Initial clinical experience of the use of digital tomosynthesis in the assessment of suspected fracture neck of femur in the elderly.

OBJECTIVE: This study was undertaken to evaluate the use of digital tomosynthesis (tomogram) for diagnosis of suspected fracture neck of femur (NOF). We hypothesised that the use of cross-sectional imaging (MRI/CT) could be reduced by using tomogram to separate the patients with suspected NOF fractures that require MRI/CT scan from those who do not. MATERIALS AND METHOD: Forty-one patients with a clinically suspected NOF fracture, following trauma, with negative AP and lateral hip X-rays, underwent a hip tomogram examination. Patients with a negative tomogram and clinically moderate to high probability of a hip fracture underwent MRI/CT within 48 h. RESULT: Tomogram identified fracture NOF in six patients, who underwent appropriate surgical treatment without needing further imaging. Fifteen patients, with negative tomogram examinations for fracture NOF and a low clinical probability of a fracture did not undergo additional MRI/CT scanning. At 6 months of follow-up, none of the patients returned to the hospital with complications. Twenty patients with moderate to high clinical probability of fracture NOF with negative or inconclusive tomogram underwent additional MRI/CT scanning (19 MRI, 1 CT). Two patients showed fracture NOF, and one patient with greater trochanter fracture on tomogram showed fracture NOF on MRI scan. Seventeen patients showed soft tissue injury, bone oedema or pubic rami/acetabular fractures on MRI scan. CONCLUSION: Tomogram is a reliable imaging modality that can be used to select the patients who will need additional MRI/CT scan following negative or equivocal plain X-ray in patients with suspected hip fractures following fall. LEVEL OF EVIDENCE: III.

A case report of Progressive subluxation leading to an anterior dislocation of the hip following sliding hip screw fixation for pertrochanteric Extracapsular 4 part fracture neck of femur.

Unstable 4 part pertrochanteric fractures without lateral cortical support presents considerable technical problem in treatment with high risk of failure with any implant. Anatomical or slight valgus reduction and subchondral central position of the lag screw (TAD <25 mm) reduces the chance of screw cut out and other complications.

A case report of periprosthetic fracture left proximal humerus with radial nerve palsy following pectoralis major repair.

Primary repair of pectoralis major tendon with bony tunnels and anchor sutures in the proximal humerus creates a potential weakness and stress riser leading to increased risk of periprosthetic fracture and nerve damage at the site of weakness with subsequent injury, if not allowed to heal satisfactorily with adequate period of rest.

Elastic tourniquet technique for decompression of extremity compartment syndrome.

Compartment syndrome of the extremities is usually associated with direct trauma and often requires surgical fasciotomy to avert potential complications and morbidity. We present a case of upper extremity compartment syndrome resulting from pressurized infusion of autologous whole blood, in which fasciotomy was avoided by the application of a simple and effective technique using an elastic Esmarch bandage. Guidelines for surgical fasciotomy and the hazards associated with pressurized infusion of fluids in the anesthetized patient are discussed.