Immediate Fixation Versus Late Osteotomy for an Unusual Scapula Body Fracture: A Report of 2 Cases.

CASE: We present 2 unusual scapula fractures that do not meet published thresholds for surgical intervention; 1 initially managed surgically with a good functional result and 1 conservatively with a poor outcome. The second patient subsequently underwent osteotomy and fixation with good effect. CONCLUSION: Despite not reaching published levels of displacement or angulation usually considered for surgical intervention, these cases demonstrate that combined patterns of scapula injury can cause functional disability if managed conservatively. The authors believe that combination patterns of injury should be considered for early surgery to avoid loss of function caused by healing of the fracture(s) in malposition.

Case report of an unusual extra-articular scapular malunion: Rare indication for surgery.

INTRODUCTION: Scapular fractures are relatively rare injuries usually associated with high-energy trauma and multiple concomitant injuries. Most of scapular fractures do not require surgical intervention. PATIENT AND CLINICAL HISTORY: A 42-year-old male sustained an extra-articular scapular body fracture along with multiple rib fractures with flail segments and right pneumothorax treated with intercostal drain. The scapula fracture was treated non-operatively initially, which resulted in very poor outcome. Operative intervention was planned following scans which showed a bony spike from the ventral surface impinging on the chest wall. SURGICAL TECHNIQUE: Bony spur was approached from dorsal side using a three-dimensional anatomical model as a guide for accurate localization. RESULTS: The patient's symptoms including shoulder stiffness and pain on deep inspiration settled down completely following removal of the spur. DISCUSSION: This case presents a new indication for surgical intervention in scapular body fracture which has not been published before. All the relevant measurements related to the fracture namely gleno-polar angle, lateral border offset and angulation were within published limits of indications for conservative treatment. Despite this, it resulted in poor outcome necessitating surgical intervention.

Grade 3 AC joint injury: A survey of current practice in the United Kingdom.

Acromio-clavicular (AC) joint injuries are a common injury seen in athletes and represent 9% to 12% of all shoulder injuries. There is no clear consensus on treatment of grade 3 injuries. We conducted a survey among upper limb surgeons in the United Kingdom to review commonly accepted practise. We found that majority of surgeons never did stress view. Most surgeons favoured surgery only if needed but not first choice. There is no consensus on timing of surgery. There are many fixation options available for AC joint dislocation and we found that surgeon's preferences were quiet wide for choosing fixation method. That is also evident from this questionnaire as there is no consensus in orthopaedic surgeons for ideal treatment of type 3 AC joint dislocations. Authors recommend randomized controlled trial to formulate definite treatment plan.

Tibial component sizing and alignment of TKR components does not significantly affect patient reported outcome measures at six months. A case series of 474 participants.

OBJECTIVES: Total knee replacement (TKR) is an effective means of alleviating the symptoms of end stage osteoarthritis. However, 20% of patients report dissatisfaction one year post-operatively. Previous literature has demonstrated contradictory evidence regarding the relationship between alignment and tibial component sizing with patient reported outcome measures (PROMs). We aim to investigate the association between alignment of TKR components and effect of tibial component sizing on PROMs. METHOD: A prospective, multicentre case series was performed at six centres. Baseline characteristics were collected at recruitment. Coronal and sagittal plain films were taken day one post-operatively. Trained medical professionals blinded to outcome measured the alignment and degree of over/underhang of the tibial component in the coronal and sagittal place, with Oxford Knee Score (OKS) measured six months post-operatively. RESULTS: 474 patients were recruited. Malaligned TKRs caused no significant difference in mean OKS change at six months (independent t-test) (p > 0.05). A multivariate regression model taking into account age, gender, body mass index and baseline OKS also demonstrated no significant difference (p > 0.05). With regards to tibial component sizing, 125 (27%) of patients had appropriately sized tibial components, 120 (26%) had overhang and 219 (53%) had underhang with no significant difference in OKS between the groups (p > 0.05). CONCLUSION: Tibial component sizing and alignment does not significantly affect short-term function, as measured by OKS, after total knee replacement. Dissatisfaction after TKR is likely due to other factors other than alignment of implant.

Technique for gentle accurate reproducible closed reduction of intracapsular fracture of neck of femur.

Non-anatomic reduction with either inferior offset or varus angulation was the strongest predictor of re-displacement of the fracture and poor outcome after fixation of intracapsular fracture of neck of femur. There are many techniques for closed reduction and can be broadly divided into non-invasive and invasive techniques. We describe a minimally invasive technique, which we believe is easy, reproducible and successful in achieving good anatomical reduction.