Improving osteoporosis assessment in the fracture clinic.

INTRODUCTION: The aim of this study was to compare the effectiveness of different ways of referring patients to an osteoporosis assessment service at an orthopaedic fracture clinic of a hospital in the UK. PATIENTS AND METHODS: Three methods of identifying and referring to an osteoporosis assessment service were evaluated. RESULTS: Relying on doctors for such a referral gave a catchment rate of only 1.6%. Involving patients themselves, asking them to self-refer, increased the catchment rate to 63% (P < 0.0001). Having a specialist osteoporosis and fracture liaison nurse present in clinic and reviewing the notes of patients checking in, to see if they match criteria for osteoporosis assessment, further increased catchment to 77% (P = 0.036). CONCLUSIONS: Simply having an osteoporosis assessment service and strict criteria to identify which patients should be referred to such a service will not necessarily increase catchment rate for osteoporosis patients. A nurse physically present in the clinic provided the best result, and supports the need of investing in an osteoporosis and fracture liaison nurse.

A modification of the McLaughlin procedure for persistent posterior shoulder instability: technical note.

We describe a modification of the McLaughlin procedure for persistent posterior shoulder instability following posterior glenohumeral dislocation with a large antero-medial reverse Hill-Sachs lesion. In the original McLaughlin description, the subscapularis was divided close to its insertion to the lesser tuberosity and sutured into the reverse Hill-Sachs lesion using bone drill holes. In our newly described technique, the subscapularis tendon is not divided but is instead plicated into the reverse Hill-Sachs lesion using suture anchors inserted in the humeral head defect. We present the case of a patient with persistent posterior instability following traumatic posterior glenohumeral dislocation, successfully treated with our new technique.