Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications.

Three commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether 'safe zones' exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient.

Where do these cadavers come from?

Cadaveric surgical courses are highly useful in developing operative skills, however, the provenance of the cadavers themselves remains opaque. Trade in cadaveric parts is an important source of material for courses, and this has spawned the unique service of body brokerage. Body brokers, however, operate in an unregulated market and obtain bodies by exploiting family members' altruistic instincts and financial concerns. Unethical and illegal sale of body parts has been well-documented, while the use of cadavers for uses other than that consented by donors is also a key concern. Undoubtedly, cadaveric surgical courses would have used bodies sourced from brokers, and questions remain about the moral and ethical implications of this. We discuss this issue using an ethical and historical context as well as offering solutions to ensure the ethical sourcing of cadavers for surgical training.

Is external fixation a better way than plaster to supplement K-wires in non-comminuted distal radius fractures?

BACKGROUND: Distal radius fractures represent about one-sixth of all fractures. There is still no consensus on the treatment of this fracture. We have several issues to assess and address; one of them is the fixation method. We tried to compare the effectiveness of two methods of stabilisation of distal radial fracture. Comparison between the techniques of Kirschner wire (K-wire) fixation with plaster and K-wire fixation with external fixation (Ex-Fix) was undertaken to assess which treatment modality gives better results in patients with distal radius fracture Frykman VII and VIII with no metaphyseal comminution. METHOD: Fifty-six patients were chosen randomly and then allocated to two different modalities of stabilisation randomly as well, they were followed up; three of them were lost to follow-up because of death and two moved away from the area. Fifty-one patients were randomised in two groups: 24 were treated with K-wire and spanning Ex-Fix supplementation and 27 were treated with K-wires and plaster. Patients were prospectively monitored following the operation with a minimum follow-up of 1 year. Measurement of range of motion was obtained after surgery. Visual Analogue Scale (VAS) scores for pain and satisfaction levels were also recorded. RESULTS: There was statistically significant difference in favour of the Ex-Fix patient group for pain (VAS, Ex-Fix group: mean 14.9; plaster group: mean 28.1) and satisfaction (Ex-Fix group: mean 89.7;plaster group: mean 76.3). Although one would expect that range of motion would be reduced in the Ex-Fix group, there were no statistically significant differences found, with the exception of supination where results were in favour of the Ex-Fix group (mean 54.4; plaster group: mean 45.2). CONCLUSION: In our study, xternal fixator (Ex-Fix) supplementation of K-wiring favoured patients with distal radius fracture, even though there was no metaphyseal comminution, and therefore is suggested in contrast to plaster supplementation.

Glenoid Fracture Fixation Using an Acu-Loc Distal Radius Plate.

Displaced fractures of the glenoid require surgical fixation. This poses multiple problems, including a difficult approach and achieving adequate reduction with current implants. We provide a surgical technical tip for fixing scapula neck and glenoid rim fractures with an Acu-Loc distal radius plate (Acumed, Weyhill, UK), illustrated with two recent case reports. Here, we present two cases of a 58-year-old female and a 51-year-old male presenting to a hospital following a fall, both sustaining an isolated right glenoid intra-articular fracture evident on plain radiographs. CT scans revealed a displaced and fragmented glenoid surface. A reverse Judet posterior approach facilitated exposure to enable the reduction of the glenoid, an uncommon approach. Current plate designs provide surgeons with limited options to fix complex fractures of the scapula and were not suitable here. The lateral scapula border and inferior glenoid have a similar anatomical shape to the distal radius. An Acu-Loc locking distal radius plate with a radial styloid plate was trialled and provided a good reduction to the fragmented glenoid. A distal radius plate can be a useful option to consider in complex scapula neck and glenoid rim fractures. A better understanding of glenoid shape will facilitate the further development of orthopaedic implants. Familiarity with various surgical approaches is needed to operate on these complex fractures.

Virtual Fracture Clinic Patients' Satisfaction Outcomes.

