures were historically thought of as a condition of skeletal immaturity. Increasingly this injury has been recognized in adults. The aim was to report on the demographics, mechanism, treatment and outcomes of this injury in adult and paediatric patients. A retrospective review of all patients presenting to Dunedin Hospital, for management of a displaced tibial eminence fracture, between 1989 and 2009. 19 cases were identified, 10 skeletally mature and 9 skeletally immature. Alpine skiing with a forced flexion and rotation injury accounted for 7 cases, primarily adult females (5 cases). A hyper-extension and rotation injury accounted for 7 cases, primarily in skeletally immature males (4 cases), while direct trauma accounted for 5 cases, primarily males (4 cases).
Introduction. This study investigates the epidemiology of proximal radial fractures and potential links to social deprivation. Patients and Methods. From a prospective database we identified and analysed all patients who had sustained a fracture of the radial head or neck over a one year period. The degree of social deprivation was assessed using the Carstairs and Morris index. The relationship between demographic data, fracture characteristics and deprivation categories was determined using statistical analysis. Results. Two hundred and ninety radial head (n=203) and neck (n=87) fractures were diagnosed with a mean age of 44.3years (13–94). There was no significant difference with regards age or gender predominance when comparing radial head and neck fractures directly. The mean age of males was significantly younger when compared to females for radial head (p<0.001) and neck (p<0.001) fractures, but with no gender predominance seen.
Purpose of the study: High-energy varus or valgus ankle trauma causes severe injury to the capsule and ligaments. We describe a presentation associating massive tears of the lateral/medial collateral ligaments with a transversal wound of the corresponding malleolus. This wound results from excessive tension on the skin cause by the major varus/valgus. We have defined this injury as an open and severe ankle sprain (OSAS). Material and method: This was a retrospective analysis. We search the databases of three participating centres using the corresponding diagnostic and therapeutic codes from January 2005 to January 2009. The identified files were screened to select patients with OSAS. Results: There were 11 cases of OSAS. Eight involved the lateral side of the ankle and three the medial side. Mean age was 41 years (range 21–45). All patients were victims of a high-energy trauma (five motorcycle accidents) and four patients had fallen from a high point.
Purpose:. Non-contiguous spinal injury can add significant complexity to the diagnosis, management and outcome in children. There is very little in the paediatric literature examining the nature, associated risk factors, management and outcomes of non-contiguous spinal injuries. The objective is to determine the incidence and clinical characteristics of non-contiguous spinal injuries in a paediatric population. The secondary objective is to identify high risk patients requiring further imaging to rule out non-contiguous spinal injuries. Methods:. All children up to 18 years of age with a spinal injury, as defined by ICD-09 codes at one paediatric trauma hospital were included (n=211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurologic injury and recovery, associated injuries, medical complications, treatment and outcome were recorded. Results:. Twenty five (11.8%) out of 211 patients had non-contiguous spinal injuries. The mean age was 10.7 years. The most common pattern of injury was a double thoracic non-contiguous injury. 16% of cases of NCSI were initially missed, but with no clinical deterioration due to the missed diagnosis.
Firecracker injuries to the hands can cause permanent functional loss and disfigurement. We assessed the injuries and treatment of 16 men, three women, five boys and two girls injured around New Year’s Eve between 1999 and 2004. In 16 of the adult patients, who included a typist and a teacher, it was necessary to amputate one or more digits. Four patients lost both the thumb and the index finger, four lost the thumb and the rest lost other digits. Only soft tissue injuries were sustained by 10 of the 26 patients. Twenty patients (77%) benefited from initial debridement and primary closure alone, but the other six needed more than one procedure, and half of this group developed sepsis. The psychological impact was important in adults.
Lower limb fractures in children are common. These fractures can be managed in a variety of ways, and the method chosen depends on a number of factors including:. Age of the child. Site of fracture. Whether the fracture is open or closed.
