Aims

We introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function.

Conventional teaching advises against using adrenaline with local anaesthetic near end-arteries due to risks of irreversible vasospasm, however there are benefits of adjunctive adrenaline including enhanced anaesthetic effect, prolonged duration and temporary haemostasis.

Retrospective analysis was undertaken for all elective finger and distal palmar surgery using digital nerve or field blocks performed by four orthopaedic hand surgeons, during a two-year period in a large teaching hospital. Data collected from theatre databases and clinical notes included procedure type, anaesthetic agent, adrenaline use, tourniquet use and evidence of post-operative digital ischaemia or wound complications.

230 procedures (mean age 59 years) were performed, including 158 cases with plain anaesthetic only (2%, 1% Lidocaine or 0.25% Bupivicaine in 150, 4 and 4 cases respectively) and 72 cases with 0.25% Bupivicaine and adrenaline (1:200,000.) Mean anaesthetic volume was 7.5ml (7.2ml vs 8.0ml without and with adrenaline respectively.) Tourniquet was used in all cases without adrenaline but was not used in 21 (29%) of cases with adrenaline. Mean tourniquet time in each group was 16 minutes. Two post-operative infections occurred in the group without adrenaline with none in the adrenaline group and there were no cases of digital necrosis in either group

In the elective setting, adjunctive adrenaline with local anaesthetic does not increase the risk of post-operative infections or digital ischaemia. For proximal finger surgery, where digital tourniquets are often restrictive, using adrenaline can prevent the need for painful arm tourniquets.

Dupuytren’s disease of the hand has only been rarely reported in children and is rarer still in infants. We report a case in a six-month-old infant who required surgery when aged ten months. Histology confirmed the diagnosis of Dupuytren’s disease.

Aims: To show that the treatment of buckle fractures in children in a soft bandage, rather than a plaster cast, is an effective and safe method of treatment. Methods: In order to determine the difference between the two groups it was decided to compare the range of movement at three weeks. Power calculations were performed. This gave a required sample size of 23 for each group. The project was submitted for ethical approval in July 1999. Patients enter the trial after parents agree and sign the consent form. Allocation to either plaster or bandage is random and parents draw previously sealed envelopes themselves. Patients are seen each week and measurements taken of their range of movement. Results: Thirty seven patients have completed the study. 17 have been allocated to bandage the rest to cast. Those in bandage show an excellent range of movement at the þrst week with no reported problems on their questionnaires. One patient has transferred from bandage to plaster at the request of the parents. Conclusion: Results suggest a positive result for treatment in bandage with no reported adverse effects and, a highly desirable result for the patient. We would hope to suggest a change in treatment policy for such fractures.

To identify any shoulder joint pathology on MRI of young patients (< 35 yrs) with a single simple antero- inferior dislocation of the shoulder at minimum 5-year follow-up.

Patients aged 16–35 years with a single antero-inferior shoulder dislocation with a minimum 5-year (range5–9 yrs) follow-up were identified. A history of recurrent dislocation or surgery excluded patients from study. Ethical approval was obtained and identified patients were asked to volunteer for clinical review and have an MRI scan. Shoulders were clinically examined, noting specifically any signs/symptoms of rotator cuff pathology or instability. All shoulders were imaged with a 1.5 Tesla open MRI scan to assess any pathology.

In a 5-year period (1994–1998), 349 patients sustained an antero-inferior dislocation. 251 were in patients aged 35 years or less. 136 of these were excluded either due to recurrent dislocations. 62 patients were lost to follow-up of 53 eligible patients 7 could attend for study. Only one patient had a positive anterior apprehension sign but he did not have any symptoms of instability in his daily activities or sport. The only abnormality demonstrated on MRI was of a united greater tuberosity fracture in one shoulder. The glenolabral and bicipitolabral complexes were normal in all shoulders imaged.

Bankart lesions, both bony and labral, are known to be associated with recurrent anterior shoulder dislocations.This study has shown no shoulder joint pathology on MRI at minimum 5-year follow-up in young patients who have sustained a single antero-inferior shoulder dislocation, confirming that labral pathology seems to be important in recurrent dislocations. Further study to image more patients is underway. These results indicate that acute imaging of dislocated shoulders may be useful to help predict young patients who are unlikely to re-dislocate and thus unlikely to require surgery.