Is there a Consensus in the Management of Distal Radial Fractures?

This unique postal survey was setup to assess the agreement on treatment options in displaced distal radius fractures and whether or not there existed a consensus amongst the surgeons contacted. With this in view we contacted 244 surgeons and 166 completed answers were received.We chose two common examples of displaced distal radius fractures. Case one was a 38 year old teacher with a closed, displaced extra-articular fracture (Frykman type II) of her left non-dominant hand and case two was a 42 year old carer, with a closed, displaced intra-articular fracture (Frykman type VII) of her right dominant wrist. There was a questionnaire included with these radiographs.In the first case, 82 (49%) surgeons favoured MUA + K-wiring, 47 (28%) favoured volar plating and 14 (8%) an external fixator. In the second case, 28 (17%) surgeons favoured MUA + K-wiring, 53 (32%) advocated volar plating and 33 (20%) an external fixator. Furthermore surgeons with specialist Upper limb interest were more likely to apply a volar plate (63% in either case) whilst the surgeons with general or other areas of expertise (18% in first case and 23% for second case).In conclusion there is no consensus among the Orthopaedic surgeons in treating displaced distal radial fractures. A multicentered randomized clinical trial would help elucidate the best treatment options.

Anatomical study comparing the thickness of the volar and dorsal cortex of cadaveric adult distal radii using digital photography.

INTRODUCTION: Dorsally displaced fractures of the distal radius fractures are one of the commonest in day-to-day practice. There is still no consensus among surgeons regarding the suitability of using volar or the dorsal cortex as basis for internal fixation for dorsally displaced fractures. BACKGROUND: We report an anatomical study, which compares the thickness of the volar and dorsal cortices of cadaveric adult radii using digital photography. RESULTS: Results of this study show that the volar cortex was statistically, significantly thicker than the dorsal cortex. We believe that the volar cortex may behave as the calcar of the distal radius and hence internal fixation devices applied to the volar cortex may provide a more stable internal fixation compared to those based on the dorsal cortex.

Early results of the Acclaim elbow replacement.

The Acclaim total elbow replacement is a modular system which allows implantation in both unlinked and linked modes. The results of the use of this implant in primary total elbow replacement in 36 patients, operated on between July 2000 and August 2002, are presented at a mean follow-up of 36 months (24 to 49). Only one patient did not have good relief of pain, but all had improved movement and function. No implant showed clinical or radiological loosening, although one had a lucent area in three of seven humeral zones. The short-term results of the Acclaim total elbow replacement are encouraging. However, 11 patients (30.5%) suffered an intra-operative fracture of the humeral condyle. This did not affect the outcome, or the requirement for further surgery, except in one case where the fracture failed to unite. This problem has hopefully been addressed by redesigning the humeral resection guide. Other complications included three cases of ulnar neuropathy (8.3%) and one of deep infection (2.8%).

Knee skin temperature following uncomplicated total knee replacement.

This prospective study aimed to establish the pattern of knee skin temperature following uncomplicated primary total knee replacement. Thirty-two patients were included. The skin temperature of operated and contralateral knees was measured preoperatively and daily during the first 6 weeks postoperatively. Measurements were also taken at 3, 6, 12 and 24 months following surgery. The difference in temperature between the two knees had a mean value of (+)2.9 degrees C at 7 days. This mean value decreased to (+)1.6 degrees C at 6 weeks, (+)1.3 degrees C at 3 months, (+)0.9 degrees C at 6 months (+)0.3 degrees C at 12 months and (+)0.0 degrees C at 24 months. Following uncomplicated total knee replacement, the operated knee skin temperature increases compared to the contralateral knee. The difference decreases gradually but remains statistically significant up to at least 6 months following surgery. In the absence of other features of infection, local knee warmth should not cause concern.

Average versus maximum grip strength: which is more consistent?

The average of three consecutive measurements is the most frequently used method for grip strength assessment. The purpose of this study was to compare the consistency of the maximum value with that of the average value of three consecutive measurements of grip strength. One hundred healthy volunteers participated in this study. Three measurements of grip strength were taken on two occasions separated by 2 weeks. For each hand, two average values and two maximum values were obtained. Ninety-five per cent limits of agreement for the average method were - 8.3 (-23%) to +7.2 (+20%)kg and for the maximum method were - 8.8 (-23%) to + 8 (+21%)kg. Both methods of grip strength assessment were found to be highly consistent with no statistically significant difference.

The position of the centre of the distal radial articular surface in the sagittal plane: a radiological study.

Using a digital vernier calliper, measurements of the position of the centre of the distal radial articular surface in the sagittal plane with respect to the long axis of the distal radius were made on 50 lateral radiographs of normal wrists. In all 50 cases, the centre of the distal radial articular surface was palmar on the long axis of the radius. The mean value for this palmar position was 5.3mm (44% of the radial shaft width). There was no correlation between the position of the centre of the distal radial articular surface and either the width of the radial shaft, the length of the articular surface of the distal radius or the age or sex of the individuals. However, the position of the centre of rotation was found to correlate with palmar tilt. The palmar position of the centre of the distal radial articular surface on the long axis of the radius may be biomechanically important.

Palmar cortical angle of the distal radius: a radiological study.

Fifty lateral radiographs of normal wrists were viewed to determine the palmar cortical angle of the distal radius. The palmar cortical angle is different to its previously described palmar tilt or angulation. The mean value for the palmar cortical angle was 37 degrees (range, 26-50 degrees). This may be clinically important in the design of palmar plates for the distal radius.

Superior dislocation of the patella; a case report and review of the literature.

Superior dislocation of the patella is a rare diagnosis. A 72 year old woman attended the accident and emergency department of the hospital with a painful right knee after a knock to the knee. Clinical examination and radiographs confirmed a superior dislocation of the patella, which was reduced and closed with the aid of simple analgesia. The authors present the case report and discuss the relevant literature.