We conducted a prospective evaluation of patients with anterior dislocation of the shoulder associated with a fracture of the greater tuberosity. Thirty-four anterior dislocations of the shoulder with greater tuberosity fractures were reviewed with a minimum follow-up of one year from the time of injury. Eight required open reduction. The final outcome with regard to pain, range of movements, and function was assessed in 34 patients. In open reduction, there were five good results, one fair, one poor and one patient died. In the non-operative group, results were good in 11 patients, fair in eight, poor in one, not assessed in five and one patient died. Two patients have died in this series, one in the open reduction group.
Despite being one of the most common injuries around the elbow, the optimal treatment of olecranon fractures is far from established and stimulates debate among both general orthopaedic trauma surgeons and upper limb specialists. It is almost universally accepted that stable non-displaced fractures can be safely treated nonoperatively with minimal specialist input. Internal fixation is recommended for the vast majority of displaced fractures, with a range of techniques and implants to choose from. However, there is concern regarding the complication rates, largely related to symptomatic metalwork resulting in high rates of implant removal. As the number of elderly patients sustaining these injuries increases, we are becoming more aware of the issues associated with fixation in osteoporotic bone and the often fragile soft-tissue envelope in this group. Given this, there is evidence to support an increasing role for nonoperative management in this high-risk demographic group, even in those presenting with displaced and/or multifragmentary fracture patterns. This review summarizes the available literature to date, focusing predominantly on the management techniques and available implants for stable fractures of the olecranon. It also offers some insights into the potential avenues for future research, in the hope of addressing some of the pertinent questions that remain unanswered. Cite this article:
We have reviewed 81 patients with fractures of the odontoid process treated between May 1983 and July 1997, by anterior screw fixation. There were 29 patients with Anderson and D’Alonzo type-II fractures and 52 with type III. Roy-Camille’s classification identified the direction and instability of the fracture. Operative fixation was carried out on 48 men and 33 women with a mean age of 57 years.
1. A study of fifty patients with dislocations of the lunate bone or perilunar dislocations has been made. The period of observation was adequate in thirty-eight. 2. The injuries generally occur in young or middle-aged men after unusually severe trauma. 3.
In 1996 the quality of the early management of 100 consecutive patients referred to a regional pelvic and acetabular unit between 1989 and 1992 was studied. The management of these patients was assessed in four specific areas, and guidelines were laid down. It was found that in 56% of patients the early management did not meet these suggested standards, with 34% having deficiencies in more than one area. These results were presented, published and circulated to referring hospitals. Five years later, the early management of a further 100 consecutive referrals was assessed using these same guidelines. The treatment of 57% of patients still did not reach the guideline standards, but the number with problems in more than one area fell to 20%. There has been some improvement in the early management of pelvic and acetabular injuries. The use of external fixators to control severe haemorrhage increased, but frames were often poorly applied. Wider access to CT scanners has reduced delays in definitive imaging.
A medical and engineering study was made of 1074 car accidents involving 2520 vehicle occupants. The injuries they sustained were correlated with details of the crash and with contact points inside the cars. Where possible the forces which were generated in the crash were estimated and related to the injuries. In all, 39 car occupants suffered femoral shaft fracture, with an incidence of 1.7% and 0.8% for front and rear seat occupants respectively. Of these, 31 had associated injuries to other regions of the body; these were the cause of 13 of the 14 deaths in this group.
Introduction: Although a relationship between long-bone fractures and patient morbidity and mortality has been previously identified, the cause and effect of bilateral femoral fractures remain obscure. Aim of Study: This study was designed to determine whether patients with bilateral femoral fractures with associated injuries die more frequently than patients with isolated bilateral femoral fractures, and the contribution of the associated injuries to patient mortality. Materials and Methods: Retrospective analysis using the UK trauma Audit &
Research Network (TARN) registry data from 1989 to 2005 on isolated bilateral femoral fractures ‘Group I’ (92) or with associated injuries ‘Group II’ (380). Univariate data analysis was performed to compare the groups’ ages, Injury Severity Scores, Glasgow Coma Scales, mortality, physiological parameters, the time to arrive to scene and the time to arrive to hospital. Logistic regression data analysis was performed to determine variables statistically associated with mortality. Results: Patients in Group II had a significantly higher Injury Severity Score (23 vs 9), lower Glasgow Coma Scales value (12 vs 15), higher mortality rate (31.6 vs 9.8%) and lower mean systolic pressures (116 vs 135) than patients in Group I.
