Fatal bilateral lower-limb deep vein thrombosis and pulmonary embolism following single digit replantation.

Venous thromboembolism in hand surgery is rare. There is no report in the literature on postoperative mortality from venous thromboembolism following microsurgery in upper limbs. We report the case of a 56-year-old Chinese man who died from pulmonary embolism as a result of bilateral lower-limb deep vein thrombosis following prolonged surgery under general anaesthesia after replantation of a finger. This case raises awareness of the need for precautions against venous thromboembolism following prolonged microsurgery and identification of high-risk patients.

The accuracy of sizing of the femoral component in total knee replacement.

PURPOSE: Femoral sizing in total knee replacement is important. Either undersizing or oversizing may result in deleterious effects to the clinical outcome after the surgery. There has been no study on the precision and accuracy of femoral sizing and the effect of measurement at different landmarks over the distal femur. This study assesses the intra-observer and inter-observer error of femoral sizing and identifies the effect of the placement site of the anterior referencing tool on femoral sizing. METHODS: Five investigators with different clinical experience measured the femoral size of 10 cadaveric specimens twice using three anterior referencing tool. The measurement of the femoral size was repeated at nine designated points on the anterior cortex of the cadaveric femora. RESULTS: Excellent intraobserver and interobserver agreements were obtained using the three anterior referencing tools. When the size on which the majority agreed was regarded as the actual size of the specimen, measurement at the nine designated points on the anterior cortex showed a deviation from the actual size from 6.2 to 46.2 %. Placing the femoral sizer stylus at the middle and 2 cm above the proximal margin of the anterior femoral condyle yielded the highest precision and accuracy. CONCLUSION: Regardless of the experience of the surgeons, measurement of the femoral size using the three anterior referencing tools is very accurate. Placing the stylus of the femoral sizer at the middle and 2 cm above the proximal margin of the anterior femoral condyle best reflects the actual size of the femur. LEVEL OF EVIDENCE: Experimental study.

Volar plate fixation of intra-articular distal radius fractures: a retrospective study.

Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series.

Osteoporosis: public awareness, commitment, and perspectives.

OBJECTIVE: To explore public awareness of osteoporosis and willingness to manage the problem, with reference to a variety of socio-economic factors. DESIGN: Cross-sectional questionnaire study. SETTING: A public hospital and a private health care clinic in Hong Kong. PATIENTS: Two hundred and fifty postmenopausal women consisting of five equal cohorts recruited at random. The cohorts consisted of: patients with fragile fracture, their next-of-kin, patients (without fragile fractures) from a government primary health care clinic, patients from a government orthopaedic clinic, and patients from a private primary health care clinic. RESULTS: Only 81% of those interviewed had heard of the disease. Among these, 92% believed that the government was responsible for managing osteoporosis. Most (83%) were willing to self-finance treatment; a higher percentage were willing to do so among those with relatives having osteoporotic fractures. Most (87%) of the subjects underestimated the cost. Less than 40% expected to pay more than HK$ 1,200 annually. Given the current market price, only 66% would still consider undertaking the treatment. Notably, 99% of interviewees would commence treatment provided the cost was lower. CONCLUSION: Direct costs of managing osteoporosis deter the public from commencing treatment. If the cost of treatment could be lowered and publicised, a dramatic increase in self-financed treatment can be anticipated.

Evaluation of a Hong Kong Chinese version of a self-administered questionnaire for assessing symptom severity and functional status of carpal tunnel syndrome: cross-cultural adaptation and reliability.

OBJECTIVES: To evaluate the application of a translated version of an established self-administered questionnaire for carpal tunnel syndrome on Chinese patients in Hong Kong. DESIGN: Evaluation of an instrument tool. SETTING: Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong; Holistic Medical Centre, Aberdeen, Hong Kong. PARTICIPANTS: Patients with carpal tunnel syndrome, translators. MAIN OUTCOME MEASURES: The adaptation was based on forward-backward translation from English to Chinese (Hong Kong) and vice versa. Meetings with translators, investigators, and patients were organised to generate an acceptable version of the questionnaire. A pilot study was carried out on 20 patients and subsequently minor adjustments were added. Fifty patients were recruited to validate the reliability and internal consistency of the questionnaire. RESULTS: The ordinality of response agreed with the original instrument. Test-retest reproducibility showed no significant difference between tests. The Pearson correlation coefficient ranged from 0.83 to 0.93. Internal consistency was good, at 0.85. CONCLUSION: Through the validation of the Hong Kong Chinese version of the questionnaire, we are able to produce an assessment tool for the local patients. Furthermore, we are able to create a platform for: (i) a cross-national and cross-cultural epidemiological comparison as well as a means of (ii) evaluating different types of treatments.