Radial head fractures are the commonest fractures involving the elbow. The goals of treatment are to restore stability, preserve motion, and maintain the relative length of the radius. Fortunately, most simple uncomplicated fractures can be treated non-operatively. Choosing between fixation and radial head replacement for comminuted fractures remains difficult. Excision of radial head fractures is not an ideal option in unstable elbow injuries. The purpose of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (open reduction internal fixation, ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. A comprehensive search of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed.Background
Method
The aims of this study were to estimate the cost of surgical
treatment of fractures of the proximal humerus using a micro-costing
methodology, contrast this cost with the national reimbursement
tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using
semi-structured interviews with 32 members of hospital staff. Its
content validity was established through a Delphi panel evaluation.
Costs were calculated using time-driven activity-based costing (TDABC)
and sensitivity analysis was performed to evaluate the determinants
of costAims
Methods
Lateral clavicular physeal injuries in adolescents
are frequently misinterpreted as acromioclavicular dislocations. There
are currently no clear guidelines for the management of these relatively
rare injuries. Non-operative treatment can result in a cosmetic
deformity, warranting resection of the non-remodelled original lateral
clavicle. However, fixation with Kirschner (K)-wires may be associated
with infection and/or prominent metalwork. We report our experience
with a small series of such cases. Between October 2008 and October 2011 five patients with lateral
clavicular physeal fractures (types III, IV and V) presented to
our unit. There were four boys and one girl with a mean age of 12.8
years (9 to 14). Four fractures were significantly displaced and
treated operatively using a tension band suture technique. One grade
III fracture was treated conservatively. The mean follow-up was
26 months (6 to 42). All patients made an uncomplicated recovery. The mean time to
discharge was three months. The QuickDASH score at follow-up was
0 for each patient. No patient developed subsequent growth disturbances. We advocate the surgical treatment of significantly displaced
Grade IV and V fractures to avoid cosmetic deformity. A tension
band suture technique avoids the problems of retained metalwork
and the need for a secondary procedure. Excellent clinical and radiological
results were seen in all our patients. Cite this article:
We conducted a study to assess the accuracy of Spatial CAD software in computing the mounting and deformity parameters. We mounted a two-ring construct on a sawbone tibia and accurately measured the mounting parameters of this frame. Then we obtained three sets of x-rays – orthogonal without magnification marker, orthogonal with magnification marker placed at the level of the bone and non orthogonal views – and put these images through software and obtained mounting and deformity parameters. Results were independently assessed and we found that the Spatial CAD™ software was accurate within 1 mm and 1 degree when orthogonal images with marker sphere placed at the bone level were used. Non-orthogonal images, with marker sphere, yielded accurate axial frame offset but other mounting parameters were at least 6 mm more than the actual measurements. Understandably angular measurements were different. In the third set of films we used frame hardware – Rancho Cube width (12 mm) as a calibrator. Since the cube was not in the same plane as the bone all measurements were way off actual measurements.Purpose of the study
Methods and end results
The rising incidence of metastatic bone disease (MBD) in the UK poses a significant management problem. Poorly defined levels of service provision have meant that improvements in patient prognosis have been mediocre at best. For that reason the British Orthopaedic Association (BOA) in conjunction with the British Orthopaedic Oncology Society (BOOS) issued guidelines in 2002 on good practice in the management of MBD. Despite the availability of these standards, there is very little robust data available for audit. The aim of this study was to conduct a regional survey of how these guidelines are being used in the management of MBD. A questionnaire was designed with 9 multiple choice questions representing the most common MBD scenarios. This was posted to 106 Consultant Orthopaedic Surgeons in 12 NHS Trusts in the South East of England.Introduction
Methods
The safe and effective management of orthopaedic patients out of hours requires the communication of radiographs between junior residents and their non-resident seniors. Despite stringent guidelines issued by the Caldecott Guardian on the transmission of patient sensitive data, there is no data describing actual exchanges in the literature. The objective was t describe current trends in the transmission of patient sensitive data between resident Orthopaedic juniors and their non-resident seniors out of hours. The method was a Questionnaire survey polling Orthopaedic registrars in North London. Seventy-six (76) trainees participated in the survey. Fifty Three (53) trainees received radiographs for review off site. Forty-eight (48) reported receiving patient radiographs for review to their personal email account. 48% of these trainees reported that the images contained patient sensitive information. 40% of the trainees who received images to their personal email had a NHS mail account which was not used. Remote access to patient radiographs improves patient management out of hours. Although there is some awareness of Caldecott guidelines for the handling of patient sensitive electronic data, compliance is extremely poor. We recommend that all trainees who routinely handle patient sensitive data remotely acquire a free NHS mail account for receiving patient radiographs
inappropriate initial treatment, subsequent late tertiary referral and poor understanding of the biomechanical basis of orthopaedic implants, with the potential for inappropriate choice of prostheses and high failure rates. Streamlining cancer care will involve establishing regional MBD units within large centres where multidisciplinary services are available. Consequently all surrounding hospitals will need a designated MBD lead that can function as a conduit to this integrated care for selected patients.
