Does surgical reconstruction of the distal oblique bundle (DOB) provide similar stability as the intact bundle or Adams procedure? A systematic review.

INTRODUCTION: The aim of this review was to summarize the available evidence for biomechanical stability following surgical DOB reconstruction, and to determine whether distal radioulnar joint (DRUJ) stability with a reconstructed DOB was similar to the native intact condition or that after the Adams procedure. MATERIAL AND METHODS: A systematic literature search according to the PRISMA guidelines was performed using the databases PubMed and Embase. The following search algorithm was used: ("DOB" OR "Distal Oblique Bundle") AND "Reconstruction". Biomechanical or human cadaveric studies that measured stability of the DRUJ after reconstruction of the DOB were included. RESULTS: Four articles were included in the final analysis. DOB incidence was reported to be between 50% and 70%. Two studies observed no differences between the intact situation and the reconstructed DOB, respectively the Adams procedure. A further author group found no signs of major instability after the Adams reconstruction or after DOB reconstruction, except for decreased stability during supination in the DOB sample. In another study, similar results could be shown for the Adams and DOB reconstruction groups; however, the DOB sample showed decreased dorsal translation of the radius during forearm supination. CONCLUSION: In conclusion, DOB reconstruction was proven to stabilize the DRUJ adequately. Moreover, the reconstructed DOB showed the same stability as the native DOB, except for one study, in which stability following reconstruction was reduced during supination. No significant difference between the DOB and the Adams reconstruction could be observed.

Two fingerbreadths, one finger's width: on the proximity of the radial nerve to the deltoid tuberosity.

INTRODUCTION: The aim of this study was to find a convenient technique to evaluate the location of the radial nerve (RN) with reference to the deltoid tuberosity (DT). MATERIALS AND METHODS: Sixty-eight upper extremities, embalmed using a modified version of Thiel's method, were included in the study. The interval between the tip of the greater tubercle of the humerus and the distal tip of the lateral humeral epicondyle (LE) was defined as humeral length (HL). The most prominent point of the DT was used as the point of reference. Through this point, a horizontal reference line which met the humeral axis at the dorsal side of the humeral shaft was simulated. The longitudinal distance between the crossing point of the horizontal line and the humeral axis and the RN was measured (distance 1). The interval between the intersection point and the reference point at the DT was measured (distance 2). Data were evaluated in centimeters. RESULTS: For the whole sample, the HL averaged 31.0 cm (SD: 2.3; range 26.2-36.9). Distance 1 averaged 2.2 cm (SD: 0.3; range 1.6-3.1), and distance 2 averaged 1.2 cm (SD: 1.0; range 0-2.8). The HL was larger in the male group when compared to females (p < 0.001; males mean: 32.2 cm; females mean 29.5 cm). There was no difference regarding distance 2 (p = 0.59; males mean: 1.2 cm; females mean: 1.3 cm) between the sexes. Distance 1 was significantly (p = 0.02) larger in the male group (mean: 2.3 cm) when compared to females (mean: 2.1 cm). Concerning sides, there were no differences regarding all evaluated parameters (HL: p = 0.6; Distance 1: p = 0.6; distance 2: p = 0.8). CONCLUSIONS: This study provides an easily applicable technique to localize the RN with reference to the DT.

Emergency approach to the femoral artery.

PURPOSE: The purpose of this study was to evaluate the applicability and potentially associated harms of emergency access to the femoral artery and vein in a sample of physicians working together in the emergency department of a level I trauma center. In addition, to investigate whether there are differences between participants in terms of different levels of training. METHODS: A sample of 36 orthopedic trauma and anesthesiology assistant doctors, specialists, and senior physician was recruited from the emergency room management at a level I trauma center in Graz, Austria. Emergency approach to the femoral vessels was performed on 33 fresh cadavers. Attention was paid to time, successful clamping of the vessels, self-assessment and learning curve. RESULTS: The approach was performed correctly in 97.2% (35/36) of all cases. 97.2% of all participants (35/36) were confident to perform the emergency access. They were proven right, since especially the resident and senior subgroups achieved satisfactory results concerning the correct performance of the approach to the femoral vessels as well as correct identification of the femoral artery and vein. CONCLUSION: In conclusion, we evaluated the emergency access to the femoral artery (FA) and femoral vein (FV) as an easily teachable procedure including high success rates (correct performance in 97.2%).

Direct anterior versus antero-lateral approach in hip joint hemiarthroplasty.

