Use of biomaterials in scaphoid fracture fixation, a systematic review.

BACKGROUND: Scaphoid fractures account for 60-70% carpal injury. Due to limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging. METHODS: A systematic search of databases including PubMed, Ovid Medline, and Google Scholar databases was made to identify studies related to the use of bioabsorbable materials in scaphoid fixation and postoperative patient outcomes. PRISMA guidelines were utilised for this review. FINDINGS: Initial search results yielded 852 studies. 124 studies were screened, with 79 patients across 7 studies included in this review. Poly-L-Lactic acid derivatives were the most common biomaterial for scaphoid fixation, with magnesium and polyglycolide also used. Levels of evidence for studies ranged between III-IV. Analysis demonstrated mixed findings with generally comparable outcomes to conventional alloy-based screws. INTERPRETATION: Development in bioabsorbable materials is ongoing, however there remains a dearth in data regarding their use in the scaphoid. Further research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.

Kicked to touch: Hoodwinked by torticollis.

A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation. Subsequent CT imaging confirmed malalignment of the upper cervical spine. The patient was admitted and worked up with MRI of the cervical spine which unexpectedly revealed a large 4×2 cm retropharyngeal abscess extending from C1 to C4. No associated structural abnormality of the spine was detected. This case report highlights the life-threatening causes of torticollis (retropharyngeal abscess and cervical spine injury), and summarises the anatomy and normal variants that one should expect on interpretation of cervical spine imagery.

Audit of Orthopaedic Surgical Documentation.

Introduction. The Royal College of Surgeons in England published guidelines in 2008 outlining the information that should be documented at each surgery. St. James's Hospital uses a standard operation sheet for all surgical procedures and these were examined to assess documentation standards. Objectives. To retrospectively audit the hand written orthopaedic operative notes according to established guidelines. Methods. A total of 63 operation notes over seven months were audited in terms of date and time of surgery, surgeon, procedure, elective or emergency indication, operative diagnosis, incision details, signature, closure details, tourniquet time, postop instructions, complications, prosthesis, and serial numbers. Results. A consultant performed 71.4% of procedures; however, 85.7% of the operative notes were written by the registrar. The date and time of surgery, name of surgeon, procedure name, and signature were documented in all cases. The operative diagnosis and postoperative instructions were frequently not documented in the designated location. Incision details were included in 81.7% and prosthesis details in only 30% while the tourniquet time was not documented in any. Conclusion. Completion and documentation of operative procedures were excellent in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions.