Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair.

The transosseous-equivalent Speedbridge™ technique is commonly used during rotator cuff repair; however, the soft bone of the lateral humerus may result in toggling of the lateral row anchors with subsequent de-tensioning of the repair. The technique presented here uses an additional third-row anchor, in a tripod fashion, that reduces the forces on the lateral humerus anchors and protects the repair.

Clavicle fracture nonunion in the paediatric population: a systematic review of the literature.

AIMS: Clavicle fracture nonunions are extremely rare in children. The aim of this systematic review was to assess what factors may predispose children to form clavicle fracture nonunions and evaluate the treatment methods and outcomes. METHODS: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aiming to find papers reporting clavicle fracture nonunion in children under the age of 18 years. Data was collected on patient demographics, fracture type, mechanism of injury (MOI), surgical intervention and reported outcome. Two independent reviewers evaluated all the data. RESULTS: A total of 13 articles reporting 21 cases of clavicle fracture nonunion were identified. The mean age at time of injury was 11.4 years (4 to 17). Falls were the most common MOI. The majority of nonunions occurred after displaced fractures on the right side. Six were refractures. Mean time of presentation following injury was 13.5 months (4 to 60). In all, 16 were treated surgically. Radiographic union was eventually achieved in 12 cases, with functional outcome satisfactory in all cases. CONCLUSION: Clavicle nonunion is an extremely rare but possible complication in children. The majority occur after displaced right-sided fractures or refractures and present around one year after injury. Surgical fixation provides good radiographic healing and functional outcomes. LEVEL OF EVIDENCE: IV.

Improved patient awareness and satisfaction using procedure specific consent forms in carpal tunnel decompression surgery.

Carpal tunnel decompression (CTD) is a common procedure amenable to procedure specific consent forms (PSCFs). These may help better inform patients and so increase patient satisfaction with the consent process. We assessed the use of a PSCF for CTD. The PSCF mentions eight complications of carpal tunnel surgery and alternative non-operative treatments. Two groups of 40 patients each were compared prospectively. Patients in one group were issued with a PSCF prior to admission whereas those in the other group were not. After standard pre-operative consent, patients were interviewed prior to surgery and assessed for their awareness of complications and alternative treatment options. The patients who received a PSCF showed greater awareness of different complications and alternative treatments and reported greater satisfaction with the consent process. We conclude that using PSCFs is a very useful and inexpensive adjunct to improve patient awareness and satisfaction with the consent process.

The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients.

Patients who report ongoing adverse symptoms following trapeziectomy may require revision surgery. We present a series of 10 patients who underwent revision surgery using a Silastic interpositional finger joint arthroplasty. Mean age was 60 (range 48-70) years, with a mean interval between primary and revision surgery of 34 (range 12-84) months. Review was performed at an average of 53 (range 21-136) months. Nine of the 10 patients reported improvement in pain, and all patients reported improvement in pinch grip, activities of daily living, and satisfaction at having undergone revision surgery. There were no complications. We found good medium-term results and high satisfaction rates. We advocate this technique as an effective treatment option in these difficult cases, provided other treatable causes of poor outcome are excluded.

The ultrasound halo sign in angiolymphoid hyperplasia of the temporal artery.

An ultrasound halo sign surrounding the temporal artery is a well recognized feature associated with giant cell arteritis. We report a previously unreported case of this halo sign being present around the temporal artery due to angiolymphoid hyperplasia with eosinophilia (ALHE) in a young female patient.

Ethics of refusing parental requests to withhold or withdraw treatment from their premature baby.

In the United Kingdom women have access to termination of pregnancy for maternal reasons until 24 weeks' completed gestation, but it is accepted practice for children born at or beyond 25 weeks' gestation to be treated according to the child's perceived best interests even if this is not in accordance with parental wishes. The authors present a case drawn from clinical practice which highlights the discomfort that parents may feel about such an abrupt change in their rights over their child, and argue that parents should have greater autonomy over treatment decisions regarding their prematurely born children.