A systematic review of pre-hospital shoulder reduction techniques for anterior shoulder dislocation and the effect on patient return to function.

PURPOSE: The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities. The management of acute dislocations in the pre-hospital setting is currently without guidelines based on the evidence. The study aims to assess the risk of acute complications in pre-hospital shoulder reduction and identify which pre-hospital reduction technique has the highest success rate in the published literature. METHODS: The involved databases were Allied and Complementary Medicine, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Embase, Europe PMC, Ovid MEDLINE®, Pedro, Proquest, Trip, and World Health Organization International Clinical Trials Registry platform. Only original research of high methodological quality was included, which was defined by the recently developed assessment tool-assessing the methodological quality of published papers (AMQPP) and investigated the management of acute anterior shoulder dislocations in the pre-hospital setting. RESULTS: Two hundred and ninety-eight articles were identified and screened. A full text review was performed on 40 articles. Four articles published between 2015 and 2018 met the inclusion criteria. A total of 181 patients were included with the study duration ranging from 6 to 60 months. All studies reported zero immediate complication following pre-hospital reduction and there were no documented subsequent adverse events regardless of the technique used. Prompt resolution of neurological symptoms was observed following the early and successful pre-hospital reduction. First attempt success rate, when performed by skilled practitioners, ranged from 72.3% to 94.9%. CONCLUSION: Pre-hospital shoulder reduction appears to be a safe and feasible option when carried out with the appropriate expertise. A novel reduction technique adapted from the mountain medicine diploma course at the University of Paris North was found to have the highest first attempt reduction success rate of 94.9%. Other techniques described in the literature included Hippocratic, Stimson's, Counter-traction and external rotation with the success rates ranging from 54% to 71.7%.

The FAST Workstation Shows Construct Validity and Participant Endorsement.

PURPOSE: To determine in what way the proposed simulation-based intervention (SBI) is an effective intervention for use in basic arthroscopic skills training. METHODS: Twenty candidates were recruited and grouped according to experience. Performance metrics included the time to activity completion, errors made, and Global Rating Scale score. Qualitative data were collected using a structured questionnaire. RESULTS: Performance on the SBI differed depending on previous arthroscopic training received. Performance on the simulator differed between groups to a statistically significant level regarding time to completion. A difference was also present between participants with no previous training and those with previous training when assessed using the Global Rating Scale. The SBI was deemed acceptable, user-friendly, and realistic. Participants practicing at the expert level believe that such an SBI would be beneficial in developing basic arthroscopic skills. CONCLUSIONS: The results of this study provide evidence that the use of an SBI consisting of a benchtop workstation, laptop viewing platform, 30° arthroscope, and defined performance metrics can detect differences in the level of arthroscopic experience. This format of SBI has been deemed acceptable and useful to the intended user, increasing the feasibility of introducing it into surgical training. CLINICAL RELEVANCE: This study adds to the existing body of evidence supporting the potential benefits of benchtop SBIs in arthroscopic skills training. Improved performance on such an SBI may be beneficial for the purpose of basic arthroscopic skills training, and we would support the inclusion of this system in surgical training programs such as those developed by the Arthroscopy Association of North America and American Board of Orthopaedic Surgery.

Functional outcome of open acromioclavicular joint stabilization for instability following distal clavicle resection.

BACKGROUND: Acromioclavicular joint instability following distal clavicle resection can result in considerable pain and dysfunction. METHOD: We present a review of 13 patients who underwent ACJ stabilization following one or more distal clavicle resection procedures. RESULTS: The mean Quick DASH and CM scores were 26(0-57) and 73(46-100) respectively. All but one patient reported an improvement in the pain component of their CM score and in the work component of the Quick DASH score. DISCUSSION: Open ACJ stabilization to treat instability following distal clavicle resection resulted in improved functional scores, pain scores and facilitated return to work in most patients.Level of evidence IV.

The effects of pharmacological blockade of the 5-HT(6) receptor on formalin-evoked nociceptive behaviour, locomotor activity and hypothalamo-pituitary-adrenal axis activity in rats.

5-hydroxytryptamine (5-HT) mediates behavioural and neuroendocrine responses to noxious or stressful stimuli. 5-HT(6) receptors are expressed in brain regions involved in nociceptive processing, however, their role in nociception is unknown. Here we demonstrate that acute, systemic administration of the 5-HT(6) receptor antagonist, 5-chloro-N-(4-methoxy-3-benzothio-phenesulfonamide (SB-271046), reduces formalin-evoked nociceptive behaviour and increases plasma corticosterone. SB-271046 dose-dependently reduced pre-formalin distance moved, rearing, grooming and defecation. These data provide the first evidence for 5-HT(6) receptor-mediated regulation of nociception and hypothalamo-pituitary-adrenal axis activity in a model of persistent pain although effects on locomotor activity demand that the putative antinociceptive effect of SB-271046 be interpreted with some caution.

Arthroscopic Posterior Glenoid Fracture Fixation Using Knotless Suture Anchors.

Shoulder instability after a posterior glenoid rim fracture is rare and potentially difficult pathology to treat. Operative techniques often involve a large dissection to view the fragments resulting in local soft tissue injury. Internal fixation is often achieved with interfragmentary screws; however, this may not be possible with small or multifragmentary fracture patterns. We describe an arthroscopic technique for posterior glenoid rim fracture fixation using knotless suture anchors. These anchors can be inserted without cannulas allowing easier access to the posterior glenoid. This procedure is simple, safe, and offers good visualization of the glenohumeral joint whilst avoiding the detrimental effects of larger surgical dissection.

The accuracy of automatic calibration of digital pelvic radiographs using two different scale markers: a comparative study.

We have investigated the accuracy of automatic calibration of digital pelvic radiographs using the single and double marker techniques. Both markers were applied by the radiographer at the time of routine, postoperative radiographs. Each radiograph was loaded into the TraumaCad(TM) software package which calculated the magnification and scaled the radiograph automatically. The median error of magnification in the double marker group was 1.14% when calculated automatically. The median error of the single marker was 5.98%. The relationship between true and predicted magnification was strongest in the double marker group with excellent correlation (r=0.91) and agreement (ICC<0.91). We believe that the double marker method with automatic calibration is the most reliable method of scaling a pelvic radiograph in clinical practice currently available.

Metal-on-metal hip resurfacing with uncemented fixation of the femoral component. A minimum 2 year follow up.

The current generation of metal-on-metal hip resurfacing designs has largely been characterized by cemented femoral fixation using a cementless cup. We present the clinical results of 135 entirely uncemented metal-on-metal hip resurfacing procedures. The primary outcome measures were revision for any cause and the Oxford hip score at the latest follow up. The average length of followup was 2.9 years. The mean Oxford hip score was 18.4 and no patient required revision of either component during the study period. Uncemented femoral fixation may be comparable to fixation with cement in metal-on-metal hip resurfacing.

Intertrochanteric femoral fracture after hip resurfacing managed with a reverse distal femoral locking plate: a case report.

Metal-on-metal hip resurfacing is a popular procedure for a select group of patients. A variety of surgical approaches are being utilised, each of which may be associated with specific complications. We describe an unusual complication following a Ganz trochanteric osteotomy approach, and the technique used to treat the subsequent periprosthetic fracture.