Healed ORIF in a fibula fracture - Hardware removal or hardware retention for the fibula in a patient with minor symptoms?

HISTORY: - A 31yo female is involved in a fall while climbing on some wet rocks. She was brought into the emergency department and was found to have suffered a closed fracture of the right fibula with a deltoid ligament injury. Distal neurovascular exam was normal. She is otherwise unhurt. She had ORIF of her ankle injury and it has gone onto heal with good results. She comes back at 6 months and complains of vague pain over her lateral ankle and hardware with a normal physical exam. She wonders about hardware removal, (Figs. 1 and 2). PAST MEDICAL HISTORY: - previous history of breast reduction surgery and she has delivered one child vaginally. No chronic diseases and she takes no pills except the birth control pill. SOCIAL HISTORY: - married with one child and works as an administrative assistant for a manufacturing company; she is a social drinker and nonsmoker. Has a history of using some recreational drugs but none for 10 years. She is moderately active.

CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review.

BACKGROUND: Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis. METHODS: A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed. RESULTS: Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ). CONCLUSION: These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.

Pediatric Terrible Triad Injury of the Elbow: A Rare and Easily Missed Injury: A Case Report.

CASE: We report the case of a pediatric terrible triad injury of the elbow consisting of an ulnohumeral dislocation, a radial neck fracture, and a coronoid chondral injury, which was diagnosed at 14 days following injury. We describe our surgical technique and provide details of the postoperative course, including the development of a rotational contracture following heterotopic ossification. CONCLUSION: We describe a rare and challenging injury that should be recognized early and managed surgically to maintain acceptable elbow function.

Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery.

Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12 h vs. 26 h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.

Does early radiography alter remanipulation rates in paediatric forearm fractures?

BACKGROUND: In paediatric patients with a forearm fracture, treated with manipulation under anaesthesia with fluoroscopic guidance, protocol varies whether a day 1 post-operative radiograph is performed. The primary aim of this study is to evaluate whether this investigation changes the management of a patient. Secondary aims evaluated number of reinterventions and factors associated with loss of position. METHODS: A retrospective study design was used. Cases were identified from the Wellington Regional Hospital radiology database between 1 January 2010 and 30 July 2011. Ethical approval was obtained for this study. RESULTS: During the study period, 148 patients under 18 years old presented with a forearm fracture; after exclusion criteria were applied, 107 fractures were included. Sixty-five fractures were evaluated with a day 1 post-operative radiograph; no reinterventions were performed as a result of this investigation. Evaluating the total study population (107), only four reinterventions were performed. No reintervention was performed earlier than 1 week. All patients who required reintervention were investigated with a day 1 post-operative radiograph. No statistically significant associations were found between patient demographic, injury or treatment factors and need for reintervention (at any stage). CONCLUSIONS: The day 1 post-operative radiograph does not influence management, and cannot be justified given the further cost for hospitals, unnecessary radiation and additional time required.

An uncommon side effect in a common procedure: a case report of an adverse reaction to prilocaine during a Bier's block.

This case report describes a rare side effect during a Bier's block. During local anaesthetic injection, the patient suffered a sudden onset painful petechial rash localised to the upper limb, distal to the tourniquet, without systemic effect. After deflation of the tourniquet, the pain resolved and no systemic effects were seen. The skin changes settled without treatment over one week. The discussion summarises standard technique and precautions required for a Bier's block. It also evaluates risks and complications.