Background During the COVID-19 pandemic, there was a need to balance optimum treatment service and the safety of patients and hospital staff. The British Orthopaedic Association recommended a virtual fracture clinic to give the right first-time decision and to minimize patient exposure to disease. This study aimed to evaluate the patients' satisfaction outcomes for the service provided through the virtual fracture clinic. Methodology From January to May 2022, all patients seen by the staff in the Emergency Department (ED) at Queens Burton Hospitals were enrolled in a prospective study. An Excel spreadsheet was provided to both ED personnel and the orthopaedic team for accessibility. Patients were continually added to the spreadsheet, and their cases were reviewed by the on-call consultant to devise treatment plans. A satisfaction questionnaire was collected from patients about their virtual clinic experience as a route to provide treatment service. Results The study comprised 150 patients, with an average age of 40 years. Distal radial fractures represented one-third of the cases. Different modalities of management were offered such as a sling, splint, cast, or referral to physiotherapy. Around 75% of cases were satisfied, understood the advice given over the phone, and were not required to attend the actual clinic. The remaining quarter attended the clinic either for further reassessment by an orthopaedic surgeon or for discussion of their injury as they could not get the full message over the phone due to fast calls, hearing struggles, or just listening to messages. Conclusions The virtual fracture clinic is an effective standalone service that gained around 75% satisfaction in patients' outcome questionnaires. It saved the actual fracture clinic slots and hospital resources. It is recommended to be part of the standard daily practice throughout the United Kingdom.

Right Shoulder Luxatio Erecta: Inferior Shoulder Fracture Dislocation.

Here, we present the case of a 68-year-old female presenting with an inferior shoulder dislocation of the glenohumeral joint. Accounting for a minority of all shoulder dislocations, the rarity of this injury makes it a unique and interesting presentation in patients. Following successful reduction and neurovascular assessment, the patient recovered adequately without any complications typically associated with this type of injury. The aim of this report is to outline the mechanism of action of the injury and describe the typical patient presentation alongside discussing management techniques and associated complications.

Open Reduction and External Fixation of a Comminuted Intra-articular Fifth Metacarpal Head Fracture: A Case Report.

Comminuted intra-articular fractures are among the most difficult to fix, with open reduction and internal fixation often being impossible. We report the case of a 15-year-old male who required an open reduction with external fixation after sustaining an extremely comminuted intra-articular fifth metacarpal head fracture of the right hand. The patient presented with swelling localised to the fourth and fifth dorsal metacarpals of the right hand, with radiographs demonstrating an intra-articular fracture with comminution and articular surface depression. Literature surrounding metacarpal head fractures, although scarce, suggests that whilst treatment must be individualised, most osteochondral fractures can be managed via open reduction with internal fixation either via K wires, interfragmentary screws or small headless screws. This case demonstrates that in challenging cases, with limited bone stock and cavities created through reduction of the fracture, fixation can be achieved through K wire with HK2 external fixation. It also highlights the apparent insufficiency in articles specifically detailing potential management options for intra-articular metacarpal fractures and has provided evidence of one potential fixation method.

The Pathogenesis of Chiari Malformation and Syringomyelia: A Case Report and Systematic Review of Current Theories.

We report a case of a 42-year-old female presenting with left axillary pain radiating down the arm and weakness in the ipsilateral hand. Specialist examinations of neurological and musculoskeletal systems were insignificant. Magnetic resonance imaging (MRI) of the whole spine and brain revealed cerebellar tonsillar herniation of 9-10mm indicating a Chiari type 1 malformation and a large tubular T2 high-intensity lesion in the cervical cord, extending from the C2/3-disc level down to C6/C7 as well as a similar but smaller lesion behind the bodies of C7 and T1. Both lesions were consistent with syringomyelia. Surgical intervention was deemed inappropriate, and she was treated with three months of physiotherapy. Regular follow-up for two years showed gradual symptom resolution, syrinx shrinkage, and no further complications arising secondary to Chiari type 1 malformation. Chiari malformation is an anatomical anomaly of the cranio-cervical junction. It is often incidentally found on MRI, but although asymptomatic in the population, complications associated with the condition such as syringomyelia are a common initial presentation. The relationship between Chiari malformation, particularly Chiari type 1 malformation, and syringomyelia is close with the majority of patients often presenting with idiopathic syringomyelia also found to have a Chiari type 1 malformation. Considerable discussion about the pathogenic mechanisms for syringomyelia development in Chiari malformation is recognized and advancing continually.

Teaching Professionalism during and Posta Pandemic to Surgical Trainees: A Survey of the Impact of a Workshop on Trainers and Trainees.

