Patients with hand injuries frequently present to Emergency Departments. The ability of junior doctors to perform an accurate clinical assessment is crucial in initiating appropriate management. To assess the adequacy of junior doctor hand examination skills and to establish whether further training and education is required.Background
Objectives
The fractures were loaded using a Lloyd’s machine and a load displacement curve was plotted.
Non-osteoporotic model. The mean force requires to produce the same depression was 1878.2N with the 2-screw construct and 1938.2N with the 4 screw construct (p=0.42). An increased fragmentation of the synthetic bone fragments was noticed with the 2-screw construct but not with the 4-screw construct.
Introduction and aims: There is a recent trend of using a raft of small diameter 3.5 mm cortical screws instead of the large diameter 6.5mm screws in depressed tibial plateau fractures (Schatzker type 3). Our aim was to compare the biomechanical properties of these two constructs in the normal and osteoporotic sawbone model.
The models were loaded to failure using a Lloyd’s machine. A displacement (depression) of 5mm was taken to be the point of failure. A load displacement curve was plotted using Nexygen software and the force needed to cause a depression of 5mm was calculated in each block. Mann Whitney U test was used for statistical analysis.
The mean force needed to produce a depression of 5mm was 700.8N with the 4-screw construct and 512.4N with the 2 screw construct. This difference was statistically significant (p=0.007). Non-osteoporotic model The mean force requires to produce the same depression was 1878.2N with the 2-screw construct and 1938.2N with the 4 screw construct. The difference was not statistically significant (p=0.42). An increased fragmentation of the sawbone fragments was noticed with the 2-screw construct but not with the 4-screw construct.
Thirty-five patients (85%) reported none or minimal pain. 81% were negative for provocative AC signs. Internal rotation increased by average of 5 vertebrae levels. The Constant, the WORC and Oxford Scores were improved by 23 points, 674 points and 16 points respectively (p<
0.05). 71% reported good or excellent function by the 3rd post-operative month.