Anterior wall and/or column acetabular fractures (AW/ C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre. Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classification were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28–64). 15 patients (10 males) met the inclusion criteria (mean age 55.5 years). Four had associated anterior dislocation.
Introduction. Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%. Method. We retrospectively identified patients with fixation for neck of femur fractures at Birmingham Children's Hospital. All patients were under age sixteen. Data were reviewed over a 10 year period (1997-2006). Fractures were classified by Delbet's classification and Ratliff's system to grade avascular necrosis (AVN). Function was assessed using Ratcliff's criteria, incorporating clinical examination and radiographic findings. Results. 15 femoral neck fractures were treated in 14 patients over a ten year period (R=1997-2006). One patient sustained bilateral fractures. Three patients had osteogenesis imperfecta and one osteopetrosis. Mean age at injury was 10.3 years (R=6-14 years). Mean follow-up was 31 months (R=6-110 months). Two fractures were Delbet type-I (13.3%), four type-II (26.7%), six type-III (40%) and three type-IV fractures (20%).
Materials &
Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome. Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular Calcaneal fractures in district general hospital. Results: 22 male and 3 female. Intraarticular fractures 15 (60%)of which 10 were displaced and 5 undisplaced. Extraarticular were 10 (40%) of which displaced and undisplaced were 5 each. Fall from height was seen in 20 (80%)patients.
Introduction: Anterior wall and/or column acetabular fractures (AW/C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre. Methods: Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classification were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28–64). Results: 15 patients (10 males) met the inclusion criteria (mean age 55.5years). Four had associated anterior dislocation.
Background: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. Methods: 107 consecutive patients with fractured scapulae (100 males) with a mean age of 35 (8–65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, injury severity scale (ISS) and the number of anatomical scapular regions involved in each fracture were studied. Patients were divided into single-region, two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain X-rays in the remaining 8. Results: Road traffic collisions were the most common cause of scapular fracture. 95 patients (89%) sustained associated injuries. The most frequent was chest injury (68 (64%)). The median ISS was 9 (4–57) for the single-region fracture group (n 55), 20 (4–59) for the two-region fracture group (n 30), and 22.5 (4–54) for more than two-region fracture group (n 22) (p=0.02, Kruskal Wallis test). The median values of abbreviated injury scale (AIS) for chest injuries for the three groups were 1 (0–4), 3 (0–5) and 3 (0–5), respectively (p=0.001, Kruskal Wallis test). The single-region fracture group had significantly less posterior structure injury (9/55) compared with the multiple-region fracture group (46/52) (p=0, Fisher’s exact test). Conclusion:
Fractures and fracture dislocations involving the lower lumbar spine and lumbosacral junction are uncommon. These high velocity injuries are often associated with neurological deficit, incontinence and dural tears. The accepted treatment has been posterior stabilisation with fusion, but loss of reduction has often been reported. We reviewed our experience over the past four years in the management of eight male patients, two of whom sustained injuries in motor vehicle accidents and two in falls from a height. Two patients had L5/S1 traumatic spondylo-listhesis with no neurological deficit. Of the six patients with fracture dislocations of L3/4, four had translation in the sagittal and coronal planes and incomplete neurological deficit.
We investigated the results of complex acetabular fractures that were treated through the extended triradiate approach between January 1996 and September 2002 in our clinic. Sixty acetabular fractures were treated surgically during this period in total. Twenty-nine complex fractures that were treated through the triradiate approach with a minimum 2 years follow-up included in the study. The mean patient age was 43 years. There were 10 both column, 9 T shaped, 2 anterior column – posterior hemitransverse, 4 transverse with comminuted roof area, 5 posterior wall with comminuted roof area and 1 posterior column posterior wall fractures.
Aim: To review the operative results and to determine factors that may significantly influence the outcome. Method: We retrospectively reviewed 38 patients treated with femoral interlocking nailing and tibial external fixation in a 5-year period (1996–2000). Two patients were excluded because of early death. Minimum follow-up was 2 years. There were 29 men and 7 women with a mean age of 27 years. Eight femoral (22%) and 29 tibial fractures (81%) were open.