Introduction: Focussed professionalism training improves surgical trainees' communication, information gathering, and counselling skills. This study reviews the impact of a professionalism workshop for surgical trainees within a large trust in the United Kingdom developed during the pandemic to support the trainees and help them develop resilience and appropriate behaviours during the time of increased pressure. Methods: A workshop involving case-based discussions and reflections on professionalism was developed from the themes and methods of training noted to be effective on a literature search of Medline, EMBASE, and PsycINFO databases carried out in May 2020. The impact of Covid on surgical trainees and educator's professionalism training and the techniques of training preferred by trainees was evaluated by a survey of trainees and trainers after the intervention to evolve future training initiatives. During the workshop, a behavioural marker checklist was used to improve feedback on the observed behaviours. Results: 83 trainers and trainees were surveyed following a professional behaviour workshop training 63 surgeons at various stages of training. Surgical list availability had reduced by at least 5-10 a month for all the trainees within the trust during the pandemic. Most trainees surveyed (49 (60%)) felt that this had reduced the opportunities to train technical skills and develop professional non-technical skills like teamwork and communication skills, adversely impacting the trainee's clinical performance. The increased support offered by the workshop helped 50 trainees (80%) to improve non-technical skill performance objectively by referencing to behavioural markers and this was felt to have become embedded in practice when surveyed 4 weeks later in 38 trainees (60%). The majority of those surveyed (47 (75%)) felt trainers and trainees had acted professionally during the pandemic and subsequently. The workshop discussions also helped (56 (67%)) trainers and trainees to consider how best to engage professionally with new ways of working as work, and training switched to virtual or telemedicine platforms during the pandemic. Conclusions: Professionalism-based education facilitates surgical trainee development, making them stronger team members and helping to restore team working skills and embrace new working practices.

A Case Report of Unicompartmental Knee Arthroplasty Fracture of the Femoral Component.

Introduction: Unicompartmental knee arthroplasty (UKA) is performed with yearly rate of 9% in UK, and <8% in USA. It has been shown to be a successful and less invasive alternative to complete knee arthroplasty in certain patients total knee arthroplasty (TKA). Fracture of the femoral component after (UKA) has never been reported in the literature. Consequently, to investigate the major causes and mechanisms of (UKA) failure, we present a case of femoral component failure following (UKA). Case Report: A 62-year-old patient with 2 years following an UKA presented with a right pain, stiffness, and gait abnormalities. After taking full history and careful examination and obtaining a new radiograph, a fracture of the femoral component was revealed. A revision surgery with TKA has been done, and the outcome was assessed regularly, and good results were achieved. Conclusion: The exact reason for a femoral component fracture following UKA is yet unknown. To make an early diagnosis and avoid the need for complex knee revision surgeries, long-term follow-up is crucial for early detection of the clinical signs and symptoms of implant failure.

Physiotherapy-Led Musculoskeletal Telephone Triage and Advice Service: A Valid Option for Patients Referred From the Emergency Department.

Introduction Musculoskeletal (MSK) conditions create a significant demand for healthcare services in the United Kingdom. The emergency department is one of the main providers of initial care for patients with MSK disorders or injuries. As attendances increase within the emergency department the demand for MSK physiotherapy services also increases. The MSK physiotherapy department at Queens Hospital, Burton, GBR introduced a telephone triage and advice (TTAD) service for patients referred from the emergency department to try and reduce waiting times and the number of initial appointments not attended. The primary outcome of the study was to investigate the number of patients discharged via the TTAD service. Secondly, the study aimed to assess if the TTAD service eased the pressures of face-to-face appointments as well as analyze the effects on the number of failed attendances and canceled appointments for both initial and follow-up face-to-face appointments. Method Data were collected retrospectively from the electronic medical records system Meditech Version 6 (Medical Information Technology, Inc., MA) from the months of August, September, and October in 2017 (pre-TTAD) and 2018 (post-TTAD). Once the data had been collected, analysis was performed comparing results from 2017 to 2018 using Statistical Product and Service Solutions (SPSS) (IBM SPSS Statistics for Windows, Armonk, NY) analysis software. Results The overall number of referrals from emergency to MSK physiotherapy increased by 11.2% between 2017 and 2018. Following the introduction of the TTAD service, 59.8% of the total referrals were offered a face-to-face initial appointment with 40.2% of patients referred being discharged via the TTAD service in 2018. The percentage of patients that failed to attend the initial appointment in 2018 also fell by 4.9%. Conclusion The introduction of a TTAD service for referrals from the emergency department has been demonstrated to be effective in reducing the number of face-to-face appointments required in the MSK physiotherapy management of these patients. Both initial and follow-up face-to-face appointments were lower in 2018 when compared to 2017, this is despite an 11.2% increase in the number of referrals throughout August, September, and October. It can therefore be concluded that the TTAD service also had a positive impact on the failed attendance rate of initial face-to-face appointments.

