Mental disorder in limb reconstruction: Prevalence, associations and impact on work disability.

OBJECTIVE: This cross-sectional survey aimed to assess the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and drug and alcohol dependence in a limb reconstruction population and examine associations with demographic and functional variables. METHODS: As part of routine clinical care, data were collected from 566 patients attending a tertiary referral centre for limb reconstruction between April 2012 and February 2016. Depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol and drug dependence were measured using standardised self-report screening tools. RESULTS: 173 patients (30.6% CI 26.7-34.4) screened positive for at least one of the mental disorders assessed. 110 (19.4% CI 16.2-22.7) met criteria for probable major depression; 112 (19.9% CI 16.6-23.2) patients met criteria for probable generalised anxiety disorder; and 41 (7.6% CI 5.3-9.8) patients met criteria for probable PTSD. The prevalence of probable alcohol dependence and probable drug dependence was 1.6% (CI 0.6-2.7) and 4.5% (CI 2.7-6.3), respectively. Patients who screened positive for depression, anxiety and PTSD reported significantly higher levels of pain, fatigue, and functional impairment. Depression and anxiety were independently associated with work disability after adjustment for covariates (OR 1.98 (CI 1.08-3.62) and OR 1.83 (CI 1.04-3.23), respectively). CONCLUSION: The high prevalence and adverse associations of probable mental disorder in limb reconstruction attest to the need for routine psychological assessment and support. Integrated screening and management of mental disorder in this population may have a positive impact on patients' emotional, physical and occupational rehabilitation. A randomised controlled trial is needed to test this hypothesis.

Is there a role for lengthening flexor hallucis and flexor digitorum longus tendons in surgery for club foot?: a preliminary report.

Most cases of club foot (congenital talipes equinovarus) respond to non-operative treatment but resistant cases may need surgery. It is broadly accepted that lengthening of tendo Achillis, the tendon of tibialis posterior and capsulotomy of the ankle and subtalar joints are necessary during surgical release, but there is no consensus as to whether lengthening of the tendons of flexor hallucis longus and flexor digitorum longus is required. We randomised 13 children with severe bilateral club foot deformities to undergo lengthening of the flexor hallucis longus and flexor digitorum longus tendons on one side and simple decompression on the other. We found no difference in the deformities of the toes between the lengthened and non-lengthened sides at a mean follow-up of four years (2 to 6). We conclude that routine lengthening of the tendons of flexor hallucis longus and flexor digitorum longus during soft-tissue surgery for resistant club foot is not necessary.

Transfer of pectoralis major in arthrogryposis to restore elbow flexion: deteriorating results in the long term.

We present the long-term results of pectoralis major transfer to restore elbow flexion in seven patients (ten procedures). The early results in all the patients were encouraging but with longer follow-up a gradual and progressive flexion deformity was observed with a decrease in the arc of flexion in eight elbows, reaching > or = 90 degrees in all cases. The results of pectoralis major transfer deteriorate with time due to the development of a recalcitrant flexion deformity of the elbow. With bilateral involvement we now recommend that the procedure be undertaken on one side only to allow the hand to reach the mouth for feeding, while the opposite side remains in extension for perineal toilet.

Separation of the proximal femoral epiphysis after derotation varus osteotomy of the femur.

Proximal femoral varus and derotation osteotomy is a common procedure performed in the management of developmental dysplasia of the hip. This procedure imposes high shear stress on the femoral epiphysis, depending on the degree of varus obtained. We report two cases of proximal femoral epiphyseal slip after varus derotation osteotomy and discuss the management and outcome. Such epiphyseal slip may or may not be symptomatic, and a careful radiologic examination should be carried out in suspected cases. Management should be individualised. Surgical correction of varus may be required.

Herbert screw insertion in the scaphotrapezial joint. A cause of degenerative change?

The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.

Elbow fractures with carpal injuries.

We report four cases with six episodes of concurrent carpal and elbow fractures or dislocations. Few such combinations of injuries have been reported in the literature. We discuss the mechanism and management of such injuries and conclude that elbow injuries should be suspected in severe carpal injuries. Surgical treatment may be required in their management.

Pancreatitis after alar-transverse fusion for spondylolisthesis. A case report.

Acute pancreatitis complicated the postoperative care of a 16-year-old girl treated by alar-transverse fusion for spondylolisthesis. Pancreatitis was diagnosed by a marked increase in plasma amylase in conjunction with abdominal ultrasonography. Symptoms resolved with conservative treatment. Pancreatitis should be suspected when unusual abdominal symptoms persist after spinal surgery.

Pigmented villonodular synovitis arising from the sheath of the extensor hallucis longus in an eight-month-old infant.

Pigmented villonodular synovitis (PVS) is a disease of unknown origin that most commonly affects the synovial joints and synovial sheaths of the skeletally mature. In an eight-month-old infant, a leg swelling thought likely to be a sarcoma proved to be PVS on biopsy.

Fracture of the scaphoid associated with volar displacement of a lower radial epiphyseal fracture. Case report.

A 13-year-old boy fell off his bicycle and landed on his outstretched left hand, sustaining a Salter-Harris type II fracture of the lower radial epiphysis with volar displacement, and an undisplaced fracture across the waist of the left scaphoid. After manipulation, and immobilisation for six weeks, he made a complete recovery and has no residual deformity. We hypothesise that the fracture was caused by the weight of the body being taken by the relatively stiff and immobile hand, and could find no report of a similar case.