Scaphoid nonunion: a novel modification of Matti-Russe technique with enhanced recovery and full clinical and radiographic union.

BACKGROUND: A scaphoid fracture is a common injury affecting the wrist joint. A fracture of the carpus scaphoid can heal uneventfully or be complicated by non-union. Scaphoid non-union can result in persistent wrist pain, and with functional difficulties affecting all activities of daily living of the patients, this disability is expected to be significant since most of these patients are young active adults. HYPOTHESIS: Extensive removal of the bone from the scaphoid, with the application of a large amount of cancellous bone graft and fixation with two to three wires, could lead to a high union rate and a good functional outcome. METHODS: Eighteen patients with scaphoid fracture non-union were recruited during their visit to the upper limb clinic at our institute. Demographic data were collected, and data regarding comorbidities, smoking, manual work, and others were recorded. Data regarding the interval between injury and surgery, time to radiographic union, and functional wrist scores were reported as well. RESULTS: A cohort of 18 patients was included. The mean age of patients was 30 years; most of our patients were healthy (83.3%), and more than two-thirds were smokers (72.2%). The mean follow-up time was 18 months (1.5 years), 15 patients (83.3%) achieved radiographic unions by 2-3 months, and the remaining 3 patients (16.7%) achieved radiographic unions by (4-5) months, i.e., all patients achieved successful radiographic unions by 5 months at maximum. The mean Mayo score for our series was 83.6 (± 12.4), with 5 patients (27%) achieved ≥ 95% which indicates a significantly high functioning wrist in our cohort. CONCLUSION: Our modified technique with enhanced stability from using three k-wires can achieve full clinical and radiographic unions and result in enhanced recovery postoperatively with cast immobilization limited to 6 weeks total. LEVEL OF EVIDENCE: IV Case series study.

Talar neck non-union in an athlete successfully treated with a synthetic bone graft: A case report.

Talar neck non-union is a rare complication of talar neck fractures. No guidelines are currently available for the proper management of this complication; thus, it can be hard for orthopaedic surgeons to successfully treat. Here we are reporting a case of talar neck non-union occurring in a 22-year-old male patient after a road traffic accident and presented to our institution 10 months after the initial injury. The non-union was managed surgically with an open reduction and internal fixation with the use of a synthetic bone graft to fill the defects. The patient regained full function and remained without complications after 7 years of follow up.

A novel method in assessing lower limb motor function.

PURPOSE: To propose a novel, accurate, and easy to perform test replacing the manual muscle testing. Our target is to develop a valuable tool for identification of patients with neurological motor impairment precisely, rapidly, and easily. METHODS: We have randomly selected patients presenting to the clinic complaining of back pain with or without lower limb symptoms. These patients were asked to walk on their heels and on their toes. Being unable to walk on heels and/or toes, the patient is considered to have positive test result (abnormal finding). After that, a full and thorough neurological examination was performed on every patient by an orthopedic resident doctor. We looked specifically to the correlation between the ability to do toe-heel walking with the results of the detailed neurological examination. RESULTS: Toe-heel walking test was able to detect all patients with weakness in their lower limb musculature. The results from the current investigation indicate a very high Pearson correlation of 0.95 ( p = 0.001) between the toe-heel test and manual muscle testing. CONCLUSION: Toe-heel walking test is superior to detailed neurological examination in identification of patients with weakness, sphincter problem, and/or positive straight leg raising test. This test is both simple and rapidly performed test, which can be easily done by any health-care provider. Owing to its ease, this test is not restricted to medical doctors, but it could be accurately performed by any health-care provider such as nurses and physiotherapists. This will enable us to decrease the referral to the specialty clinic and to decrease the overall cost.

Does integrating research into the prosthetics and orthotics undergraduate curriculum enhance students' clinical practice? An interview study on students' perception.

BACKGROUND: Problem-based learning (where rather than feeding students the knowledge, they look for it themselves) has long been thought of as an ideal approach in teaching because it would encourage students to acquire knowledge from an undetermined medium of wrong and right answers. However, the effect of such approach in the learning experience of prosthetics and orthotics students has never been investigated. OBJECTIVES: This study explores the implications of integrating problem-based learning into teaching on the students' learning experience via implementing a research-informed clinical practice module into the curriculum of last year prosthetics and orthotics undergraduate students at the University of Jordan (Amman, Jordan). STUDY DESIGN: Qualitative research pilot study. METHODS: Grounded theory approach was used based on the data collected from interviewing a focus group of four students. RESULTS: Students have identified a number of arguments from their experience in the research-informed clinical practice where, generally speaking, students described research-informed clinical practice as a very good method of education. CONCLUSION: Integrating problem-based learning into teaching has many positive implications. In particular, students pointed out that their learning experience and clinical practice have much improved after the research-informed clinical practice. CLINICAL RELEVANCE: Findings from this investigation demonstrate that embedding problem-based learning into prosthetics and orthotics students' curriculum has the potential to enhance students' learning experience, particularly students' evidence-based practice. This may lead to graduates who are more knowledgeable and thus who can offer the optimal patient care (i.e. clinical practice).

A systematic procedure to optimise dose and image quality for the measurement of inter-vertebral angles from lateral spinal projections using Cobb and superimposition methods.

BACKGROUND: Patients with vertebral column deformations are exposed to high risks associated with ionising radiation exposure. Risks are further increased due to the serial X-ray images that are needed to measure and asses their spinal deformation using Cobb or superimposition methods. Therefore, optimising such X-ray practice, via reducing dose whilst maintaining image quality, is a necessity. OBJECTIVES: With a specific focus on lateral thoraco-lumbar images for Cobb and superimposition measurements, this paper outlines a systematic procedure to the optimisation of X-ray practice. METHODS: Optimisation was conducted based on suitable image quality from minimal dose. Image quality was appraised using a visual-analogue-rating-scale, and Monte-Carlo modelling was used for dose estimation. The optimised X-ray practice was identified by imaging healthy normal-weight male adult living human volunteers. RESULTS: The optimised practice consisted of: anode towards the head, broad focus, no OID or grid, 80 kVp, 32 mAs and 130 cm SID. CONCLUSION: Images of suitable quality for laterally assessing spinal conditions using Cobb or superimposition measurements were produced from an effective dose of 0.05 mSv, which is 83% less than the average effective dose used in the UK for lateral thoracic/lumbar exposures. This optimisation procedure can be adopted and use for optimisation of other radiographic techniques.