Talar head fracture: A case report, systematic review and suggested algorithm of treatment.

INTRODUCTION: Talar head fractures are uncommon. This rarity contributes to the lack of structure and clarity in its management. The purpose of this systematic review is to analyse the published literature on management of these injuries and suggest a treatment plan that was followed in our case. METHODS: A search of Medline, EMBASE, AMED and Google Scholar was performed on 1st September 2014. Any article reporting case(s) of talar head fractures were included and studies of other anatomical types of talar fractures, stress fractures or paediatric cases were excluded. The paucity of data precluded data synthesis and instead a narrative synthesis was performed. RESULTS: Of 45 studies identified, five publications with seven case reports met the inclusion criteria. One occurred secondary to snowboarding, one wakeboarding, one inversion injury whilst walking and one gymnastic injury. Two patients were managed operatively and two non-surgically with one requiring surgery for a symptomatic mal-union. CONCLUSION: Talar head fractures are rare and high quality literature regarding management of these injuries is lacking. A suggested algorithm for treatment is proposed, but further robust studies are required to substantiate this approach.

Total proximal interphalangeal joint arthroplasty for osteoarthritis versus rheumatoid arthritis--a systematic review.

Osteoarthritis (OA) and rheumatoid arthritis (RA) of the proximal interphalangeal joints (PIPJ) can be treated with arthroplasty, although the complicated anatomy of the joint makes surgery challenging. Controversy exists regarding outcomes in relation to disease aetiology. This study aims to compare functional outcomes and re-operation rates in these two conditions. The electronic databases MEDLINE, EMBASE, Cochrane database and Google scholar were searched in accordance with PRISMA. The study quality was assessed using the Methodological Index for Non-Randomised Studies (MINOR). A total of 16 studies were reviewed including 506 cases in the OA and 542 in the RA group. Five studies assessed function and patient satisfaction, demonstrating a non-significant improvement in the OA group. Five studies reported re-operation rate; three showing it to be lower in the OA group and two reporting similar rates. This review suggests that those undergoing PIPJ arthroplasty for OA may have a better functional outcome and lower re-operation rate.

Rupture rate following primary flexor tendon repair of the hand with potential contributing risk factors.

This study aimed to investigate rupture rates following primary flexor tendon repair and to identify potential risk factors of rupture. Fifty-one patients with 100 flexor tendon injuries who underwent primary repair over a one-year period were reviewed. We collected demographic and surgical data. Causes of rupture were examined. Ruptured primary tendon repairs were compared with those that did not rupture. Univariate and multivariate analysis were undertaken to identify significant risk factors. Eleven percent of repaired tendons ruptured with a higher rupture rate noted in the non-dominant hand (p value = 0.009), in Zone II (0.001), and when more than 72 hours surgical delay occurred (0.01). Multivariate regression analysis identified repair in Zone II injuries to be the most significant predictor. Our rate of rupture of 11% was associated with delay in surgery, repair on non-dominant hand, and Zone II repairs. Careful consideration of these factors is crucial to reduce this rate.