ABSTRACT
Volar locking plates are increasingly used in the management of distal radius fractures. As with any new implant, understanding the rate and type of potential metalwork related complications is important. In this study, we reviewed 114 distal radius fractures treated with volar locking plating. Our aim was to determine the type and rate of metalwork complications requiring reoperation. In our series, 12 cases (10%) underwent further surgery for metalwork related complications mainly for screw protrusion into the radiocarpal joint following fracture collapse. Our results suggest that volar locking plates are associated with a high rate of metal work related complications requiring further surgery. Technical aspects to reduce such complications are discussed.
Subject(s)
Bone Plates/adverse effects , Bone Screws/adverse effects , Fracture Fixation, Internal/adverse effects , Postoperative Complications/surgery , Radius Fractures/surgery , Reoperation/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Internal/instrumentation , Fracture Healing , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Radiography , Radius Fractures/diagnostic imaging , Retrospective Studies , United Kingdom/epidemiology , Young AdultABSTRACT
PURPOSE: Loosening is an important cause of failure of upper limb arthroplasty and improvement in cementation techniques may limit this. The currently accepted medullary canal preparation techniques use saline washing and gauze drying. Another method of bone preparation uses carbon dioxide compression gas jet which blows debris from the canal, whilst simultaneously drying the bone. We compared the push out strengths of cement plugs in sections of human cadaveric radii that had been prepared using either syringed saline or carbon dioxide jet cleaning. METHODS: Following bone preparation, four radii in each group, were cemented in a standardised fashion, and cut into 1 cm sections. An Instron materials testing machine was used to measure the force needed to push the cement plug out of the bone section. RESULTS: The force needed to push out the cement plug was significantly higher in the carbon dioxide jet (median 580.61, IQR 429.10-650.05) as compared to the saline group (median 366.57N, IQR 271.05-502.23), P = 0.009. The mechanism of failure of the bone-cement interface also differed between the two groups, with 100% of the sectioned cortices fracturing prior to cement extrusion in the carbon dioxide jet group, but only 23% of the sectioned cortices doing so in the saline group. CONCLUSION: Our results suggest that there is a statistically stronger macro-interlock at the bone-cement interface after preparation of the medullary canals of radii using a carbon dioxide compression gas jet as compared to saline irrigation.
Subject(s)
Bone Cements , Cementation , Radius , Stress, Mechanical , Therapeutic Irrigation/methods , Carbon Dioxide , Humans , In Vitro Techniques , Materials Testing , Prosthesis Failure , Sodium ChlorideSubject(s)
Muscle, Skeletal/injuries , Tendon Injuries/surgery , Humans , Muscle, Skeletal/surgery , RuptureABSTRACT
We describe a modification of the McLaughlin procedure for persistent posterior shoulder instability following posterior glenohumeral dislocation with a large antero-medial reverse Hill-Sachs lesion. In the original McLaughlin description, the subscapularis was divided close to its insertion to the lesser tuberosity and sutured into the reverse Hill-Sachs lesion using bone drill holes. In our newly described technique, the subscapularis tendon is not divided but is instead plicated into the reverse Hill-Sachs lesion using suture anchors inserted in the humeral head defect. We present the case of a patient with persistent posterior instability following traumatic posterior glenohumeral dislocation, successfully treated with our new technique.
Subject(s)
Joint Instability/surgery , Shoulder Dislocation/surgery , Suture Anchors , Tenodesis/methods , Adult , Chronic Disease , Female , Humans , Joint Instability/diagnostic imaging , Postoperative Complications/diagnostic imaging , Radiography , Range of Motion, Articular/physiology , Recurrence , Shoulder Dislocation/diagnostic imagingABSTRACT
INTRODUCTION: Cutiplast (absorbent perforated dressing with adhesive border; Smith & Nephew) is commonly used following orthopaedic operation, but complications of its use have been reported. A prospective, randomised, controlled study was performed to compare the efficacy of Cutiplast versus an Aquacel (hydrofibre dressing; ConvaTec) covered with Tegaderm (vapour-permeable dressing; 3M). PATIENTS AND METHODS: Two-hundred patients were randomised to receive one of the two dressings following elective and non-elective surgery of the hip and the knee. We were able to study 183 patients. The condition of the wound and any complications such as skin blistering or signs of infection was noted as was the frequency of dressing changes. RESULTS: The Aquacel and Tegaderm dressing was 5.8 times more likely to result in a wound with no complications as compared to a Cutiplast dressing (odds ratio, 5.8; 95% CI 2.8-12.5; P < 0.00001). CONCLUSION: Aquacel covered by Tegaderm is a superior dressing to Cutiplast following surgery to the hip and knee.