Purpose: Vascular injuries occur in approximately 3% of all patients with major civilian trauma and peripheral vascular injuries account for 80% of all cases of vascular trauma. Upper extremity arterial injuries represents about 30% of all cases arterial trauma. The present study was designed to document and analyze the respective role of arterial damage and associated injuries on functional outcomes after upper extremity arterial trauma. Material and Methods: Excluding the arterial injuries resulting in immediate amputation there were 57 patients who sustained arterial trauma of the upper extremity. Their mean age was 33 years (range 4–68 years), and 40 were males and 19 were females. The most frequently injured vessel was the ulnar artery (42%) followed by the brachial artery (29.8%), radial artery (26.3%) and axillary artery (1.7%). Concomitant fractures or nerve injuries were present in 54% and 45% respectively. Results: An average of 5.6 hours elapsed between the time of injury and the time of vessel reconstruction. The most common method of surgical management was end to end anastomosis. Twenty one autogenous vein grafts were employed. Primary nerve repair was carried out in 29 patients and in another 18 secondary repair was performed. None of patients had any residual compromise from the arterial injury. Discussion: Vascular injuries are potentially limb threatening. Improvements in the technical ability to revascularize injured extremities and advances in microsurgery, resulting in the low present day limb loss rate associated with attempted vascular repairs.
Dislocations of the thoracolumbar spine, which account for 11% of injuries in the T10 to L2 region, follow a high-energy, flexion-distraction force. In this region, there is a transition from a fixed kyphosis to a mobile lordosis, an absence of costotransverse ligaments and a change of facet alignment from a coronal to a sagittal plane. In 1999, we treated 12 male and nine female patients with dislocations of the thoracolumbar spine. Their mean age was 30 years. Sixteen patients had been involved in motor vehicle collisions, four had fallen from a height and one had been assaulted with an iron bar. There were 14 Frankel grade-A injuries, one Frankel grade-C, two Frankel grade-D and four Frankel grade-E injuries. The site of injury was T12/L1 in 14 patients, L1/L2 in four, T11/T12 level in four and T10/T11 in one.
We have reviewed the patients with vertical shear fractures of the Pelvis and report on our treatment protocol and long-term functional outcome. Methods: Between January 1993 and January 2002, out of 581 pelvic ring injuries treated in our unit, we identified 31 vertical shear fractures in 29 (4.9%) patients (4 female). Data such as age, sex, aetiology, associated injuries, ISS, resuscitation and transfusion requirements were recorded. ICU/HDU stay, surgical stabilization, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome was assessed using the following generic tools: EuroQol EQ-5D, SF36v2, SMFA, Majeed score and VAS. Results: The mean age was 43.5 (16–71). The median ISS was 22 (12–32). Motorcycle accidents were responsible for 27%.
The aim of this retrospective study was to assess the effects of several preoperative and intraoperative factors on the final clinical and radiological outcomes in pediatric hip fractures. Forty-four pediatric patients with a hip fracture were treated at our department between January 1998 and September 2007. Thirty-nine patients with a minimum follow-up period of 1 year were included the study. Three patients had inadequate follow-up and two died at the early postoperative period. Mean age of 39 patients were 11.1 (4–16) years. There were 22 boys and 17 girls. The two main etiologic factors were traffic accident and fall from height.
