To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL). Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis.Aim:
Background:
Internal rotation (IR) contracture of the shoulder is a frequent complication of obstetric brachial plexus injury, even in the face of full neurological recovery. Surgical procedures to treat this complication include tendon transfers, capsular release and osteotomies. We compared the outcomes in patients who had arthroscopic release only and those who also underwent a tendon transfer. We retrospectively reviewed the clinical records of all patients with OBPI presenting to our unit in the years 2002–2012 who underwent surgical procedures for the treatment of an IR contracture of the shoulder. Increase in range of external rotation (ER) in adduction and abduction intra-operatively was recorded. At follow-up, active ER, the Mallet score, presence of an ER contracture and the “drop-arm” sign was recorded.Purpose of study
Methods
We aimed to assess the efficacy of conservative management of proximal phalanx fractures in a plaster slab. 23 consecutive patients with proximal phalanx fractures were included in this prospective study. The fractures were reduced and the position was held with a dorsal slab for three weeks. They were followed up an average of 7 weeks (range 2 to 45) after the injury. Radiographic confirmation of adequate reduction was carried out each week until union. After removal of the plaster, range of motion of the finger and radiological evidence of union, non-union or malunion was documented.Aim
Methods
Over a four-year period, nine patients with tuberculosis of the wrist were treated. The mean time to diagnosis was 5 months (1 to 20). Restricted wrist motion and an increased sedimentation rate were universal. Swelling, pain on motion and severe restriction of metacarpopha-langeal joint flexion, especially in patients with extensor involvement were common. In three patients, the disease involved the carpal bones, while in five it was limited to the tenosynovium. One patient had a cold abscess not involving tendon, sheath or bone. Granulomatous inflammation on the paraffin section was seen in most patients. Only four had a positive tissue culture of Mycobacterium tuberculosis. These patients were treated either medially or surgically. In the group treated medically, an incisional biopsy was done and antituberculous chemotherapy administered for a minimum of six months. In the group treated surgically, surgical synovectomy and debridement were done and antituberculous drugs administered. All patients had a brief period of splintage followed by intensive physiotherapy. At a mean follow-up of 12 months (6 to 24) all patients showed improvement in symptoms, with an increased range of motion. At final follow-up 50% of the patients had some residual loss of wrist motion. Those with extensor involvement seldom regained functional metacarpophalangeal joint flexion. The results showed no recurrence of infection in this study. The treatment resulted in good recovery of function, with low morbidity.
In an attempt to formulate a classification that might facilitate prognostication of outcome and possibly dictate early intervention, we conducted a retrospective review of fractures in which the extent of diaphyseal comminution was greater than 8 cm and resulted in nonunion. We looked at 150 femoral diaphyseal and 100 tibial diaphyseal fractures caused by gunshots and treated at our institution.
In this retrospective radiographic review, we compared the adequacy of reduction of 18 femoral fractures treated by retrograde and 35 fractures treated by pro-grade nailing. The groups were similar with regard to age, gender and side of the fracture. In the prograde group, there were eight fractures of type A5, 25 of type A3 and two of type C2. In the retrograde group there were two type-A2 fractures, 14 type-A3 and two type-C2. On the Winquist classification there were eight group-0, two group-1, two group-3 and 23 group-4 fractures in the prograde group, and two group-0, one group-3 and 15 group-4 fractures in the retrograde group. We measured the lateral femoral angle (LFA) from the anatomical axis to assess alignment postoperatively. We considered an LFA value of 83( normal and LFA values between 78( and 88( acceptable. The LFA was greater than 88( in 3% of the prograde group and in 6% of the retrograde group. In the prograde and retrograde groups, 86% and 83% of the nails respectively were in the acceptable range. In both groups, the LFA was less than 78( in 11%. There was shift of more than 1 cm in 17% of the prograde and in 44% of the retrograde groups. Recurvatum of more than 5( was seen in 31%( of prograde and 22% of retrograde nailings. In the retrograde group, 67% of nails were distal to the femoral notch on the lateral radiograph and were deemed to be proud. We concluded that prograde and retrograde nailing of distal third femur fractures gave comparable results in terms of alignment, but that recurvatum could be problematic with prograde nailing and that shift and proud nails were a concern with retrograde nailing. The clinical significance of these results has still to be determined.
Humeral shaft fractures, which make up about 3% of all fractures, can often be managed non-operatively, with outcomes ranging from good to excellent. Conservative management techniques include the hanging arm cast, U-slab coaptation splintage, thoracobrachial immobilisation, shoulder spica cast, skeletal traction and functional bracing. The outcomes of functional bracing and U-slab coaptation splint-age have been shown to be equally good, but Sarmiento et al reported that patients found functional bracing more acceptable. We compared the costs in time and money. The U-slab coaptation splint is bulky and not uncommonly the slab slips or loosens, requiring repeated reapplication. We looked retrospectively at the frequency of U-slab reapplication in our outpatient setting, and multiplied the frequency of reapplication by the cost per unit and time per unit, comparing these parameters with those for functional braces. Our study showed that in monetary terms U-slab coaptation was cheaper than functional bracing, but highlighted the hidden cost in terms of application time, additional imaging and rehabilitative physiotherapy. Functional bracing has the added advantages of single application, increased patient comfort and hygiene, more rapid rehabilitation of shoulder and elbow movements and ease of access for soft tissue dressing.
