Open Latarjet Versus Arthroscopic Bankart Repair for the Treatment of Traumatic Anterior Shoulder Instability in High-Demand Patients With Minimal Glenoid Bone Loss.

BACKGROUND: This study compared the clinical outcomes and return to sports/work between open Latarjet and arthroscopic Bankart repair in high-demand patients with traumatic anterior shoulder instability with minimal glenoid bone loss. METHODS: We prospectively recruited 30 patients and randomised them to either open Latarjet or arthroscopic Bankart. The mean duration of follow-up in our study was 13.27 months±2.70. All patients were males with a mean age at surgery of 28.6 years (range, 18-41 years). RESULTS: The overall mean for the Rowe score in the 30 patients increased from 33.5±14 points preoperatively to 79.6±18 points. However, there was no statistically significant difference in the postoperative ROM (range of motion) and Rowe score among the Bankart and Latarjet groups. The main finding in our study was the time to return to sports/work which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (seven months). CONCLUSIONS: Open Latarjet is considered a more invasive and non-anatomical procedure, however, it is less costly with a shorter time to return to sports/work compared to the Bankart procedure, which is very crucial for high-demand patients, especially the competitive athletes targeting an early return to sports at the same pre-injury level with minimal incidence of recurrence, making the surgeon's choice very challenging.

A case report with review of literature of a rare variant of midfoot dislocations (mid-Chopart dislocation): Combined naviculo-cuneiform and calcaneo-cuboid dislocation.

Closed midfoot and Chopart dislocations are uncommon injuries. Moreover, a combination of these dislocations is extremely rare. A 30-year-old male presented to our emergency department with mid-Chopart dislocation (combined naviculo-cuneiform and calcaneo-cuboid dislocation). Adequate open reduction with dual approach (dorsomedial and dorsolateral) and fixation with K-wires were achieved. Although the patient had satisfactory functional outcome postoperatively, he developed midfoot arthritis 12 months later. This type of dislocation is not yet classified, with only few cases reported in the literature. LEVEL OF CLINICAL EVIDENCE: 4.

Clinical Outcome of Percutaneous Intramedullary Fixation for Midshaft Clavicular Fractures Using Elastic Stable Nails.

BACKGROUND: This study investigated the clinical outcomes of fixation of displaced middle-third clavicular fractures using percutaneous elastic stable intramedullary nails. MATERIAL AND METHODS: This study included sixty patients with a mean age of 26.40 ± 8.91 years (16-53 years) presented with a displaced middle third fracture of the clavicle. According to the Robinson classification, 48 cases (80%) were type 2B1, 9 cases (15%) type 2B2 and 3 case (5%) 2A1. All cases were treated by elastic intramedullary nails and followed up for at least 12 months. RESULTS: At the end of the twelve months' follow-up period, the mean Constant Shoulder score was 95.70 ± 13.55, ranging from 48 to 100. 54 patients (90%) had excellent results, 3 patients (5%) had an adequate result and 3 patients (5%) had a poor result. There was a statistically significant relationship between the final score and age and associated medical conditions. CONCLUSIONS: 1. Elastic Stable Intramedullary Nailing is an image-dependent procedure indicated best for young medically free athletes with simple 2-part middle third clavicle fracture. 2. Hammering is not recommended to avoid dorsolateral cortex perforation. 3. The most common complication is medial skin irritation because of the subcutaneous position of the clavicle as well as the sharp end of the cut nail.

Sub-Axial Cervical Facet Dislocation: A Review of Current Concepts.

Cervical facet dislocation is a serious injury that carries risks of short- and long-term morbidity. The optimal management of these injuries remains controversial with the ongoing debate regarding indications and requirements for closed reduction, timing, type of surgical approach and method of fixation. This review gives an update on the relevant anatomy, classification systems for sub-axial cervical facet dislocation and an overview of the current concepts regarding their management, including surgical approaches and the choice of implants.

Mortality Following Distal Femur Fractures Versus Proximal Femur Fractures in Elderly Population: The Impact of Best Practice Tariff.

Background and objectives The mortality after hip, proximal femur, fractures in elderly patients has steadily declined in the last decade in the United Kingdom as a result of implementing of multiple protocols focusing on prompt multidisciplinary pre- and post-operative optimization and reducing time to surgery. The pinnacle of these protocols is the development of the best practice tariff as an incentive program for hospitals that meet set criteria by the National Health Service (NHS) England in managing these injuries. Until the time of writing this paper, there was no parallel program for the management of fractures involving distal femur in the elderly. The aim of this study is to evaluate the outcomes of distal femur fractures in elderly patients against proximal femur fractures regarding post-injury mortality, the prevalence of surgical treatment and time delay till surgery. Methods A retrospective study of all patients above the age of 60 admitted to Queens Hospital Burton between 2010 and 2014 with fractures involving distal end of the femur. Patient data were assessed for demographic criteria, co-morbidities as per Charleston Comorbidities Index, type of management, time-lapse before surgery and 30-day, six-month and one-year mortality. Results were compared to an age-matched control group of patients with proximal femur fractures randomly selected during the same time window. Results The main demographic criteria such as age, gender, and Charleston Comorbidities Index were similar in both groups. There were more patients treated non-operatively in the distal femur group than in the proximal femur group (15% vs 4%). Time to surgery was statistically significantly longer in distal femur group compared to the proximal femur (49.130 hours vs 34.075 hours, P = 0.041). The mortality in distal femur group was higher at all times (9.68% at 30 days, 20.32% at six months and 34.41% at one year) when compared to that in the proximal femur group (6.99% at 30 days, 14.52% at six months, 21.51% at one year). Conclusion The distal femoral fractures showed higher mortality at 30 days, six months and one year compared to the proximal femur group. This could be partly influenced by the implementation of best practice tariff in the proximal femur fracture group reflected in less time to surgery, pre- and post-operative multidisciplinary approach and more frequent operative management.

Short-term Clinical Outcome of Proximal Humeral Fracture Fixation Using Minimally Invasive Trans-Deltoid Approach.

BACKGROUND: This study examined the clinical outcomes of fixation of displaced fractures of the proximal humerus using a trans-deltoid approach. MATERIAL AND METHODS: Twenty patients (13 male and 7 female) were treated with this technique, with a mean age of the patients of 38.85 years (range, 19 to 64 years). All patients were followed up for at least twelve months and were evaluated according to the Constant shoulder score. RESULTS: The mean Constant Shoulder score was 87.45, ranging from 63 to 100. Ten patients (50%) had excellent results, four patients (20%) had good results, three patients (15%) had satisfactory results, and three had adequate results (15%). There was a statistically significant difference between the type of the fracture and the final score (p=0.013), where 3-part fractures with impaction (11-B1), either valgus or varus impaction, showed higher scores than those without impaction. Four patients presented with post-operative complications varying from superficial infection to radial nerve palsy. CONCLUSIONS: 1. The trans-deltoid approach was a safe and reliable alternative to the delta-pectoral approach for the treatment of displaced proximal humerus fractures. 2. The impacted (11-B1) fracture type was a signifi-cant contributing factor in terms of good functional outcomes.

A Case Report of an Open Pan-Talar Dislocation.

Total talar extrusion is a rare injury that most commonly occurs secondary to high-energy trauma. There are few reported cases of open dislocations in literature and still, there is no consensus regarding the appropriate treatment of the extruded talus. In this case report, we present a 12-month follow-up of a patient with an open talar dislocation with extrusion treated with immediate surgical debridement, reduction and temporary fixation with one Steinmann pin. No infection was reported, although the patient developed avascular necrosis.