BACKGROUND: Femoral neck fractures are common injuries in the elderly and represent a major source of morbidity and mortality. Due to the benefits, bipolar hip hemiarthroplasty (BHH) is a popular method to treat. The purpose of this study is to evaluate the functional and radiographic outcomes for BHH comparing the direct anterior approach (DAA) to the anterolateral approach (ALA) to the hip joint. METHODS: We used a prospective, randomized observational study design, where we enrolled 83 patients at a level-I-trauma center presenting with indication for BHH. We followed up the participants at defined intervals over a period of 1 year. The follow-up examinations were carried out at defined time intervals for a period of 1 year. Calculations were performed with Statistical Package for Social Sciences (SPSS) 21.0. RESULTS: Concerning postoperative pain sensation, the anterior group had statistically significantly decreased pain levels at one (p = 0.02), seven (p = 0.04) and 14 days (p = 0.02) following the intervention when compared to the ALA sample. The postoperative modified Barthel-Index showed a statistically significant difference on the first postoperative day at the anterior group. CONCLUSION: Although we compared two minimally invasive approaches, our results shows a statistically significant difference in pain intensity and mobility for the early postoperative period using the direct anterior approach.

Proportional localisation of the entry point of the coracobrachialis muscle by the musculocutaneous nerve along the humerus.

PURPOSE: To project the distance between the tip of the greater tubercle (GT), respectively, the proximal border of the tip of the coracoid process (CP) and the entry point of the coracobrachialis by the musculocutaneous nerve (MCN) proportionally onto the humeral length. METHODS: Sixty-six upper extremities were included in the study. The distance between the tip of the GT and the distal tip of the lateral humeral epicondyle (LE) was evaluated as the humeral length (HL). The interval between the tip of the GT and the entry point of the coracobrachialis muscle by the MCN was measured. The distance between the proximal border of the tip of the CP and the distal portion of the medial humeral epicondyle (ME) and the entry point of the MCN into the coracobrachialis were evaluated. Proportions were used to project the entry point of the coracobrachialis by the MCN along the HL, respectively, the interval between the proximal border of the tip of the CP and the distal tip of the ME. RESULTS: The entry point of the MCN into the coracobrachialis muscle can be expected at an interval between 14.9 and 33.9% of the HL (between the tip of the GT and the LE), starting from the tip of the GT. Regarding the reference line between the proximal border of the CP and the ME, the nerve's entry point was located between 14.2 and 34.4%, starting from the CP. CONCLUSION: Results represent easily applicable intervals for intraoperative localisation of the MCN.

Is plating of mid-shaft clavicular fractures possible with a conventional straight 3.5 millimeter locking compression plate?

OBJECTIVES: Current literature describes improved clinical outcomes and a minor rate of pseudoarthrosis following operatively treated clavicular fractures. We investigated the feasibility of using a standard 3.5 mm AO locking compression plate (LCP) of adequate length for the stabilisation of mid-shaft fractures of the clavicle. METHODS: The length and acromial and diaphyseal curvature depths were measured in 49 cadaveric clavicles. We then assessed how well the 6, 7, 8 and 9-hole plates fit on the clavicles. RESULTS: The mean clavicular length was 155±12 mm, with a mean acromial curvature of 18.1±3.7 mm and a mean diaphyseal curvature of 12 mm±4 mm. The optimum plate for the clavicle was a 7-hole LCP, providing adequate fixation in 48 of the 49 clavicles. CONCLUSION: The described technique for plate osteosynthesis of the clavicle with AO locking compression plate is feasible and results in a biomechanically strong construct for mid-shaft fractures. With the use of a locking plate, comminuted fractures may be bridged without a reduction in the strength of the construct.

Schellong test in orthostatic dysregulation: a comparison with tilt-table testing.

OBJECTIVE: To evaluate the role of the Schellong test (ST) in forms of orthostatic dysregulation in comparison with the tilt-table test (TT). METHODS: 67 young males (mean age 22 +/- 4 years) from the military service, representing two different cohorts, were examined by ST and TT, which served as gold standard. 32 of the 67 subjects were asymptomatic while 35 had sought medical advice because of orthostatic complaints. The subjects subsequently were classified into four categories according to the TT: normal TT, orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS), and neurocardiogenic syncope (NCS). Chi-square test was used to calculate the sensitivity and specificity of ST in detecting forms of orthostatic dysregulation (OH, POTS and NCS). RESULTS: In total, TT detected 23 recruits with POTS, 16 with NCS and 2 with OH. Out of the 32 asymptomatic subjects only one was diagnosed having POTS by TT and ST, the rest had a normal ST and TT. For detecting POTS, ST sensitivity was 61% and specificity was 100% compared with TT. For detecting NCS, ST sensitivity was 31% and specificity 100% compared with the reference test, the TT. The data concerning OH could not be analyzed because of the small number of cases. CONCLUSIONS: In conclusion the results of our study indicate that ST can be used in first line in the diagnosis of patients with orthostatic symptoms by the medical practitioner. If the ST is normal, further examination by TT is indispensable, because sensitivity of ST concerning POTS and NCS is relatively low.