Outcomes of day case shoulder replacement surgery in a stand-alone day care unit in the United Kingdom.

Background: This review aims to compare the outcomes for day case shoulder replacement with in-patient shoulder replacement surgery in a district general hospital. Methods: Seventy-three patients had 82 shoulder arthroplasty procedures. Forty-six procedures were undertaken in a dedicated stand-alone day-case unit and 36 were undertaken as in-patient cases. Patient were followed up at 6 weeks, 6 months and annually. Results: There was no significant difference between the outcomes of shoulder arthroplasty procedures performed in the day case or in-patient settings making this a safe option for surgical care in a unit with an appropriate care pathway. Six complications in total were observed, three in each group. Operation time was statistically shorter for day cases by 25.1 min (95% CI - 36.5 to -13.7; d = -0.95, 95% CI -1.42 to 0.48). Estimated marginal means (EMM) revealed lower post-surgery oxford pain scores in day cases (EMM = 3.25, 95% CI 2.35, 4.16) compared with inpatients (EMM = 4.65, 95% CI 3.64 to 5.67). Constant shoulder scores were higher in day cases versus inpatients. Conclusion: Day case shoulder replacement is safe with comparable outcomes to routine inpatient care for patients up to ASA 3 classification with high satisfaction and excellent functional outcomes.

Outcomes Following Type C Distal Humeral Fracture Fixation Using Two Different Osteosynthesis Techniques.

BACKGROUND: Distal humeral fractures are notorious injuries, and they require surgical fixation. The reliability of reconstruction devices has been a subject of debate. Our primary outcome was to detect differences, if any, between two different groups of patients using the patient-reported outcomes measurement information system (PROMIS) Global-10 form and to compare it with the Mayo elbow performance score (MEPS) results. Other secondary outcomes included the difference in union time between patients who received a reconstruction plate vs those who received a pre-contoured anatomical plate. MATERIAL AND METHODS: It is a prospective randomised study which included a total of 30 cases equally distributed into two groups. RESULTS: The mean PROMIS and MEPS scores for group A were 31.5 SD 6.6 and 77.7, respectively, compared to 33.7 SD 6.66 and 73, respectively, for the other group. Time to union was 13.4 weeks for group A and 12.6 weeks for the other group. There was no statistically significant difference between the groups regarding union and function. However, reconstruction plates were more cost effective. The correlation between the MEPS and PROMIS G scores in both groups was statistically significant. CONCLUSION: 1. Recon plates continue to be a cost-effective method of treatment in simple intra-articular fractures. 2.PROMIS is a valuable tool to be used along with other scores in future studies.

Evaluation of Acute Outcomes and Factors Influencing the Care of Chest Trauma in a District General Hospital in the United Kingdom.

