Concomitant coracoid base fracture and acromioclavicular joint disruption: A series of patients treated with a clavicle hook plate and review of the literature.

INTRODUCTION: Concomitant acromioclavicular joint (ACJ) disruptions with coracoid base fractures are rare high energy injuries. The management of these injuries can be challenging. The aim of this study is to assess the functional and radiographic outcomes of a retrospective case series of patients presenting with concomitant ACJ and coracoid base injuries managed with a clavicle hook plate with subsequent hardware removal at a later stage. METHODS: Six patients were identified for inclusion in the study. Radiographic and clinical data were available which allowed for collection of demographic information as well as classification of the fractures. Telephone consultation with patients allowed for collection of functional scores which included the Oxford shoulder score (OSS), QuickDASH (Q-DASH), Euroqol-5 Dimension (EQ-5D) and the SF-12 score. RESULTS: All patients were male with a mean age of 39.8 years and a median follow-up period of 34 months. All patients underwent a successful operative procedure with a median time to union of 3.75 months. Good functional outcomes were reported by all patients: mean OSS 45.0, mean Q-DASH 4.8, mean EQ-VAS 82.8 and encouraging SF-12 scores (mean PCS 56.0, mean MCS 56.4). CONCLUSION: The use of a lateral clavicle hook plate can achieve good healing and functional outcomes when managing patients with acromioclavicular joint disruptions associated with a coracoid base fracture.

Gap Non-union Patella Fractures: Case Report and Review of the Literature.

INTRODUCTION: Gap non-union patella fractures are rare but can be particularly challenging for the orthopedic surgeon. We report a case of a 12 cm gap non-union patella fracture in a patient with osteoporosis and its surgical management, functional outcome, and implications on clinical practice. CASE REPORT: A 73-year-old fully independent female with a background of osteoporosis was referred to our outpatient knee clinic. She reported a fall from stairs following an initial soft-tissue injury to the left knee 6 months prior. She has had progressive decline in mobility since the injury and was restricted to a wheelchair when she was seen in clinic. On examination, she had significant wasting of the quadriceps on the left side. Her range of movement was from 40° extensor lag to 90° flexion actively. Passive movements of the knee were preserved. She was unable to straight leg raise. Plain radiographs revealed a 12 cm gap non-union of her left patella. The patient was managed operatively in a two-staged approach. The first stage involved application of ring fixator device to achieve gradual skeletal traction from 5 to 12 lbs over a period of 10 days. The second stage involved conventional tension band wiring. CONCLUSION: At 1-year follow-up, the patient achieved full independent mobility. This case highlights the efficacy of a two-staged approach in the management of gap non-union patella fractures in patients with poor bone quality.

Assessment of lower limb rotational profile and its correlation with the tibial tuberosity-trochlea groove distance: A radiological study.

OBJECTIVE: The purpose of our study was to determine whether there is a correlation between the lower limb rotational profile and tibial tuberosity-trochlea groove (TT-TG) distance. DESIGN AND PATIENTS: The computed tomography cross-sectional imaging on 50 patients' lower limbs (100 limbs) was investigated at our institution. The TT-TG distance was measured along with rotational measurements including femoral version (FV), tibial torsion and knee joint rotation angle (KJRA). Patients were divided into two groups. Group 1 had a TT-TG ≥ 20 mm which was considered pathological and group 2 with a non-pathological TT-TG (≤19 mm). Rotational angles were compared between groups. Statistical analysis was performed using the t-test and Mann-Whitney U analysis. RESULTS AND CONCLUSIONS: Our results demonstrated a statistically significant difference in the mean KJRA (p = 0.026) between the pathological (mean = 10.6, standard deviation (SD) = 7.79°) and the non-pathological TT-TG groups (mean = 6.99, SD = 5.06°). A higher mean value for FV and tibial torsion was also demonstrated in patients with a pathological TT-TG (18.2 vs. 13.7, 32.8 vs. 30.9, p > 0.05, respectively). In conclusion, there was a statistically significant higher mean value for the KJRA in patients with a pathological TT-TG. Hence, a lateralized tibial tubercle as demonstrated by an increase in the TT-TG distance may be associated with a coexisting lower limb rotational malalignment.

Treating the Many Using a Few: A Novel Approach for the Application of External Fixators in Mass Casualties.

AIM: The aim of this is to allow the use of unsterile kit (clamps and rods) in situations where the demand for external limb fixators exceeds the available sterile equipment. BACKGROUND: In view of the recent rise in violence and terrorist activity, we have to be prepared for situations causing major incidences. These can place a large strain on our operating theaters and the available surgical kit due to the potential number of casualties. MATERIALS AND METHODS: We propose a sterile dressing technique during the application of an external limb fixator that provides an adequate seal around the pin sites and allows the use of simply decontaminated external fixator parts. CONCLUSION: This technique prevents the intraoperative contamination of the clamps and connecting rods, which allow for a sterile barrier to minimize pin site infections. HOW TO CITE THIS ARTICLE: Vris A, Al-Obaedi O, Vaghela KR, et al. Treating the Many Using a Few: A Novel Approach for the Application of External Fixators in Mass Casualties. Strategies Trauma Limb Reconstr 2019;14(2):92-93.