The purpose of this study was to determine the motion pattern of the Acromio-Clavicular (AC) joint in a normal shoulder with the use of the new 4 Dimensional CT scan.

From April 2010 till January 2011 fourteen healthy volunteers (4 female, 10 male)(mean age 42±11 years) with no previous history of shoulder complaints participated in this study. The 4D CT machine scans motion, allowing a 3D reconstruction of the shoulder joint and its movements. Patients were positioned supine with their arm elevated 90° in the sagittal plane. During the 7 seconds duration of the scan they adducted their arm at that level and then elevated their arm upwards resisted by the gantry for 4 seconds, in this way simulating the clinical Bell-van Riet test for AC pathology.

In the transverse plane the mean AC joint space measured in the neutral position is 1.8±0.5 mm. While adducting the arm the AC joint narrows 0.0±0.4 mm (with a positive value being narrowing and a negative value widening). On resisted elevation the joint space is narrowed 0.2±0.6 mm. The mean antero-posterior (AP) translation in this same plane is 0.2±2.2 mm on adduction (with a positive value being posterior translation of the clavicle and a negative value anterior translation) and 0.4±2.9 mm on resisted elevation.

The new 4D CT scan demonstrates that the AC joint in a normal shoulder mainly translates in an AP direction, rather than being narrowed or widened, when the arm is adducted (with or without resisted active elevation).

To examine all open fractures presenting to Bundaberg Base Hospital—from January 2007 to January 2009—by monitoring the clinical course of the patients, with attention to the time intervals between injury, presentation and orthopaedic treatment. The complications of treatment and the implications for future practice were also examined.

A search was performed of all open fractures and compound fractures during the period of January 2007 until January 2009. The eligible patients were selected and their charts reviewed. The time of the injury, the time they presented to the emergency department (ED) and the time to orthopaedic treatment were noted. The site of the fracture, the Gustillo classification and the number of days of admission were recorded. Complications of the fractures were investigated. The impact of time delays and fracture severity on subsequent infections were correlated.

A total of 127 admissions were recorded, 38 were excluded and 89 open fractures were included in the study: 54 upper limb, 34 lower limb and 1 pelvic fracture. Thirty-six patients had Gustillo I, 34 II, 9 IIIa, and 11 IIIb classifications. Patient arrival times were as follows: less than one hour (19%), 1–3 hours (44%), 3–6 hours (26%), 6–12 hours (8%) and greater than 12 hours (2%). From presentation, 28% of patients received treatment in 1–3 hours, 3–6 hours (27%), 6–12 hours (22%) and greater than 12 hours (22%). 40.4% of patients received treatment within 6 hours of injury and 59.5% greater than 6 hours. 33% of patients stayed in hospital 24 hours, 1–3 days (44%), 3–7 days (15%) and for greater than one week (1%).

There were a total of 17 complications (19%), of which 11 (12%) were associated with infections. Of these, six were superficial wound infections and five were deep infections. Of these deep infections, two were associated with non-unions and one with a mal-union. Four complications were associated with non-infectious non-unions, one non-infectious mal-union. One had a missing bone fragment. Complications were found to be more prevalent when there was delayed treatment of the fractures.

The results demonstrate that the majority of open fractures treated are upper limb and Gustillo I in classification. The complication rate for open fractures during the two year period was 19%. These findings provide a base for continued monitoring of open fracture management at Bundaberg Base Hospital.