Aims

The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating.

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA.

Cite this article: Bone Joint J 2020;102-B(5):550–555.

The foregoing suggestions may be summarised in the following recommendations for the treatment of osteogenic sarcoma. 1. Deep x-ray therapy in high dosage, followed by local resection, should be given serious trial especially: 1) in the upper limb; 2) in the group with atypical clinical or radiographic signs, or histology resembling that of inflammatory lesions; 3) with Grade I histology; and 4) in the young. 2. Deep x-ray therapy followed at once by amputation should be used for osteogenic sarcoma if : 1) local resection would leave a lower limb more unstable than an artificial leg ; or 2) if response to x-rays is poor. 3. Deep x-ray therapy alone should be used: 1) if the patient is unsuitable for, or refuses, any operation ; and 2) palliatively, if metastases are present or the tumour is too advanced, or the patient is not fit for radical treatment. 4. Amputation alone should be used palliatively, for pain or fungation, when x-ray therapy has failed to relieve, or is not readily obtainable. 5. Biopsy and histological grading must be performed in every case. A histological diagnosis is most important. Coley (1949) and MacDonald and Budd (1943) support this view. 6. The records of every possible case should be sent to and discussed by a group with special experience of these tumours

We reviewed the results of reconstruction of 97 upper limbs in a consecutive series of 57 tetraplegic patients, treated from 1982 to 1990. Of these, 49 had functional and eight had cosmetic reconstructions. The principal functional objectives were to provide active elbow extension, hook grip, and key pinch. Elbow extension was provided in 34 limbs, using deltoid-to-triceps transfer. Hook grip was provided in 58 limbs, mostly using extensor carpi radialis longus to flexor pollicis longus transfer, and key pinch in 68, mostly using brachioradialis to flexor pollicis longus transfer. Many other procedures were employed. At an average follow-up of 37 months, 70% had good or excellent subjective results, and objective measurements of function compared favourably with other series. Revisions were required for 11 active transfers and three tenodeses, while complications included rupture of anastomoses and problems with thumb interphalangeal joint stabilisation and wound healing. We report a reliable clinical method for differentiating between the activity of extensor carpi radialis longus and brevis and describe a successful new split flexor pollicis longus tenodesis for stabilising the thumb interphalangeal joint. Bilateral simultaneous surgery gave generally better results than did unilateral surgery

1. The causes of pressure on the neuro-vascular bundle of the upper limb are many and varied. No one cause such as clavicular pressure can explain all cases. 2. Costo-clavicular pressure is not possible when there is a normal first rib and a normal thoracic outlet, but it is certainly a factor when the costo-clavicular interval is narrowed by the presence of a large cervical rib or an abnormal first thoracic rib. Clavicular pressure can act only during retraction and abduction, not in depression of the shoulder. 3. Temporary alterations in the radial pulse on movements of the shoulder in normal individuals are due to causes distal to the clavicle and have no relation to costo-clavicular pressure. 4. While irritation of sympathetic nerve fibres may explain the majority of cases of thrombosis, there are others in which clotting occurs in an aneurismal dilatation produced by pressure between the clavicle and the abnormal costal element. It is likely that the thrombosis occurs in an aneurism which has been present for some length of time. The cause of the aneurismal dilatation may be vaso-motor paralysis of a segment of the artery, ending distally at a point where a fresh intact leash of nerves is relayed to the vessel. 5. The importance of the scalenus anterior syndrome has been over-emphasised. If operative treatment is limited in all cases to anterior scalenotomy the results will be disappointing. 6. If operation is advised it should be performed without rigid and preconceived ideas, through an adequate incision, and with exploration wide enough to allow thorough investigation of the cause of pressure

Aims

The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children.

1. In this series of thirty-eight cases of osteoclastoma, twenty-five occurred at the end of a long bone. Nineteen were in the lower limb and half tif these were near the knee joint; six were in the upper limb; of the remainder, nine occurred in the vertebrae or the sacrum. 2. More cases occurred in females than males, the ratio being twenty-three females to fifteen males. Just over half the cases occurred in the second and third decades. 3. In seven there was a definite history of injury preceding symptoms by several months. 4. It is often difficult to arrive at a diagnosis on clinical and radiographic findings alone. Histological information is usually necessary before a certain diagnosis can be made. A limited biopsy is safe and reliable. 5. Malignant change with the development of metastases occurs in a small proportion of cases, regardless of the particular treatment that has been employed. This is illustrated in Case 3 of this series, in the case reported by Gordon Taylor, and in the case reported by Finch and Gleave. 6. The methods of treatment used in the patients here reported included curettage or local excision, with or without radiation, and radiation alone. 7. The patients treated by curettage or excision were dealt with during an earlier period than those treated by irradiation alone, and an exact comparison of results is not possible. The follow-up of patients treated by radiotherapy alone is too short to exclude the possibility of recurrence; but the immediate results appear to show definite improvement upon those of surgical treatment. 8. In this limited series it is to be noted that malignant change occurred in a higher proportion of cases treated by curettage and radiotherapy than in those treated by radiotherapy alone. 9. It appears that, in the treatment of osteoclastoma of bone, radiotherapy alone is the treatment of choice

Aims

The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma.

Aims

The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires.

Objectives

To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies.

Aims

The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures.

Aims

The aim of this study was to identify factors that determine outcomes of treatment for patients with chondroblastic osteosarcomas (COS) of the limbs and pelvis.