Aims

To assess the accuracy of posterior and anterolateral methods of injection into the subacromial space (SAS) of the shoulder.

Purpose: The current gold-standard for atlanto-axial fixation is C1-C2 Transarticular Screw (TS) fixation. In certain cases, the complicated nature of vertebral artery injury could make the application of bilateral transar-ticular screws impossible. This study biomechanically compares three atlantoaxial transarticular salvaging fixation techniques.

Method: Nine Fresh ligamentous human cervical spine specimens (C0-C4) were thawed and the tissue surrounding the spine, except the ligaments and discs, was carefully removed. Pure moments were applied to skull in increments of 0.5 Nm from 0 Nm to 2.0 Nm with the help of loading arms, nylon strings and pulleys. The specimens were tested in extension (EXT), flexion (FLEX), left lateral bending (LB), right lateral bending (RB), left axial rotation (LR) and right axial rotation (RR) for all the cases. The positions of the LEDs were recorded using an Optotrak Motion Measurement System (Northern Digital, Waterloo, Ontario, Canada) and was converted into three rotations (flexion/extension, lateral bending and axial rotation) using rigid body kinematic principles in relation to the fixed base. The specimens were tested intact and after type II odontoid fracture, were instrumented and tested with three fixation constructs:

C1-C2 TS on right side and C1LMS-C2PS on contralateral side

Results: All of the three instrumented cases significantly reduced motion across C1-C2 segment in all the modes when compared to intact (P< 0.005, two-tailed unpaired t-test at confidence interval of ninety-five percent) except in extension. TS+C1lM+C2PS is significantly stiffer than TS+ Wire only in axial rotation (P< 0.05) and equivalent in flexion/extension (P=0.75/P=0.51) and left/right bending (P=0.22/P=0.58). TS+C1LM +C2PS is equivalent to TS+C1LM+C2IL in all the loading modes (P> 0.05). TS+C1LM+C2IL is significantly stiffer than TS+Wire in axial rotation (P < 0.05) and equivalent in flexion/extension (P=0.93) and left/right bending (P=0.69/P=0.84).

Conclusion: This study showed that TS+C1LMS+C2PS fixation is equivalent to TS+C1LMS+C2ILS fixation in all the rotation modes and superior to TS+Wire fixation in axial rotation averaged over all ranges of motion. Also, TS+C1LMS+C2ILS fixation is superior to TS+Wire fixation in axial rotation averaged over all ranges of motion.

Introduction: Physical challenges and a long term treatment for Perthes disease can affect patients’ behaviour in their adolescence. We carried out a study to assess the long term psychosocial development of children treated non-operatively using abduction cast and brace.

Methodology: 104 patients treated for Perthes disease between 1992 and 2001 were recruited for a retrospective study. Besides clinical review, patients and their main carers were asked to fill in Strengths and Difficulties Questionnaires (SDQ). SDQ included scores for total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, social behaviour and total impact. 70 controls, matched for age and sex, attending the clinics for other unrelated pathology were requested to fill in the same questionnaires along with their main carers.

Results: Data from 91 patients was available for assessment. Age at diagnosis was 1.9 to 7.3 years (median 3.9 years). Follow-up duration was 5.6 to 15.1 years (median 8.7 years). The age of subjects at final follow up was 8.9 to 20.4 years (median 15.3 years). The mean duration of treatment in abduction cast or brace was 2.4 years.

57 controls and 69 subjects were found to be low risk for emotional disorder (p> 0.05).

Similarly 58 control and 74 subjects were predicted to be low risk for behavioural disorder. 16 controls and 18 subjects had medium or high risk for hyperactivity or concentration disorder (p> 0.05; student t test). There was no significant difference between the self report and parent questionnaires for difficulties or their impact.

Conclusion: Perthes disease and the resultant restricted physical activities in early childhood does not affect the emotional and mental well being of patients in a long term.

100 fibula fractures sustained at or below the syndesmosis were studied retrospectively. They were consecutive trauma clinic referrals with an initial conservative treatment plan. All initial radiographs studied were taken prior to application of below knee plaster splintage. Weber A and B classification was n=47 and 53 respectfully. Serial radiographs showed that none of the 100 ankles developed further displacement during their treatment. There was 5.6 and 6.6 individual radiographs and 4.2 and 4.3 clinic reviews for Weber A and B respectfully. We conclude that Weber A and B fractures without talar shift are stable injuries. Once the decision has been made to treat them conservatively, no further radiographs need be requested. This will result in reduction to two clinic reviews and one single initial anteroposterior and lateral radiograph. Significant cost savings to the health service and reduction in ionising radiation exposure to the patient will result.