Use of biomaterials in scaphoid fracture fixation, a systematic review.

BACKGROUND: Scaphoid fractures account for 60-70% carpal injury. Due to limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging. METHODS: A systematic search of databases including PubMed, Ovid Medline, and Google Scholar databases was made to identify studies related to the use of bioabsorbable materials in scaphoid fixation and postoperative patient outcomes. PRISMA guidelines were utilised for this review. FINDINGS: Initial search results yielded 852 studies. 124 studies were screened, with 79 patients across 7 studies included in this review. Poly-L-Lactic acid derivatives were the most common biomaterial for scaphoid fixation, with magnesium and polyglycolide also used. Levels of evidence for studies ranged between III-IV. Analysis demonstrated mixed findings with generally comparable outcomes to conventional alloy-based screws. INTERPRETATION: Development in bioabsorbable materials is ongoing, however there remains a dearth in data regarding their use in the scaphoid. Further research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.

Injuries associated with arm wrestling: A narrative review.

OBJECTIVE: Arm wrestling is common sport amongst amateur enthusiasts. Multiple injuries are described as a result of the sport. The authors present a narrative review of the common injuries associated with the sport. DESIGN: Systematic review with a critical appraisal of the literature and a narrative review of the injuries associated with arm wrestling. DATA SOURCES: Seven electronic databases were systematically searched using medical subject headings (MeSH) terms as follows. Arm wrestling, Indian Wrestling, Fractures, Injury, Ligament Injury with Boolean search terms "AND". An extensive review of orthopaedic textbooks was also performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were publications which included patients who suffered bony or soft tissue injuries as a result of arm wrestling published in English language. RESULTS: A total of 152 patients was seen across all studies. Spiral fractures of the distal third of the humerus are by far the most common injury reported in the setting of arm wrestling. The humerus fails due torsional and bending stresses. 23% were complicated by medial butterfly fragment and the incidence of radial nerve palsy was 23%. Fracture patterns differ in the skeletally immature arm wrestler, who show an increased incidence of medial humeral epicondyle fractures. We also report on the atypical fracture and soft tissue injury patterns that present.

Scaphoid fractures: A bibliometric analysis of the most influential papers.

Scaphoid fractures are commonly seen following a fall on an outstretched hand and often missed on initial presentation. An untreated scaphoid fracture may result in avascular necrosis of the scaphoid due to its retrograde blood supply. Published articles guide our investigation and management of these injuries. A citation analysis was performed on the top 30 articles relating to scaphoid fractures ranked by citation number. The 30 articles have been cited a total of 4595 times originating from 9 different countries. The leading article was cited 443 times with an average of 12.66 citations/year. Although this may not directly correlate with study quality, it does provide an insight to the influence which a paper has had on the scientific community. This list may prove invaluable to clinicians involved in the treatment of patients with scaphoid fractures and those actively furthering the development of the field.

A Case of Dorsal Scapular Neuropathy in a Young Amateur Boxer.

Neuropathies of the muscles surrounding the shoulder joint are a well-documented cause of pain and weakness in sports people. Repetitive or excessive traction on the nerve supplying the affected muscle is believed to be the primary mechanism. We describe a case of this phenomenon in a young amateur boxer which has never been described in the literature previously. We document our hypothesis on the mechanism of injury as well as a successful treatment strategy we employed. This paper is designed to highlight shoulder pain with associated winging of the scapula should make one wary of a dorsal scapular neuropathy particularly in a sports person who utilises repetitive forceful actions.

The use of weekly departmental review of all orthopaedic intra-operative radiographs in order to improve quality, due to standardized peer expectations and the "Hawthorne effect".

INTRODUCTION: Clinical governance highlights risk management, clinical effectiveness and use of evidence based practice as key elements in the provision of a quality service. A change in the method of quality control in our orthopaedic trauma unit allowed us the opportunity to study if the quality of operative outcomes had changed as a result. The Hawthorne effect refers to phenomenon whereby employees work quality improves by virtue of their awareness that their labour is being assessed. METHODS: A new outcome appraisal forum was introduced in our department in 2009. This forum involved a weekly whole department review of all the previous week's intraoperative radiographs. We used the tip apex distance (TAD) of the dynamic hip screw (DHS) procedures in hip fracture patients as a surrogate marker, of any objective change in the quality and consistency of intra-operative radiographs, in the year prior to and after the introduction of this review system. RESULTS: We found that the mean TAD and the number of TAD measurements over 25 mm decreased significantly in the year after the new quality control mechanism was introduced. CONCLUSION: We would recommend the use of a weekly quality control meeting scrutinizing every intraoperative radiograph as a simple, cost effective method of incorporating many aspects of clinical governance, as well as fostering a culture of quality.

Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years.

BACKGROUND: The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric hip fractures. Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the fracture environment. METHODS: There were 17 patients at our institution over a 2-year period whose long oblique subtrochanteric fractures would not reduce perfectly in an anatomical fashion using closed methods. All these patients had their fractures treated identically using a new policy at our unit. This strategy involved reduction of the fracture through an open approach, and then employing cerclage cables to stabilise the fracture in an anatomical position before finally inserting a cephalomedullary nail. These patients were retrospectively reviewed at an average of 18 months postoperatively, to assess their progressive functional and radiological outcome up to that point. RESULTS: One patient had nonunion and required a secondary procedure. One patient died 8 days postoperatively from a medical complication. The remaining 15 healed within 6 months and all returned to independent living. CONCLUSIONS: The results demonstrate that judicious use of cerclage cables to augment fixation of subtrochanteric femur fractures does not have a deleterious effect on healing. One should endeavour, however, to minimise the number of cables used. The basic science literature underpinning our approach to these unstable fractures is also discussed.

Hypertonic saline reduces inflammation and enhances the resolution of oleic acid induced acute lung injury.

BACKGROUND: Hypertonic saline (HTS) reduces the severity of lung injury in ischemia-reperfusion, endotoxin-induced and ventilation-induced lung injury. However, the potential for HTS to modulate the resolution of lung injury is not known. We investigated the potential for hypertonic saline to modulate the evolution and resolution of oleic acid induced lung injury. METHODS: Adult male Sprague Dawley rats were used in all experiments. Series 1 examined the potential for HTS to reduce the severity of evolving oleic acid (OA) induced acute lung injury. Following intravenous OA administration, animals were randomized to receive isotonic (Control, n = 12) or hypertonic saline (HTS, n = 12), and the extent of lung injury assessed after 6 hours. Series 2 examined the potential for HTS to enhance the resolution of oleic acid (OA) induced acute lung injury. Following intravenous OA administration, animals were randomized to receive isotonic (Control, n = 6) or hypertonic saline (HTS, n = 6), and the extent of lung injury assessed after 6 hours. RESULTS: In Series I, HTS significantly reduced bronchoalveolar lavage (BAL) neutrophil count compared to Control [61.5 +/- 9.08 versus 102.6 +/- 11.89 x 10(3) cells.ml-1]. However, there were no between group differences with regard to: A-a O2 gradient [11.9 +/- 0.5 vs. 12.0 +/- 0.5 KPa]; arterial PO2; static lung compliance, or histologic injury. In contrast, in Series 2, hypertonic saline significantly reduced histologic injury and reduced BAL neutrophil count [24.5 +/- 5.9 versus 46.8 +/- 4.4 x 10(3) cells.ml-1], and interleukin-6 levels [681.9 +/- 190.4 versus 1365.7 +/- 246.8 pg.ml-1]. CONCLUSION: These findings demonstrate, for the first time, the potential for HTS to reduce pulmonary inflammation and enhance the resolution of oleic acid induced lung injury.

The association between aspirin and blood loss in hip fracture patients.

This is a cohort study involving 98 patients who presented to a regional orthopaedic unit with a hip fracture. Blood loss was assessed by pre and post operative haemoglobin concentrations, and transfusion requirements were used as outcome measures. The influence of pre-operative aspirin use and fracture type was analysed with respect to these outcome measures. Forty two percent of patients were regular aspirin users, and were comparable to the non aspirin group, apart from having a significantly greater prevalence of atherosclerotic vascular disease. There was no significant difference between the aspirin and non aspirin groups in terms of preoperative haemoglobin concentrations, perioperative changes in haemoglobin levels and transfusion requirements. Fifty one percent of patients had extracapsular hip fractures, and these patients were comparable in terms of demographic characteristics, including aspirin use, to the group with intracapsular hip fractures. The extracapsular hip fracture group were found to have significantly increased peri-operative blood loss as measured by changes in the haemoglobin level, and in transfusion requirements when analysed against the intracapsular hip fracture group. We found that it is the fracture site, rather than aspirin use pre-operatively, that is predictive of blood loss and transfusion requirements in patients presenting with hip fractures.