Surgical treatment of physeal injuries of the lateral aspect of the clavicle: a case series.

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.

Diathermy training and usage trends among surgical trainees--will we get our fingers burnt?

INTRODUCTION: We aimed to assess the current trends in diathermy use as well as the presence or absence of formal diathermy training amongst higher surgical trainees (HSTs) in the UK. MATERIALS AND METHODS: A national e-mail survey was implemented, contacting 300 randomly selected HSTs in general surgery. A questionnaire was used to ascertain their current practice and the presence or absence of formal diathermy training. RESULTS: Overall 126 (42%) HSTs across all levels of training and subspecialty interests responded. Only 50.8% stated they had received formal diathermy training whereas 49.2% had no formal training. Diathermy is used by 23.8% of responders for laparotomy skin incisions, while 76.2% use a scalpel. For colonic mobilisation, 49.2% use diathermy and 50.8% scissors. For rectal mobilisation 55.5% use diathermy, 42.9% scissors and 1.6% a harmonic scalpel. Nearly 90% of responders do not place diathermy pads on the patient themselves, 68.3% do not routinely check diathermy equipment before use and 66.7% do not check the diathermy pad site at the end of the operation. Only 80.9% stated that a diathermy complication is the surgeon's responsibility, while the remaining 19.1% would blame the scrub nurse, circulating nurse, operating department assistant (ODA), manufacturer or a combination of the above. CONCLUSION: Nearly half of HSTs in this study did not receive any training in the use of diathermy, resulting in failure to adhere to what is considered best practice. This may lead to adverse events for the patient along with medico-legal consequences. This problem could be overcome by ensuring HSTs receive adequate formal diathermy training and we suggest that a dedicated diathermy course is incorporated in basic surgical training curricula.

Development of electronic software for the management of trauma patients on the orthopaedic unit.

INTRODUCTION: Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. METHODS: Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. RESULTS: With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. CONCLUSIONS: The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.