Background The rate of chest trauma admissions under the Queen Hospital Burton Orthopedic team has been steadily increasing, surpassing other hospital trusts. Patients are managed locally by the Orthopedic department, unlike in major trauma centres. Understanding the management outcomes and patient factors in this setting is crucial for enhancing patient safety. Methodology A retrospective analysis of 139 patients with chest trauma referred to the QHB Orthopedic team from October 2017 to May 2021 was conducted using the Meditech-V6 electronic medical records system (Meditech, Westwood, US). This study aims to evaluate the outcomes of patients admitted with chest trauma and improve current practices. The objectives include assessing patient factors influencing outcomes, initiating discussions with a major trauma centre, and enhancing the quality of care for chest trauma patients. Results The mechanism of injury in all cases of chest injuries was blunt trauma, accounting for 100% of the cases. The specific mechanisms of injury observed in the study included falls from standing, falls from height, road traffic collisions, and assault. The study comprised 139 individuals, 128 of whom were diagnosed with rib fractures, and 11 who did not have any rib fractures. In addition, two patients were hospitalized with bilateral rib fractures, both of which were life-threatening. Tragically, one of these cases resulted in the death of the patient. With regard to outcomes, 67% of the patients received a consultation at Royal Stoke Hospital (RSH). Eight individuals were transferred to RSH for further management, while the remaining 131 patients were not transferred. Eighty-seven individuals were discharged from the hospital, indicating successful recovery and readiness for discharge. However, it is noteworthy that nine patients experienced complications during their hospital stay, highlighting the potential challenges and risks associated with chest trauma management. Tragically, seven patients succumbed to their injuries and passed away.  Conclusions The majority of patients in this study were aged 65 and over and presented with multiple comorbidities, indicating the complex medical profile of this population. However, despite the presence of life-threatening injuries and the associated risks, only a minority of patients in the study were transferred to a designated trauma centre. This raises concerns about the adequacy of the current transfer protocols and the potential impact on patient outcomes.

How Do Orthopaedic Patients Prefer to Be Contacted During a Pandemic?

Introduction Communication with patients is a vital part of the surgical pathway, and when done effectively, it can greatly improve patient outcomes and patient satisfaction and reduce canceled appointments. Different forms of communication work well for different patient demographics, and it is important to optimize communication techniques. We designed a study to review the communication preferences of orthopedic patients during the COVID-19 pandemic. Methods A cross-sectional study was performed by asking patients who were due to undergo orthopedic procedures to answer a questionnaire on their communication preferences, the reminder notice period for appointments, and safety and satisfaction ratings during the COVID-19 pandemic. Results Communication method preferences are influenced by patient factors such as gender and age. Phone calls were the most popular communication method throughout all patient groups, with 61% selecting it as their preference. Younger patients preferred multiple communication methods of phone calls, texts, and emails, whereas the older group had a stronger preference for letters. Letters were more popular among females (28% compared to 10% of males), whereas males had a stronger preference for other communication methods. The majority of patients said they would not have liked a letter prior to their clinic appointment (65%). Of those who indicated a preferred notice period, 73% would have liked five days or less notice prior to their clinic appointment, while 65% would have liked 10-14 days notice prior to their surgery. The average safety rating was 55%. The overall satisfaction rating with the communication process was 71.7%. Conclusion The COVID-19 pandemic has changed patient feelings towards healthcare and, as a result, changed the way healthcare is delivered. Communication method preferences among trauma and orthopedic patients vary and depend on factors such as gender and age. If healthcare departments can optimize their communication processes, they will improve their patient outcomes and enhance their resources.

A Rare Presentation of Myositis Ossificans in a Diabetic Individual.

Introduction: Myositis ossificans (MO) is a disease with self-limiting, benign ossifying lesions. MO traumatica is most common cause and occurs after blunt trauma to muscle tissue and the most common site of occurrence is the anterior thigh often developing after an intramuscular hematoma. The pathophysiology of MO is not well understood. The association of myositis and diabetes is quite rare. Case Report: A 57-year-old male presented with a discharging ulcer on the right lateral lower leg. A radiograph was carried out to ascertain the degree of bone involvement. However, the X-ray showed calcifications. Ultrasound, magnetic resonance imaging (MRI) and X-ray imaging were used to exclude malignant disorders such as osteomyelitis or osteosarcoma. The diagnosis of myositis ossificans was confirmed with MRI. As the patient had a background of diabetes, this could have led to MO as a result of the macrovascular complication of a discharging ulcer; hence, diabetes could be considered a risk factor for the disease. Conclusion: The reader may appreciate that diabetic patients may present with MO and that repeated discharging ulcers may imitate the effects of physical trauma on calcifications. The specific take home message is that regardless of the apparent rarity of a disease and subversion to typical clinical presentation, it should still be considered. Furthermore, the exclusion of severe and malignant diseases which benign diseases may mimic is of utmost importance to correctly manage patients.

Systematic Review of Current Approaches to Tibia Plateau: Best Clinical Evidence.

