Gunshot injuries to the shoulder are rare and
difficult to manage. We present a case series of seven patients
who sustained a severe shoulder injury to the non-dominant side
as a result of a self-inflicted gunshot wound. We describe the injury
as ‘suicide shoulder’ caused by upward and outward movement of the
gun barrel as the trigger is pulled. All patients were male, with
a mean age of 32 years (21 to 48). All were treated at the time
of injury with initial repeated debridement, and within four weeks
either by hemiarthroplasty (four patients) or arthrodesis (three patients).
The hemiarthroplasty failed in one patient after 20 years due to
infection and an arthrodesis was attempted, which also failed due
to infection. Overall follow-up was for a mean of 26 months (12
to 44). All four hemiarthroplasty implants were removed with no
feasible reconstruction ultimately possible, resulting in a poor functional
outcome and no return to work. In contrast, all three primary arthrodeses
eventually united, with two patients requiring revision plating
and grafting. These patients returned to work with a good functional
outcome. We recommend arthrodesis rather than replacement as the
treatment of choice for this challenging injury. Cite this article:
Outcome measures quantifying aspects of health in a precise,
efficient, and user-friendly manner are in demand. Computer adaptive
tests (CATs) may overcome the limitations of established fixed scales
and be more adept at measuring outcomes in trauma. The primary objective
of this review was to gain a comprehensive understanding of the
psychometric properties of CATs compared with fixed-length scales
in the assessment of outcome in patients who have suffered trauma
of the upper limb. Study designs, outcome measures and methodological
quality are defined, along with trends in investigation. A search of multiple electronic databases was undertaken on 1
January 2017 with terms related to “CATs”, “orthopaedics”, “trauma”,
and “anatomical regions”. Studies involving adults suffering trauma
to the upper limb, and undergoing any intervention, were eligible.
Those involving the measurement of outcome with any CATs were included.
Identification, screening, and eligibility were undertaken, followed
by the extraction of data and quality assessment using the Consensus-Based
Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.
The review is reported according to the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) criteria and reg istered (PROSPERO: CRD42016053886).Aims
Materials and Methods
Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons.Objectives
Methods
Fracture clinics are often characterised by the referral of large
numbers of unselected patients with minor injuries not requiring
investigation or intervention, long waiting times and recurrent
unnecessary reviews. Our experience had been of an unsustainable
system and we implemented a ‘Trauma Triage Clinic’ (TTC) in order
to rationalise and regulate access to our fracture service. The
British Orthopaedic Association’s guidelines have required a prospective evaluation
of this change of practice, and we report our experience and results. We review the management of all 12 069 patients referred to our
service in the calendar year 2014, with a minimum of one year follow-up
during the calendar year 2015. Aims
Patients and Methods
