A new approach for plate fixation of midshaft clavicular fractures.

The majority of midshaft clavicle fractures unite uneventfully. Although the indications for operative intervention are limited and reported complication rates high, there are circumstances in which surgery is required. We describe a new, infraclavicular surgical approach to the clavicle used in a series of 89 patients over 9 years. Average time to union was 13.5 weeks. There was one case of deep infection and one of non-union, both of which resolved with further treatment. These results compare very favourably with previously published series and we submit that this operative approach allows safe management of an otherwise potentially hazardous procedure.

Transient pulmonary embolism during impaction bone grafting of the femur.

We report a case of pulmonary embolism occurring transiently during impaction of morsellized bone graft in the femoral medullary canal as a part of revision hip arthroplasty. To our knowledge this complication has not yet been reported during impaction bone grafting. Increased awareness would lead to use of monitoring devices and early intervention during revision hip surgery. (Hip International 2004; 14: 48-50).

Plain radiography in the degenerate knee. A case for change.

We took posteroanterior weight-bearing radiographs, both with the joint fully extended and in 30 degrees of flexion, in a consecutive series of 50 knees in 37 patients referred for the primary assessment of pain and/or stiffness. These radiographs were reported 'blind' both by an orthopaedic surgeon and a radiologist. Direct measurement of the joint space, together with grading of the severity of erosion according to the Ahlback criteria, was undertaken. Any other abnormality present was also documented. The radiographs of the knees in 30 degrees of flexion consistently showed more advanced erosion in both the medial (p = 0.001) and the lateral (p = 0.0001) tibiofemoral compartments, when compared with those of knees in full extension. The Ahlback classification of 25 joints was altered, in some cases by several grades, by the flexed position of the joint. In every case in which another abnormality was identified on the radiograph in full extension, it was also noted on that of the knee in 30 degrees of flexion. In a further four cases, additional pathology could only be seen in the flexed knee. Every patient was able to complete the radiological examination without difficulty. Our study supports the adoption of a weight-bearing view in 30 degrees of flexion as the standard posteroanterior radiograph for the assessment of tibiofemoral osteoarthritis in patients over 50 years of age.

Development of an information system for a physiotherapy department.

This paper outlines the rationale for the development of an information system and shows how much a system can become an effective management tool for physiotherapy department directors. The author points out the need to assess both costs and benefits before venturing into the world of computerized information systems, but also makes a case for the need to establish a useful system for the gathering and processing of data that will provide useful information, whether or not computers are used to store and analyze the data. A five-step approach to the development of an information system is presented. The steps include: system analysis, selection of design approach, systems design, implementation, and system maintenance. The author states that management information systems for the future--if they are to be efficient and effective---will require department heads to develop specific methodologies of approach.

Functional value analysis of a physiotherapy department.

In these days of rising health care expenditures and public demand for physiotherapy services, physiotherapy managers are faced with many decisions regarding demands for services which run counter to budgetary limitations. This paper presents a new methodology -- Functional Value Analysis (FVA) -- which the physiotherapy department manager can use as one solution to his problem of continuing the provision of services while under financial constraints. Functional Value Analysis is a process that can be used to analyze and determine the cost of various activities that occur in a physiotherapy department. This process can also be used to generate cost-saving ideas and to priorize them. The Task Force Committee of a Manitoban hospital wanted cost-saving ideas, for 30 per cent of its budget, documented. Therefore, the physiotherapy department, along with other professional service departments at the hospital, undertook such an FVA study in October of 1978. Out of the physiotherapy departments annual budget of $615,960, the department was able to document cost-saving ideas of $267,346. Functional Value Analysis is one tool for a department manager's use which can reduce costs in an organized logical manner.