Posterolateral rotatory laxity following surgery to the head of the radius: biomechanical comparison of two surgical approaches.

The lateral ligament complex is the primary constraint to posterolateral rotatory laxity of the elbow, and if it is disrupted during surgery, posterolateral instability may ensue. The Wrightington approach to the head of the radius involves osteotomising the ulnar insertion of this ligament, rather than incising through it as in the classic posterolateral (Kocher) approach. In this biomechanical study of 17 human cadaver elbows, we demonstrate that the surgical approach to the head can influence posterolateral laxity, with the Wrightington approach producing less posterolateral rotatory laxity than the posterolateral approach.

The 'modified triple staple' technique: a variant stapling technique for anastomosis after low anterior resection.

INTRODUCTION: Stapled techniques of coloanal anastomosis in anterior resection have gained widespread acceptance over hand anastomosis. We believe a modification of the 'triple staple technique' has ergonomic advantages over existing stapling methods and present our technique and experience here. METHODS: Fifty consecutive patients underwent anterior resection with a concomitant defunctioning ileostomy in 44 (86%) patients. A modified triple staple technique of side to end coloanal anastomosis was performed without the need of a purse string suture on the proximal and the distal segments. RESULTS: There were no major intra-operative complications. 2/50 (4%) clinical leaks and 2/37 (5.4%) radiological leaks were noted. A combined leak rate of 4/50 (8%) was reported. The incidence of anastomotic stricture encountered was 1/50 (2%). CONCLUSION: The modified triple staple technique for side to end anastomosis in anterior resection has ergonomic advantages and comparable safety to the existing techniques of stapling coloanal anastomosis. We believe this technique can be widely adopted as an added alternative to the current techniques of stapled anastomosis after anterior resection.

Should the tibia be reamed when nailing?

A systematic review was performed to assess reamed and unreamed tibial nailing. Only prospective, randomised studies comparing reamed and unreamed tibial nailing in adults were included. A literature search found 1200 possible articles. There were seven comparative studies. These articles were independently assessed by all three authors. Three studies met the inclusion criteria. Each outcome measure tested was assessed for heterogeneity. If significant heterogeneity was present, data from the studies was not combined. If there was no significant heterogeneity, a combined odds ratio was calculated using a fixed effects model and a Z-test was performed to test the overall effect. Two hundred and ninety-one tibial shaft fractures were entered into the included studies. Two hundred and eighty (96%) were followed up (148 reamed; 132 unreamed). There was an increased non-union rate when the tibia was not reamed (p = 0.02). Screw breakage was more common in the unreamed group (p<0.0001). This study could find little difference in the incidence of other complications following reamed or unreamed tibial nailing.

Reaming during anterograde femoral nailing: is it worth it?

A systematic review was performed to assess the relative merits of reamed and unreamed antegrade femoral nailing. To be included, a study had to be prospective, randomised or pseudorandomised, comparing reamed and unreamed antegrade femoral nailing in adults. Where more than one study from the same institution was available, only the study with longest follow-up was included. A literature search found 2044 possible articles. Of these, eight studies compared reamed and unreamed femoral nailing. The methodology of these articles was independently assessed by all the three authors. Five studies met the inclusion criteria. Each outcome measure tested was assessed for heterogeneity. If significant heterogeneity was present, the data were not combined. If there was no significant heterogeneity, a combined odds ratio or weighted mean difference was calculated using a fixed effects model, and a Z-test was performed to test the overall effect. Six hundred and forty-seven femoral fractures (315 reamed; 332 unreamed) were entered into the included studies. Unreamed nailing was quicker and associated with significantly less blood loss (P < 0.00001). Reaming significantly reduced the time to union (P = 0.00001), non-union (P = 0.002), delayed union (P = 0.005), technical problems (P = 0.01) and reoperation rate (P = 0.001). The use of reamed femoral nails gives significant advantages over unreamed femoral nails.

Arthroscopic meniscal repair.

Although the first meniscal repair was performed over 100 years ago, many aspects of meniscal repair remain controversial. This article reviews the structure and function of the menisci, the rationale for repair and the clinical results of arthroscopic meniscal repair.