Management of clinical radial nerve palsy with closed fracture shaft of humerus--a postal questionnaire survey.

The management of radial nerve palsy associated with fracture shaft of humerus is still a matter of debate. Various studies based on surgical and conservative management of this clinical problem have shown good results. After a recent systematic review by Shao et al. we felt that it was timely to survey the current practice among trauma and orthopaedic surgeons in England. Postal questionnaires were sent to orthopaedic surgeons in the north of England. The response rate was 64%. The survey showed that surgeons still differ in the ways of management of radial nerve palsy associated with fracture shaft of humerus, with a slightly higher percentage of surgeons preferring conservative treatment. The study also reveals the current practice of immobilisation, investigations and the duration of expectant treatment before surgical exploration among surgeons in the north of England.

Eleven-year results of the ABG I hip replacement.

The ABG I uncemented hip prosthesis has demonstrated an unacceptably high failure rate and poor functional outcome in our patients. A prospective review was performed of 38 implanted hips with a mean follow-up of 11 years. Sixteen hips have been revised or are candidates for revision hip surgery, due principally to polyethylene wear and pelvic osteolysis. Contributing factors were likely to be the poor wear characteristics of the polyethylene liners--which were gamma irradiated in air--and the thinness of these liners. Of further concern were the poor pain and function scores in the remaining hips [mean Harris Hip Scores (HHS) of 70 (SD 22) at 11-year follow-up]. The influence of the surgical learning curve on clinical results may have been an important factor. Undersized femoral components were associated with poor pain and functional scores in five patients with HHS < 60. All ABG I hip implants must remain under careful, long-term review.

Functional treatment of acute metatarsal fractures: a prospective randomised comparison of management in a cast versus elasticated support bandage.

A randomised controlled trial was performed in 50 patients with acute isolated minimally displaced lesser metatarsal fractures in order to compare plaster immobilisation with elasticated support bandage treatment. Patients treated with elasticated support bandage had significantly higher AOFAS mid-foot scores at 3-months follow-up and complained of less pain throughout the treatment period. There was no difference between the two groups in time to independent mobility, mid-foot circumference, analgesic requirements and radiological union at 3 months. As plaster casts are associated with serious complications, which were encountered in these studies, we conclude that minimally displaced metatarsal fractures are better treated without a cast.

A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow.

We conducted a prospective, randomised, controlled trial of 45 patients (47 elbows), with tennis elbow, who underwent either a formal open release or a percutaneous tenotomy. All patients had pre- and post-operative assessment using the Disability of Arm, Shoulder and Hand (DASH) scoring system. Both groups were followed up for a minimum of 12 months. Statistical analyses using the Mann-Whitney U test and repeated measured ANOVA showed significant improvements for patient satisfaction (p = 0.012), time to return to work (p = 0.0001), improvements in DASH score (p = 0.001) and improvement in sporting activities (p = 0.046) in the percutaneous group. Those patients undergoing a percutaneous release returned to work on average three weeks earlier and improved significantly more quickly than those undergoing an open procedure. The percutaneous procedure is a quicker and simpler procedure to undertake and produces significantly better results.

Single or double plating for nonunion of the clavicle.

Between January 1982 and January 1999, 684 patients presented with a fracture of the clavicle to the accident and emergency departments of the Tamside and Bury District General Hospitals. Twenty patients (3%) subsequently developed symptomatic nonunion of the clavicle. The original injury resulted from a road traffic accident in 13 patients, from a fall on an outstretched hand in five patients, and two patients had sports related injuries. Mean age of the patients was 39 years (range, 17 to 76 years). Mean time from injury to surgery was 2.5 years (range, 6 months to 8 years). Fifteen patients underwent open reduction and internal fixation of the nonunion of the clavicle with a single plate (DCP or AO plate) and in the remaining five patients two plates were used. The clavicle went on to unite both clinically and radiographically in all patients. Mean time for clinical recovery of symptoms was 4 weeks (range, 3 to 15 weeks) and mean time for radiological union was 17 weeks (range, 15 to 35 weeks). The Constant score component for pain rose from a preoperative score of 0.71 to 13.8 +/- 3.5 (p < 0.0001, paired t-test). There was significant improvement for the level of activity of daily living from a preoperative score of 2.95 +/- 1.63 to 19.0 +/- 3.9. (p < 0.0001, paired t-test). The Imatani score for shoulder function rose from a preoperative score of 56.75 +/- 5.9, to a postoperative score of 98.39 +/- 4.0. No complications related to surgery were noted in the immediate postoperative period. Three patients required removal of the metal work. After removal of the plates there were no refractures of the clavicle. In conclusion, single or double plating of the clavicle is an effective technique in dealing with nonunions of both middle and distal thirds of the clavicle.

Surgery of Morton's neuroma: dorsal or plantar approach?

In this prospective study, 52 patients with 55 neuromas were studied in two groups. 26 patients underwent excision of the neuroma through a plantar approach and 26 through a dorsal approach. Average follow-up was 3.1 years after excision. Histology confirmed a neuroma in 51 cases. Results show that in the dorsal group weight-bearing and return to work was faster, and the duration of hospital stay was shorter, than in the plantar group. There were five painful scars in the plantar group and two in the dorsal group.

Thomas's splint with adjustable ring.

A Thomas's splint with an adjustable ring has been devised with a stainless steel hose clip, which can be adjusted up to 5 or 7.5 cm, attached on the lateral side and a hinge attached on the medial aspect of the anterior half of the ring. Thus when there is swelling in the upper part of the thigh the ring can be widened and when it goes down the ring can be tightened again so that it remains an exact fit. This prevents pressure sores developing and avoids cutting the ring in order to relieve pressure from swelling.

Lateral dome fracture of the talus.

A report of an unusual fracture of the lateral dome of the talus. The lateral fragment was displaced upwards into the inferior tibiofibular joint. Reduction was achieved by open reduction without internal fixation, and resulted in satisfactory union of the fracture without deformity or loss of joint function.