Postoperative results of Ogawa type IIB meta-acromion fracture fixation with a 90° twisted reconstruction plate.

INTRODUCTION: Acromion fractures are rare and difficult to treat. There is no consensus on type of fixation. Due to the rarity of the injury, it is difficult to compare different techniques of osteosynthesis. OBJECTIVES: The aim of this study was to present the long-term results of an alternative method of plating Ogawa type IIB meta-acromion fractures and to review the literature. DESIGN: Retrospective study. MATERIALS AND METHODS: We present a case series of 11 consecutive patients with displaced Ogawa type IIB meta-acromion fracture, treated with open reduction internal fixation using a 3.5-mm contoured pelvic reconstruction plate with a 90° twist. Patients' mean age was 53.3 years (23-80 years) and the mean follow-up was 48.3 months (15 months-9 years). The outcomes related to pain and shoulder function were evaluated by Modified American Shoulder and Elbow Surgeons Score (ASES) and SF-36 score. All patients were asked about their satisfaction level. RESULTS: Nine out of eleven patients were included in this study. Eight of them obtained union and all were satisfied with the final outcome. The mean ASES and SF-36 score were 69.75 (42.4-98.14) and 61.37 (41.64-94.99), respectively, with poor scores to be largely associated with comorbidities and concomitant injuries. CONCLUSIONS: The use of 3.5-mm reconstruction plate with a 90° twist for open reduction internal fixation (ORIF) of meta-acromion fractures presents satisfactory results and could be technically a more stable biomechanical construct in comparison to the existing surgical techniques.

Impact of surgical waiting time on paediatric spinal deformity patients.

BACKGROUND: Scoliosis has been shown to affect quality of life of young people. There can be a lengthy wait for surgery. We aim to assess whether the length of time waiting for surgery has an impact on quality of life and surgical outcomes. METHODS: Patients who were waiting for or had completed surgery for paediatric spinal deformity in the last 3 years were contacted and asked to complete the Scoliosis Research Society-30 (SRS-30) questionnaire as well as a questionnaire designed to specifically assess the impact of waiting for surgery. Hospital records and X-rays were reviewed to determine surgical outcomes. RESULTS: Longer waiting time was associated with both lower SRS scores (0.13 points per 6 months, P = 0.01) and lower wait time questionnaire values (0.12 points per 6 months, P < 0.01). Within the SRS-30 questionnaire, pain, satisfaction with management and self-image domains showed a statistically significant decrease with increasing wait time (P = 0.02, 0.05, >0.01 respectively). Cobb angles progressed with increased waiting time, but progression was not statistically significant. No correlation was found between waiting times and the other surgical outcomes measured (surgical duration, hospital stay, blood transfusion, return to theatre or other complications). CONCLUSION: Increased waiting time for surgery has a negative impact on quality of life of patients with scoliosis.

What clinical and laboratory parameters determine significant intra abdominal pathology for patients assessed in hospital with acute abdominal pain?

BACKGROUND: Abdominal pain is a common cause for emergency admission. While some patients have serious abdominal pathology, a significant group of those patients have no specific cause for the pain. This study was conducted to identify those who have non-specific abdominal pain who can be either admitted short term for observation or reassured and discharged for outpatient management. PATIENTS AND METHODS: A prospective documentation of clinical and laboratory data was obtained on a consecutive cohort of 286 patients who were admitted to a surgical unit over a nine month period with symptoms of abdominal pain regarded severe enough for full assessment in the casualty department and admission to a surgical ward. The patients were followed until a definite diagnosis was made or the patient's condition and abdominal pain improved and the patient discharged. The hospital where the study took place is a small peripheral general hospital draining a population of 120,000 people in a rural area in New Zealand. RESULTS: There were 286 admissions to the emergency department. Logistic regression multivariate statistical analysis showed that guarding raised white cells count, tachycardia and vomiting were the only variables associated with significant pathology. CONCLUSION: Patients with no vomiting, no guarding, who have normal pulse rates and normal white cell counts are unlikely to have significant pathology requiring further active intervention either medical or surgical.