If not treated adequately, tibia plateau fractures result in premature osteoarthritis and lifelong disability. The advent of newer implants and techniques to improve outcomes has necessitated the development of different surgical approaches. A Medline and EMBASE search (June 2020) was conducted to identify publications during the last 10 years that focused on surgical approaches for proximal tibia fractures/ tibia plateau management. A total of 2107123 and 2715399 articles were found related to fractures in this area with 133 and 103 review articles looking at the approach on MEDLINE and EMBASE, respectively. This article reviews the continued development of the surgical approaches to aid understanding for surgeons and identify areas for future research to help improve outcomes. Although the anterolateral approach is the most commonly applied surgical technique, having the knowledge of newer approaches (medial, posteromedial, posterolateral, or direct posterior) in the armamentarium is necessary to treat the vast array of fracture patterns. There has been a shift amongst trauma surgeons of using a combination of approaches for complex tibia plateau fractures.

An algorithmic approach to shoulder pathology.

Introduction: Shoulder pain is a common presentation in both hospitals and the community. Shoulder pain can result from a number of different pathologies and to manage the shoulder pain, an accurate diagnosis is needed. Method: An accurate diagnosis can often be made following a detailed history and examination. Investigations, such as imaging and blood tests may also be required. In this study, we provide an algorithmic approach to shoulder pain that can be used in the clinical setting. Summary: This algorithm can be used in hospitals and the community to help identify and manage the different causes of shoulder pain.

Results of Wedgeless Distal Femoral Osteotomy for the Treatment of Genu Valgus Deformity.

INTRODUCTION: Coronal plane knee deformities are common disorders affecting adolescents. Valgus deformities (tibiofemoral angle (TFA) > 12-15 degrees and intermalleolar distance (IMD) > 10 cm) often require corrective osteotomy and a wedgeless "V" distal femoral osteotomy is a good treatment option for such deformities. MATERIALS AND METHODS: Thirty adolescent patients (13-17 years) with valgus deformities were included. Patients with severe collateral ligament instability, subluxation, and sagittal plane deformity > 15 degrees or genu valgum due to tibial deformity were excluded. Preoperative clinical (Bostman's knee score, IMD, and knee-flexion test) and radiological evaluations were done. The surgery (wedgeless distal femoral V osteotomy) was performed and stabilized with two Kirschner wires (K-wires). Postoperative clinical and radiological parameters were recorded including complications. RESULTS: The preoperative TFA was 20.23 ± 3.63 degrees, which reduced to 5.5 ± 0.73 at six months postoperatively. The preoperative IMD was 12.45 ± 2.2 cm, which reduced to 1.63 ± 0.32 cm at six months. The mean mechanical axis deviation (MAD) and lateral distal femoral angle (LDFA) were recorded as 2.8 ± 0.39 and 87.7 ± 0.83, respectively, and the differences were statistically significant from preoperative values. The Bostman score was 26.2 ± 1.79 at three months and 29.47 ± 0.9 at six months. The complications included infection in two patients, a hypertrophic scar in one patient, and common peroneal neuropraxia in one patient. CONCLUSION: Wedgeless distal femoral osteotomy with K-wire fixation is a viable option for correction of genu valgus deformity with potential advantages of minimal blood loss, no leg length discrepancy, non-rigid fixation, and early union as compared to other treatment options.

The Use of Fluoroscan in Hand Clinic During the Covid Pandemic to Optimise Conservative Treatment.

Introduction The study assessed the use of Fluoroscan (Hologic, Inc., Marlborough, MA) in hand clinic as advised by the British Orthopaedic Association (BOA) during the COVID-19 pandemic to facilitate treatment of fractures requiring manipulation and reduce admissions to evaluate if this should be embedded in practice permanently. Method Eighty-three wrist and hand fractures requiring manipulation were identified between April 2020 and March 2021. Demographics, mechanism of injury, timing of intervention, radiological outcome, further intervention and functional assessment by QuickDASH scoring were recorded. Results Sixty-eight cases were manipulated within the first week of fracture, simple pain control measures were used, and dose area product (DAP) averaged 1.3 Gy cm2 well below the dose limit set by the trust. Satisfactory fracture reduction was achieved in 59 cases avoiding admission. Further surgical intervention was offered to 24 patients: five re-manipulated while 19 had operation, all with a good functional outcome. Conclusion Fluoroscan use in fracture clinics achieved effective fracture control in 77% of cases. The use of Fluoroscan avoided admissions for surgery during the pandemic and lengthy clinic visits, four out of five did not need admission.