Functional Outcome of Complex Elbow Fracture Managed With the Boyd Approach.

INTRODUCTION: The Boyd approach allows excellent access to the elbow and is used to treat complex elbow injuries using a single incision approach. MATERIALS AND METHODS: In this study, we retrospectively evaluated 16 patients with complex elbow injuries treated with open reduction and internal fixation using the Boyd approach between 2016 and 2018. RESULTS: All fractures were well united in anatomical position. Postoperatively, the range of motion was not significantly different between the affected and unaffected elbows. The mean Mayo Elbow Performance Index score was 95 ± 5 (range 90 to 100). All study participants had satisfactory results and recovered to full activity. There was no incidence of posttraumatic arthritis of the elbow joint or synostosis of the radius and ulna. CONCLUSION: Thus, according to our study, the Boyd elbow approach is a safe and effective method of treating elbow injuries.

Observational Study of the Clinical Impact of E-scooter Injuries at a Major Trauma Centre.

Background Due to the increased use of e-scooters in the UK, associated injuries have increased, and its cost has increased as well. Worldwide data on injuries related to e-scooter use are relatively limited, owing to the short duration since their first introduction to the public.  Aim There has been an increase in using e-scooters as a method of transport recently. It was noticed that the severity and frequency of its injuries are increasing as well. This study focuses on the frequency of e-scooter-associated injuries, especially open fractures, and to evaluate its burden on the health system. Methods Data on e-scooter injuries were extracted from our trauma database from November 2017 to July 2022. Patients' notes and images were reviewed. Outcome measures were the type of injuries: site of bony fractures, closed vs. open fracture (using Anderson and Gustilo classification), number of operations, complications, and length of hospital stay. Results The number of patients enrolled was 104. The mean age was 34.3 years, and 78.8% (n = 82) were male. The main mechanism of injury was riding (91%, n = 95) vs. hitting by an e-scooter (9%, n = 9). Injured patients were more likely not to wear helmets (82% of total injured patients). Patients with bony injuries were 65.4% (n = 68), with 22.1% (n = 15) of them being open fractures. The most common bony injuries were lower limb-only fractures at 45.6% (n = 31), then upper limb-only injuries at 39.7% (n = 27). Combined upper and lower limb cases were 8.8% (n = 6), and pelvic injuries were 5.9% (n = 4). Head and neck injuries composed 23.1% (n = 24) of the reported injuries, including intracranial haemorrhages (9.6%, n = 10), extensive traumatic brain injury (3.8%, n = 4), haematoma/lacerations (3.8%, n = 4), cervical spine fractures (1.9%, n = 2), and skull fractures (1.9%, n = 2). The mean duration of hospital stay was 8.6 days, and 9.6% (n = 10) of patients needed intensive therapy unit (ITU) admission. The number of patients presented as trauma calls was 55.8% (n = 58). Patients who needed surgical intervention either under orthopaedics or other specialties were 52.9% (n = 55) and 21.2% (n = 22) of total patients had complications either due to surgical intervention or a long hospital stay.  Conclusion E-scooter riding can lead to serious injuries that can end with limb- or life-threatening conditions. The most common demographic characteristics were adults in their early 30s. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.

Lisfranc Injury: Recent Trends in Management.

Lisfranc injury refers to a group of bony or ligamentous injuries in which one or more of the metatarsals are displaced with respect to the tarsus. These injuries can occur as a result of either high-energy trauma like motor vehicle accidents and falls from height, or low-energy trauma from sports activities. A significant proportion of Lisfranc injuries are missed initially. The effects of delayed and missed diagnosed cases can be devastating as patients may develop progressive midfoot instability, collapse of arch, abduction of forefoot, and post-traumatic osteoarthritis, which can cause chronic pain, stiffness, and foot and ankle complex dysfunction. Favourable outcomes are associated with early diagnosis and prompt treatment. Open reduction and internal fixation (ORIF) with arthrodesis has better results than ORIF alone in functional outcomes. Dorsal bridge plates are currently the preferred mode of fixation due to advantages over trans-articular screws.

Anterior Cervical Reduction Decompression Fusion With Plating for Management of Traumatic Subaxial Cervical Spine Dislocations.

STUDY DESIGN: Prospective case series. OBJECTIVE: To evaluate the efficacy of anterior-only approach, for treatment of type C F4 (AO classification) traumatic subaxial cervical spine injuries. METHODS: Patients with type C F4 traumatic cervical injuries presenting to a tertiary center between June 2017 and July 2018 were included. Outcome measures included self-reported measures (Neck Disability Index, visual analogue scale, and return to work), radiological measures (local segmental angle, Ishihara curvature index, cervical lordosis angle, and step-off distance), fusion state, and neurological state according to American Spinal Injury Association (ASIA) Impairment Scale (AIS). RESULTS: Twenty-one cases were operated by anterior approach with mean age 39.1 ± 13.8 years. The most common injury was at C4-5 (47.6%). Six out of 7 cases (85.7%) with preoperative neurological impairment showed late follow-up improvement by one or more grade in AIS. Complete anatomical reduction and imaging measures did not correlate significantly to the self-reported outcome measures. Median value of local segmental angle improved from -16° (-11° to -20) preoperatively to 0° (-7°) to 8°) at late follow-up. The cervical lordotic angle and Ishihara curvature index improved from 35° (29° to 43°) and 6.92 (-2.7 to 28.9) preoperatively, to 44° (33° to 51°) and 18.7 (-3.5 to 26.9) at the late follow-up, respectively. Step-off distance decreased postoperatively, however; complete reduction could not be achieved. CONCLUSION: Surgical treatment of lower cervical traumatic instability by anterior decompression and fusion is efficient regarding fusion state and patients' satisfaction. The anterior approach can be recommended in cases with neurological impairment and in patients with medical comorbidities or when a short operative time-compared with combined approach-is preferred.