Scapular dyskinesis: the surgeon's perspective.

The scapula fulfils many roles to facilitate optimal function of the shoulder. Normal function of the shoulder joint requires a scapula that can be properly aligned in multiple planes of motion of the upper extremity. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. As such, it may be the underlying cause or the accompanying result of many forms of shoulder pain and dysfunction. The present review looks at the causes and treatment options for this indicator of shoulder pathology and aims to provide an overview of the management of disorders of the scapula.

Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

Epidemiology of spine trauma in an Irish regional trauma unit: a 4-year study.

Currently there is a lack of information on the full spectrum of spine trauma presenting to medical services in a defined geographic area. This study analyses the aetiology and demographics of a cohort of spine trauma in the West of Ireland. A regional trauma unit has been investigated for a 51-month period. Two hundred and eighty-five cases admitted with spine trauma were documented. The annual incidence of traumatic spinal injury was 19.54 cases/100,000 persons per year. Falls and low-energy trauma are shown to constitute a significant proportion of all cases (60.35%). Injury at greater than one level is frequently present. The highest peak of injury occurred in the 20-24-year-old age group (11.58%). A second peak occurred at 75-79 years of age (7.37%). The commonest cause of neurological injury was falls (n=9; 64.3%). This spine trauma register has provided valuable insights into the patterns of injury encountered in spine trauma patients in this region. It may act as a blueprint for a national spine trauma register and highlights the importance of patient education and injury prevention strategies.

Compliance and satisfaction with foot compression devices: an orthopaedic perspective.

INTRODUCTION: Although mechanical methods of thromboembolic prophylaxis have proven efficacy, relatively little is known about levels of patient compliance in the usage of these devices. Based on anecdotal evidence, we hypothesised that levels of compliance are sometimes insufficient to provide adequate thromboprophylaxis in the clinical setting. We prospectively analysed the use of foot pumps in 30 orthopaedic patients undergoing lower limb arthroplasty in order to assess levels of both patient compliance and satisfaction. MATERIALS AND METHODS: The study was carried out over a 5-month period. Levels of compliance were measured by using a system of random "spot checks". Each patient completed a questionnaire before discharge. Parameters investigated included comfort levels while using the device and identification of factors about the device which the patients disliked. RESULTS: Three hundred and ninety-one measurements were made. The utilisation of the device was found to be effective in 40.2% of measurements. We detected an overall progressive decline in the level of compliance as post-operative time increased [P < 0.001, Chi-square (chi(2)) test]. The average level of patient "comfort" was 7.1 on a visual analogue scale of 0-10. Sleep disturbance was reported by 57% of patients, while 43% complained of "heat intolerance". We have also shown that compliance is significantly reduced in those who complained of "sleep disturbance" while using the foot pumps (t-test, P < 0.05). CONCLUSIONS: These findings suggest that satisfactory levels of compliance can be difficult to achieve in the clinical setting despite the proven efficacy in clinical trials of this device. Greater emphasis on patient education may help improve compliance. Unless compliance can be strictly enforced, it appears advisable to only use foot pumps in combination with other forms of pharmacological prophylaxis.