Restoration of the volar cortex: predicting instability after manipulation of distal radial fractures.

INTRODUCTION: Distal radial fractures are one of the most common fractures that are presented to the emergency department (ed). The management of non-emergent cases often involves closed reduction and immobilisation before referral to orthopaedic services. Surgical intervention is offered based on the criteria for instability. This can be predicted from the initial and post-manipulation radiographs. The purpose of this study was to assess the role of various predictors of instability in the requirement for surgery, based on specific evidence-based criteria. PATIENTS AND METHOD: We audited 87 consecutive distal radial fractures that had been manipulated by the ED and analysed what factors predicted instability. RESULTS: The most significant predictor of instability and hence further surgery was the failure to anatomically restore the volar cortex (VC) (p = 0.002) during the manipulation. Other significant factors were increasing age (p = 0.006) and fracture of the ulna styloid (p = 0.028). If the VC was restored or remained intact during the manipulation, only 38% required further surgery. If the VC was displaced or not restored, 65% required further surgery. CONCLUSION: The restoration or maintenance of volar cortical alignment during the manipulation of distal radial fractures offers patients the best chance of avoiding the need for further surgery. This factor should be taken into account in the decision-making process for these fractures.

Hip stability after ligamentum teres resection during surgical dislocation for cam impingement.

PURPOSE: The purpose of this study was to investigate whether patients who have undergone surgical hip dislocation with excision of the ligamentum teres exhibited symptoms of a Type I ligamentum teres rupture. METHOD: A questionnaire was designed to enquire about specific symptoms attributed to Type I injuries (complete rupture) in the literature: gross instability, incomplete reduction, inability to bear weight and mechanical symptoms. 217 consecutive patients were surveyed and 161 patients (75%) returned 168 questionnaires (75%). Mean age was 34 and median follow-up was 51 months (35 to 97). RESULTS: All patients were able to fully weight bear after surgery while 77% experienced no groin pain and 61% experienced no pain on exercise. 35% of patients experienced popping and locking in their operated hip and 24% had subjective feeling of their hip giving way. CONCLUSION: Patients who have had surgical excision of the ligamentum teres during open osteochondroplasty for cam deformities do not exhibit symptoms of a Type I ligamentum teres rupture. Our results show that minor instability symptoms may be present but symptoms present more like to Type II (partial) injuries. We propose that Type II injuries be divided into Type IIa; partial tear and Type IIb; iatrogenic rupture.