Introduction and Aims: Knee dislocation is an uncommon but serious injury. This study assessed the initial mechanism of injury, pattern of ligament injury, osteochondral and peri-articular soft-tissue trauma, and associated neurovascular injuries in the multi-ligament knee injury. Outcomes following operative and non-operative management were reviewed. Method: Retrospective review of patients with multi-ligament knee injuries was performed. Inclusion criteria were either a confirmed knee dislocation, or complete rupture of two or more ligaments requiring reconstruction. Systematic review of hospital records and imaging was performed for all patients, and clinical assessment, including validated outcome scores, were performed in the majority of patients. All reconstructive surgery was performed by the two senior authors. Results: Forty-five patients with 47 knee injuries were identified over a 13-year period (1990–2003). The most common mechanisms of injury were motorcycle and motor vehicle accidents. Other mechanisms included pedestrians hit by cars, sporting injuries and falls. Approximately half had a documented knee dislocation, while the remainder were located at the time of presentation. Vascular injury occurred in around 25% of patients, all having positive clinical findings. Routine angiography was not performed in the absence of positive clinical findings. Neurological injury also occurred in approximately 20% of patients. Transient neuropraxia was more common than permanent nerve palsy, and there was an association between neurological and vascular
Purpose: To assess the usefulness of Bone Transport and other “compression-distraction” systems for the treatment of Segmental Bone Defects (SBD) in patients younger than 16 years-old. Patients and methods: This series includes 18 patients (12 boys, 6 girls) with SBD of the following etiologies: Post-traumatic defects with/without sepsis (14 cases) and post-resection defects (3 Congenital Pseudoartrosis of the Tibia -CPT- and 1 Aneurismal Bone Cyst). The age of the patients ranged from 8 to 16 years and the length of the defect from 5 cm to 13 cm except for one case (23 cm). The defect was located in the tibia in 14 cases and in the femur in four. Nine patients (the longest defects) were treated by conventional Bone Transport whereas other compression-distraction techniques were used in the remaining. Monolateral frames were used in all cases. All but one of the post-traumatic cases had additional injuries and in four occasions one of the joints adjacent to the defect was involved. Results: All cases healed, 6 with only one operation and 12 with more than one procedure. Healing time depended upon the length of the defect, age of the patient, etiology and occurrence of complications. Healing index also varied mainly depending on the etiology (CPT cases were slower) ranging form 1.5 to 0.7 months/cm. Bone graft at the compression site was used in 9 cases. Radiologically the most striking feature was the very early tubulization of the reconstructed segment along with the quick healing of the SBD. The most frequent complication was pin tract infection (37%), one case needing change of pins. Fracture at the pin site was seen in two cases. Functional results were closely related to: a. The healing of the defect and b. The existence of injuries to the joints adjacent to the defect. With a minimum follow-up of 18 months there were 2 poor functional results due to an avascular necrosis of the dome of the talus (talus neck fracture). Conclusion: These techniques are very useful in selected cases of large SBD in young patients. They have shown low morbidity, quick healing and, above all, very good remodeling potential.
The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler ultrasound (DUS), to assess the incidence of pulmonary embolism (PE) using CT angiography, and to identify the factors that predict postoperative DVT in patients with a pelvic and/or acetabular fracture. All patients treated surgically for a pelvic and/or acetabular fracture between October 2016 and January 2020 were enrolled into this prospective single-centre study. The demographic, medical, and surgical details of the patients were recorded. DVT screening of the lower limbs was routinely performed using DUS before and at six to ten days after surgery. CT angiography was used in patients who were suspected of having PE. Age-adjusted univariate and stepwise multiple logistic regression analysis were used to determine the association between explanatory variables and postoperative DVT.Aims
Methods
Purpose: Van Den Bosch reported diminished quality of sexual intercourse in 40% of the patients victims of pelvic fractures. Using the Rosen self-administered questionnaire, five aspects of sexual activity were analysed: erectile function and orgasm, sexual desire, satisfaction with sexual intercourse and overall satisfaction. This retrospective series included patients with pelvic ring fractures in 1999. Material and methods: The situation of 46 patients, aged 30 to 70 years was assessed with the International Index of Erectile Function self-administered questionnaire and a questionnaire concerning the patient’s status. The radiographic analysis included the Tyle classification.
