What is a Bristow-Latarjet procedure? A review of the described operative techniques and outcomes.

OBJECTIVES: A variety of operative techniques have been described as under the term 'Bristow-Latarjet' procedure. This review aims to define the original procedure, and compare the variation in techniques described in the literature, assessing any effect on clinical outcomes. MATERIALS AND METHODS: A systematic review of 24 studies was performed to compare specific steps of the technique (coracoid osteotomy site, subscapularis approach, orientation and position of coracoid graft fixation and fixation method, additional labral and capsular repair) and detect any effect this variability had on outcomes. RESULTS: Overall recurrence rate was 5.36% (2.94% to 43%). Half of the studies performed the procedure for recurrent shoulder instability, with only five studies documenting glenoid bone loss as an indication: 12 studies used the procedure as the primary surgical intervention for recurrent instability. No change in outcome was noted when examining variation in the coracoid osteotomy site, the fixation site on the scapular neck, the fixation method or whether a capsular repair was also performed. Performing a horizontal split in subscapularis may preserve external rotation compared with performing a tenotomy. CONCLUSIONS: This is the first review to examine various operative techniques of the Bristow-Latarjet procedure, and their effect on outcome. We found that other than the approach through subscapularis, outcome was independent of the surgical technique, and depended more on patient selection. We would commend future publications on this procedure to provide a detailed description of the surgical technique, and as a minimum present rates of recurrence as an outcome measure. Cite this article: Bone Joint J 2016;98-B:1208-14.

Ligament repair and reconstruction in traumatic dislocation of the knee.

We treated 21 patients with 22 dislocations of the knee by repair or reconstruction of all injured ligaments. Eight knees were treated in the acute phase (less than two weeks after injury); the remainder were treated more than six months after injury (6 to 72). Reconstructions were carried out with a combination of autograft and allograft tendons and by direct ligament repair where possible. At a mean follow-up of 32 months (11 to 77) the mean Lysholm score was 87 (81 to 91) in the acute group and 75 (53 to 100) in the delayed group. The mean Tegner activity rating was 5 in the acute group and 4.4 in the delayed group. The International Knee Documentation Committee assessment revealed no differences between the two groups. Instrumented testing of knee stability indicated better results for anterior cruciate ligament reconstructions which had been undertaken in the acute phase, but no difference in the outcome of posterior cruciate ligament reconstructions. There was no difference in the loss of knee movement between the two groups. Although the differences were small, the outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees which had been reconstructed within two weeks of injury.

Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols.

We compared two protocols of early mobilisation for minimally displaced radial head fractures through a single-blinded, prospective randomised trial. Sixty patients were randomly allocated to either immediate active mobilisation or 5-day delay before active mobilisation was commenced. Patients were reviewed at 7 days, 4 weeks and 3 months after injuries. A blinded observer assessed each patient. All fractures united by the third month. At the end of 7 days, the mobilisation group had less pain (visual analogue scale (VAS) 6 versus 7.6, P=0.002); greater flexion (mean 112 versus 98 degrees, P=0.0004); greater strength in supination (P<0.001) and better elbow function (Morrey Score: 54 versus 43, P=0.005). By the fourth week, both groups were comparable in all parameters and improvement continued into the third month. Mean limit of extension at the third month were 2.3 degrees in the immediate mobilisation group and 1.8 degrees in the delayed group (NS). All had excellent function on the basis of the Morrey Score. Immediate mobilisation did not adversely affect the outcome; the patients had less pain and better elbow function at 1-week post-injury. Pain, ranges of movement and function were similar by the fourth week post-injury.

The reliability of the American Knee Society Score.

We have investigated the reliability of the American Knee Society Score (AKS), a widely used functional outcome score for knee arthroplasty. 29 subjects were assessed in random order by 6 observers, each patient seen twice by each observer. The interobserver reference intervals were 16 points for the Knee Score (0-100 points) and 21 points for the Function Score (0-100 points). The intraobserver reference intervals were smaller, 11 points and 13 points for the Knee Score and the Function Score, respectively. The presence of arthritis in other joints and general debility did not affect the reliability of the scores. The more experienced observers had greater intraobserver reproducibility. Notably, we found moderate agreement between observers in the subjective variables, while the objective variables produced lower levels of agreement. The high inter- and intraobserver variations of the AKS makes estimation of score change questionable. Reliable use of the AKS would necessitate repeated evaluation by an experienced observer.

Spiral computed tomography with two- and three-dimensional reconstruction in the management of tibial plateau fractures.

Spiral computed tomography (CT) with three-dimensional and multiplanar reconstructions was used in the evaluation of tibial fractures in nine patients. Computed tomography added important information to that obtained by plain radiographs. Five (55%) fractures were reclassified. The degree of articular depression was often underappreciated on plain radiographs. Furthermore, the fracture complexity and the spatial relation of fragments could be readily demonstrated with 3-D reconstruction. This technique is useful in planning operative reconstruction.

Which primary total knee replacement? A review of currently available TKR in the United Kingdom.

Comparative information on total knee replacements (TKRs) is not readily available. With the help of implant manufacturers and distributors, we have compiled a list of TKRs on the market in the UK and summarised the information about these implants in a table. There are 37 different TKRs, marketed by 14 companies; 54% have been introduced since 1990. The number of different implants is increasing. At least eight designs have undergone major modifications, while many have had minor alterations. Of the TKRs on the market, 60% are modular. Some 54% of TKRs have no published results in peer-reviewed journals; only one of the four most widely used prostheses has published survival figures. New and modified implants are introduced without clinical evidence of their superiority over other available designs. Published results in peer-reviewed journals are currently the best evidence available on the reliability of an implant. When selecting an implant, surgeons should be aware if the prosthesis has any such results, the length of the follow-up, and the survival rates that are achieved. More detailed interpretation is difficult because of the different combinations used in modular implants and because of the frequent modification of existing designs. Properly conducted long-term clinical trials should be encouraged as they are the only means of evaluating new designs.

Hair thread tourniquet syndrome.

Tourniquet of hair and thread fibres may become tightly wrapped around a child's digit. The resultant ischaemia may lead to tissue necrosis and autoamputation. Experience with two patients is reported. The need for prompt recognition and complete removal of all fibres is stressed. The possibility of non-accidental injury should be born in mind.