Isolated volar dislocation of the distal radioulnar joint: a case series and systematic review.

INTRODUCTION: Isolated volar dislocations of the distal radioulnar joint are reported as rare. We observed three such cases over a 12-month period. Literature to date consists of multiple case reports and case series with no structured reviews. There is debate as to incidence, mechanism, investigation, treatment and prognosis. METHODS: A case series and formal systematic review was performed. This included an analysis of the demographics, mechanism, presentation, investigation, treatment and outcome of the cases identified from the wider published series. FINDINGS: In total 99 cases of this injury were identified from 59 papers, with a further 9 cases having an associated ulna styloid fracture. CONCLUSIONS: This is a rare injury, representing up to 0.02% of all bony injuries, which is diagnosed late in 36% of cases. Inability to obtain a true lateral radiograph may contribute to the diagnosis being missed. Computed tomography scans are useful in suspected cases without radiographic confirmation. Acute cases are successfully treated with closed reduction in 78% of cases; however associated soft tissue injuries may need to be surgically addressed. Delayed presentation is more likely to require open surgery and preoperative MRI scans are indicated to aid surgical planning. Chronic instability rarely occurs and may need treatment with reconstruction or salvage. A good, subjective, result is reported in the majority of patients.

The relationships between maternal HbA1, maternal size and fetoplacental size in Indian pregnancies.

A study of pregnant Punjabi, Indian women was carried out to establish whether or not there was a relationship between maternal HbA1 at term and birth weight of the baby. Measurements were made on the mother, placenta and baby. The regression of birth weight on placenta weight gave a correlation (r = 0.7, P less than 0.01, n = 59). No correlation was found between HbA1 and birth weight, birth weight corrected for placenta weight, or placenta weight. However, there was a weak but significant correlation between HbA1 and an adjusted placenta weight, expressed as a ratio Bwt'/Plwt', (r = 0.27, P less than 0.05, n = 56).