The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS. From 2008 to 2017, all patients with a humeral diaphyseal fracture were retrospectively identified. Patient demographics and injury characteristics were recorded. Details of pre-injury employment, sporting participation, and levels of return post-injury were obtained via postal questionnaire. The University of California, Los Angeles (UCLA) Activity Scale was used to quantify physical activity among active patients. Regression was used to determine factors independently associated with failure to RTW or RTS.Aims
Methods
Major upper limb arterial injuries sustained in combat are associated with significant trauma. We analysed the survival and complication rates following upper limb vascular injury in Iraq and Afghanistan (2004–2014). Fifty-two soldiers sustained 59 major arterial injuries in 54 limbs. Axillary artery injuries were more likely to be caused by gunshot wounds (86%), whilst brachial and ulnar artery injuries were primarily associated with blasts (72% and 87% respectively); no such correlation was identified with radial artery injuries. Apart from three temporary shunts, all vascular injuries were treated definitively in the local field hospital before repatriation. Proximal injuries were predominantly treated with long saphenous vein grafts and distal injuries with ligation. One soldier required an immediate amputation following failed LSV grafting, however no amputations followed repatriation. There were five identified graft failures (21%), although these were not associated with subsequent perfusion issues. There were no graft failures following temporary shunting.
Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function.Aims
Methods
Introduction. This is the first study to illustrate spinal fracture distribution and the impact of different injury mechanisms on the spinal column during contemporary warfare. Methods Retrospective analysis of Computed Tomography (CT) spinal images entered onto the Centre for Defence Imaging (CDI) database, 2005-2009. Isolated spinous and transverse process fractures were excluded to allow focus on cases with implications for immediate management and prospective disability burden. Fractures were classified by anatomical level and stability with validated systems. Clinical data regarding mechanism of injury and associated non-spinal injuries for each patient was recorded. Statistical analysis was performed by Fisher's Exact test. Results 57 cases (128 fractures) were analysed. Ballistic (79%) and non-ballistic (21%) mechanisms contribute to vertebral fracture and spinal instability at all regions of the spinal column. There is a low incidence of cervical spine fracture, with these injuries predominantly occurring due to gunshot wounding. There is a high incidence of lumbar spine fractures which are significantly more likely to be caused by explosive devices than gunshot wounds (p<0.05). 66% of thoracolumbar spine fractures caused by explosive devices were unstable, the majority being of a burst configuration.
Introduction. This is the first study to illustrate spinal fracture distribution and the impact of different injury mechanisms on the spinal column during contemporary warfare. Methods. A retrospective analysis of Computed Tomography (CT) spinal images entered onto the Centre for Defence Imaging (CDI) database, 2005-2009. Isolated spinous and transverse process fractures were excluded to allow focus on cases with implications for immediate management and prospective disability burden. Fractures were classified by anatomical level and stability with validated systems. Clinical data regarding mechanism of injury and associated non-spinal injuries for each patient were recorded. Statistical analysis was performed using Fisher's Exact test. Results. 57 cases (128 fractures) were analysed. Ballistic (79%) and non-ballistic (21%) mechanisms contribute to vertebral fracture and spinal instability at all regions of the spinal column. There is a low incidence of cervical spine fracture, with these injuries predominantly occurring due to gunshot wounding. There is a high incidence of lumbar spine fractures which are significantly more likely to be caused by explosive devices than gunshot wounds (p<0.05). 66% of thoracolumbar spine fractures caused by explosive devices were unstable, the majority being of a burst configuration.
Introduction: Forearm fractures are the most common long bone fracture in the paediatric population.
The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed.Aims
Methods
The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (Aims
Patients and Methods
In this randomized study, we aimed to compare quality of regenerate in monolateral Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study.Aims
Patients and Methods
Different methods of anterior cruciate ligament (ACL) reconstruction
have been described for skeletally immature patients before closure
of the growth plates. However, the outcome and complications following
this treatment remain unclear. The aim of this systematic review
was to analyse the outcome and complications of different techniques
which may be used for reconstruction of the ACL in these patients. We performed a systematic review of the literature according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. This involved a comprehensive search of PubMed, Medline,
CINAHL, Cochrane, Embase and Google Scholar databases using the
following combinations of keywords, “knee”, “anterior cruciate ligament”,
“reconstruction”, “injury”, “children”, “adolescent”, “skeletally
immature”, “open physis” and “surgery”.Aims
Materials and Methods
The aim of the study was to analyze the results of primary tendon
reinsertion in acute and chronic distal triceps tendon ruptures
(DTTRs) in the general population. A total of 28 patients were operated on for primary DTTR reinsertions,
including 21 male patients and seven female patients with a mean
age of 45 years (14 to 76). Of these patients, 23 sustained an acute
DTTR and five had a chronic injury. One patient had a non-simultaneous
bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture
or dislocation. Comorbidities were present in four patients. Surgical
treatment included transosseous and suture-anchors reinsertion in
22 and seven DTTRs, respectively. The clinical evaluation was performed
using Mayo Elbow Performance Score (MEPS), the modified American
Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities
of the Arm, Shoulder and Hand score (QuickDASH), and the Medical
Research Council (MRC) Scale.Aims
Patients and Methods
We performed a retrospective, comparative study of elderly patients
with an increased risk from anaesthesia who had undergone either
anterior screw fixation (ASF) or halo vest immobilisation (HVI)
for a type II odontoid fracture. A total of 80 patients aged 65 years or more who had undergone
either ASF or HVI for a type II odontoid fracture between 1988 and
2013 were reviewed. There were 47 women and 33 men with a mean age
of 73 (65 to 96; standard deviation 7). All had an American Society
of Anesthesiologists score of 2 or more.Aims
Patients and Methods
Our aim was to investigate the outcomes of patients with a displaced
fracture of the glenoid fossa who are treated conservatively. There
is little information in the literature about the treatment of these
rare injuries non-operatively. We reviewed 24 patients with a mean age of 52 years (19 to 81)
at a mean of 5.6 years (11 months to 18 years) after the injury.Aims
Patients and Methods
In adults with brachial plexus injuries, lack
of active external rotation at the shoulder is one of the most common residual
deficits, significantly compromising upper limb function. There
is a paucity of evidence to address this complex issue. We present
our experience of isolated latissimus dorsi (LD) muscle transfer
to achieve active external rotation. This is a retrospective review
of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus
dorsi muscle transfer to restore external rotation of the shoulder
between 1997 and 2010. All patients were male with a mean age of
34 years (21 to 57). All the patients underwent isolated LD muscle
transfer using a standard technique to correct external rotational
deficit. Outcome was assessed for improvement in active external rotation,
arc of movement, muscle strength and return to work. The mean improvement
in active external rotation from neutral was 24° (10° to 50°). The
mean increase in arc of rotation was 52° (38° to 55°). Mean power
of the external rotators was 3.5 Medical Research Council (MRC)
grades (2 to 5). A total of 21 patients (88%) were back in work by the time of
last follow up. Of these,
13 had returned to their pre-injury occupation. Isolated latissimus
dorsi muscle transfer provides a simple and reliable method of restoring
useful active external rotation in adults with brachial plexus injuries
with internal rotational deformity. Cite this article:
Between 2002 and 2011, 81 patients with a traumatic total brachial
plexus injury underwent reconstruction by double free muscle transfer
(DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve
transfers (NT, 18 cases). They were evaluated for functional outcome and quality of life
(QoL) using the Disability of Arm, Shoulder and Hand questionnaire,
both pre- and post-operatively. The three groups were compared and
followed-up for at least 24 months.Aims
Methods
Injuries to the limb are the most frequent cause
of permanent disability following combat wounds. We reviewed the medical
records of 450 soldiers to determine the type of upper limb nerve
injuries sustained, the rate of remaining motor and sensory deficits
at final follow-up, and the type of Army disability ratings granted.
Of 189 soldiers with an injury of the upper limb, 70 had nerve-related
trauma. There were 62 men and eight women with a mean age of 25
years (18 to 49). Disabilities due to nerve injuries were associated
with loss of function, neuropathic pain or both. The mean nerve-related
disability was 26% (0% to 70%), accounting for over one-half of
this cohort’s cumulative disability. Patients injured in an explosion
had higher disability ratings than those injured by gunshot. The
ulnar nerve was most commonly injured, but most disability was associated
with radial nerve trauma. In terms of the final outcome, at military
discharge 59 subjects (84%) experienced persistent weakness, 48
(69%) had a persistent sensory deficit and 17 (24%) experienced
chronic pain from scar-related or neuropathic pain. Nerve injury
was the cause of frequent and substantial disability in our cohort
of wounded soldiers. Cite this article: