Sacroiliac joint (SIJ) fusion is a controversial yet last resort operative technique to address SIJ pain. The current study aims to determine the patient outcomes of SIJ fusions, in a single surgeon series utilising an anterior approach with 2 DC plates across the joint and iliac crest autograft. Retrospective case series involving 11 patients who had 13 SIJ fusions performed over an 8 year period (2002–2010). Patients were identified by electronic key word search from databases at Middlemore hospital and the private sector. Dictated clinic letters and operation notes were reviewed to obtain demographic data and outcomes data including complications. Postoperative radiology reports were reviewed to document radiographic fusion status. Telephone interviews were conducted to measure clinical outcome scores via the Majeed Pelvic Score and the 12-item Short-Form Health Survey (SF-12). 10 out of 11 patients (entailing 12 SIJ fusions) responded and participated in the study, equating to over 90% follow up. 2 cases were managed at Middlemore Hospital, with the remainder in the private sector. All cases but one had a ‘post-traumatic arthritis’ etiology. Diagnosis was made by CT guided local/steroid injection into the joint in conjunction with CT/bone scan/MRI imaging. The Majeed score improved markedly for 9 of 12 SIJ fusions (75%). 10 of 12 patients stated they would have the procedure again. 7 of 12 fusions (58%) had postoperative complications including blood loss, haematoma, nerve injury (including one case of permanent foot drop), non-union, infection of the joint/metal ware, hernia and urinary retention. 5 of 12 fusions (42%) experienced altered sensation over the lateral femoral cutaneous nerve distribution. All except one patient eventually had x-rays or CT scans postoperatively that reported radiographic fusion of the joint. In appropriately selected patients with SI joint arthrosis, 3/4 patients reported significant improvement in function and pain level after SIJ fusion. Chronic pain (from other sources) and major complications were a feature amongst those failing to benefit. Lateral femoral cutaneous nerve palsy has high incidence with the current operative technique.
Fractures of the proximal humerus can offer a difficult surgical challenge particularly if they occur in elderly patients and/or are a complex fracture configuration. Much of the morbidity of the surgery relates to the extensile delto-pectoral approach traditionally used for operative treatment of these fractures. A minimally invasive technique for approaching these fractures has was developed using a proximal deltoid split approach at the anterior edge of the deltoid and sliding a precontoured proximal humeral locking plate submuscularly after provisional fracture reduction. This technique was tested in a cadaver model to identify “safe” and “at risk” holes in the plate for percutaneous fixation in relation to the axillary nerve. A case series of eighteen patients who had surgery using this technique were reviewed. All patients achieved acceptable reductions and went on to unite without any signs of AVN or implant failure. One patient had a transient sensory disturbance in an axillary nerve distribution post op. One patient has asymptomatic fibrous union of the greater tuberosity. Minimally invasive plate fixation using a lateral deltoid split approach is technically possible with excellent results. The danger zone around the axillary nerve has been identified and should be avoided with percutaneous fixation utilising this procedure. A jig to allow accurate MIPO fixation has been developed.
Motorcross motorbiking has seen a great upsurge in popularity since the year 2000 globally. With extreme sports come extreme injuries, characterised by high energy trauma patterns. 55% of all such injuries are orthopaedic in nature, with a significant proportion comprising foot and ankle injuries. In New Zealand, ‘recreational motorbiking’ as a category made up 2.3% of all ACC coded sporting injuries in the year 2002. At Middlemore Hospital we have seen a greatly increased number of motorcross injuries over the past decade. To date, there is a dearth of literature (particularly in Australasia) on this injury group. The current study was a retrospective review of 208 episodes of trauma in 176 patients between February 1993 and June 2005, at Middlemore Hospital. Thirty-one of these trauma episodes in 30 patients were foot and ankle trauma (17% of patients, 15% of all trauma episodes). The aims of the study were to describe the demography of the motocross injury patient population, any associations between modes of injury and resultant injury patterns and to identify any injury clusters peculiar to the motorcross foot and ankle injury subgroup. A better understanding of these factors will ultimately improve injury identification and management of motor-cross foot and ankle trauma at primary contact. The study found that the majority of patients are male and Caucasian. The mean age was 26 years (range: 8–55 years). Seven of the 31 cases (22.5%) represented multi-trauma presentations. The majority of injuries occurred in group whereby a rider was ejected from bike (22/31). Twelve out of 31 cases had ‘polybone’ trauma in the foot (with all forefoot trauma being ‘polybone’ in nature) There was a clinically observed injury association between ankle and talus fractures. Four of 20 forefoot injuries required an operation, while 32 of 37 (86.5%) midfoot, hindfoot, ankle and intra-articular distal tibial injuries required operations. We conclude that foot and ankle trauma represents a significant proportion of all orthopaedic motorcross trauma that is seen at this institution. Over one in five injuries involving the foot and ankle are multi-traumatic in nature, with rider ejection perhaps playing a role. Over four out of five injuries extending proximally from the midfoot required operative management. Foot and ankle motorcross injuries are frequently high energy in nature and their assessment requires a moderate index of suspicion for other bone injuries in the foot, as well as elsewhere.
