In our quality improvement project we implemented a novel pathway, performing acute fixation in mid-third clavicle fractures with >15% shortening. Patients with <15% shortening reviewed at 6 weeks, non-union risk identified as per Edinburgh protocol and decision to operate made accordingly. Retrospective pre-pathway analysis of patients presenting 04/2017–04/2019. Prospective post-pathway analysis of patients presenting 10/2020–10/2021. Fracture shortening measured using Matsumura technique. QuickDASH and recovery questionnaires posted to >15% shortening patients and done post-pathway at 3 months.Abstract
Introduction
Methods
Assess and report the functional and post-operative outcomes of complex acute radial head fractures with elbow instability treated by arthroplasty using an uncemented modular anatomic prosthesis. Over a 3-year period (2007–2010), 21 patients (mean age 51.9 years) were treated primarily with modular radial head arthroplasty (mean follow up of 27.1 months). Data was collected retrospectively using clinical notes, operation documentation and prospectively using validated scoring systems namely the Oxford Elbow Index, Quick DASH and the Mayo Elbow Performance Score. Associated elbow fractures, ligamentous injury and short to mid term post-operative outcomes including radiographic assessment were recorded.Purpose
Methods
Distal radius fractures are very common and they often require surgical intervention to prevent long-term complications. We noticed that several patients were being managed non-operatively for prolonged periods of time, when ultimately surgical fixation was inevitable. Delayed fixation of these injuries results in prolonged immobilisation, repeat fracture clinic attendances, callous formation, poor soft tissues, stiffness and union. Our aim was to analyse the time to fixation of distal radius fractures at our hospital using a standard volar locking plate. Between December 2010 and September 2011, our study population included all patients who underwent surgical fixation for a distal radius fracture at Royal Derby Hospital. All fractures were fixed using a volar locking plate. Data collected included date of injury, fracture clinic attendances, date listed for surgery and date of surgery. There were 100 patients who underwent surgical fixation, with a mean age of 63.6 years (17 to 91). The mean date from injury to fixation was 7.7 days (range 0 to 23). 82% of fractures were operated on within 14 days, and 98% were fixed within 21 days. We accept that our study does have some limitations; this includes patients who are unwilling to accept surgery at their initial consultation. Distal radius fractures have a strong tendency to revert back to their original configuration; hence we suggest that a decision to operate should ideally be made at the one-week fracture clinic appointment. This avoids the difficulties and complications associated with delayed surgical intervention. Stability, displacement, reduction and patient factors should all be taken into account.
Recurrent shoulder instability in those with bony defects is a difficult surgical problem to resolve. Burkhart and De Beer described an unacceptably high recurrence rate for arthroscopic Bankart repair in the presence of an inverted-pear glenoid with or without an engaging Hill-Sachs lesion, with suggestions that an open modified Latarjet procedure should be recommended in such patients. The Congruent-Arc Latarjet is a modification of the Latarjet open bony stabilisation for shoulder instability developed by Burkhart and De Beer. It involves rotation of the coracoid so the curved under-surface lies congruent with the glenoid. At the Royal Derby Hospital, UK, this procedure has been adopted by our four shoulder surgeons, two of whom undertook fellowship training with De Beer, we studied the outcomes of the patients who had undergone the modified Congruent-Arc Latarjet procedure in our department. Fifty-two consecutive patients were identified over a five-year period at the Royal Derby Hospital or Derbyshire Royal Infirmary between 2006 and 2010 inclusive. With the approval of the clinical audit department, the data was collected using theatre records and clinical coding information to identify the patient group. A review of the case notes and local PACS system was undertaken to establish pre and post-operative examination findings, radiology findings regarding Hill-Sachs defects and glenoid bone loss, re-dislocation rates and post-operative function with return to normal activity. The endpoints of this study were aimed at finding out whether patients did return to normal function, were able to continue doing activity that would have provoked dislocation prior to surgery, and how many of the cases re-dislocated. No surgeon consultant had a patient who re-dislocated after this procedure. The follow-up period was from 1 year to 6 years post-operatively. The complications of this procedure were found to be the dislodgement of bone anchors in 2 patients, who required further arthroscopy to remove the suture anchor from the gleno-humeral joint. One patient had prolonged functionally limiting loss of external rotation, which resolved after intensive physiotherapy at 7 months follow up. We will provide graphical representation of the pre and post operative functional scores. We have demonstrated that the Congruent-Arc Latarjet is a reproducible procedure in the hands of surgeons other than the original authors, particularly when comparing our current 0% re-dislocation rate with the published literature, which suggests that 3.9% of patients undergoing this procedure with greater than 25% bone loss of the glenoid or an engaging Hill-Sachs will re-dislocate post-operatively, and this is better than the 6% re-dislocation rate of the standard Bristow-Latarjet procedure.
