Optimal positioning of the DVR plate in distal radius fractures: a cadaveric examination of a referencing technique.

INTRODUCTION: Volar locking plates have revolutionised the treatment of distal radius fractures but complications are not uncommon. We present a cadaveric study and a technical tip to assist in the accurate and reproducible placement of one such plate. STUDY: We placed 25-g needles in the distal radioulnar joint and radiocarpal joint and measured the distance from these needles to a DVR plate in its optimal position. This distance measured 5mm, corresponding to the width of the depth gauge handle. Placing this next to needles in these joints can help pre-plan the most distal and ulnar extent of the plate allowing for reproducible optimal positioning of the DVR plate. TECHNIQUE: The technique developed uses the existing kit and is simple and easy to build into one's existing fixation technique.

Outcome of axillary nerve injuries treated with nerve grafts.

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

The detection of full thickness rotator cuff tears using ultrasound.

We have examined the accuracy of 143 consecutive ultrasound scans of patients who subsequently underwent shoulder arthroscopy for rotator-cuff disease. All the scans and subsequent surgery were performed by an orthopaedic surgeon using a portable ultrasound scanner in a one-stop clinic. There were 78 full thickness tears which we confirmed by surgery or MRI. Three moderate-size tears were assessed as partial-thickness at ultrasound scan (false negative) giving a sensitivity of 96.2%. One partially torn and two intact cuffs were over-diagnosed as small full-thickness tears by ultrasound scan (false positive) giving a specificity of 95.4%. This gave a positive predictive value of 96.2% and a negative predictive value of 95.4%. Estimation of tear size was more accurate for large and massive tears at 96.5% than for moderate (88.8%) and small tears (91.6%). These results are equivalent to those obtained by several studies undertaken by experienced radiologists. We conclude that ultrasound imaging of the shoulder performed by a sufficiently-trained orthopaedic surgeon is a reliable time-saving practice to identify rotator-cuff integrity.

The tent drape for the C-arm image intensifier.

Frequent maneuvering of the C-arm during intra-operative fluoroscopy in orthopaedic surgery is rarely avoidable. This can often bring the C-arm into close proximity of the surgical field risking de-sterilisation. We describe a simple and effective solution by using a sterile tent.

The use of a carbon fiber plate for periprosthetic supracondylar femoral fractures.

Operative management of periprosthetic supracondylar femoral fractures in poor-quality bone presents a challenging task for the orthopaedic surgeon. We report our experience with the use of a semirigid carbon fiber-reinforced plate in the treatment of 5 patients, all of whom were elderly women with severe osteoporosis and highly restricted mobility. All 5 of the fractures were sustained after low-energy trauma at least 2 years after primary knee arthroplasty. Except for 1 patient who died of pulmonary embolism, all 4 surviving patients progressed uneventfully to fracture union with good mobility and no residual pain. The use of this method for the treatment of periprosthetic femoral fractures has not been reported previously, and we believe it provides a successful and technically undemanding solution to this difficult problem.

Determination of total chromium in phosphate rocks by ion chromatography.

Chromium(VI) is one of seven elements which is classified in the fertilizer industry as being harmful to plants and biological systems. Phosphate rocks represent the raw material for complex fertilizer production in the world. This paper investigates for the first time the determination of total chromium in phosphate rocks by ion chromatography. The developed analytical method involves the digestion of phosphate rocks with nitric acid followed by sample treatment of the resulting solution. The digestion solution obtained was treated with an oxidising agent (potassium peroxosulphate) to convert all chromium to the hexavalent state. The analytical method developed utilizes anion-exchange ion chromatography to achieve the separation and spectrophotometric post-column reaction for detection with diphenylcarbazide. The relative standard of deviation from analytical data comparison of six different phosphate rocks with atomic absorption spectrometry and inductively coupled plasma atomic emission spectrometry techniques, and cross-analysis data against an internationally certified phosphate rock standard were between 0.58 and 1.45%. Calibration curve between 0.2 and 0.9 microgram/ml was excellent, and the method has a detection limit for Cr(VI) of 0.05 ng. The developed method offers a fast, a reliable and an alternative procedure for the determination of total chromium in phosphate rock deposits by ion chromatography.

Open-packing method for the severely comminuted fractured mandible due to missile injury.

A new approach is introduced to treat a severely comminuted fractured mandible due to missile injury, whereby denuded bony pieces are re-incorporated into the defect. These are then immobilized by open-packing with iodoform ribbon gauze. The pack is changed regularly every 10-14 days until the cavity is completely obliterated with healthy granulation tissue by which time the mandible shows good consolidation with re-alignment of all displaced bony fragments. The method is simple, safe, does not need an expert surgeon and avoids the need for a future bone graft. Iodoform packs were used in different sites of the facial skeleton and none of our patients showed signs of sensitivity to iodoform or to iodine toxicity.

Nutrient intakes of university women in Kuwait.

This study assessed the nutrient intakes of 203 female college students, aged 20-31 years, mean 21 years. Results from computer analysis of 3-day food records showed that, on the basis of group means, two thirds of Recommended Daily Allowance (RDAs) was met for all nutrients except iron, zinc, folacin and vitamin D. Nutrient intake and RDAs showed no significant differences related to marital status with the exception of vitamin D and manganese (p less than 0.05). The indexes of Nutritional Quality indicated that, on average, diets of the students met or exceeded nutrient density allowance for protein, vitamin A, vitamin C, thiamin, riboflavin, niacin, vitamin B6 and phosphorus. Nutrients for which the average female student consumption was below recommended standards on a calorie basis, were carbohydrates, fat, vitamin D, folacin, calcium, iron, zinc and sodium. The diets were limited in fibre, high in sugar, high in caffeine and slightly above recommendations in cholesterol. Female college students needed guidance in selecting nutrient dense foods. Attention in nutrition education programmes should be directed toward the individual student rather than the group.

A two-site immunoradiometric assay with magnetizable particles: human liver ferritin as a model.

Using human liver ferritin as a model, we have developed a two-site immunoradiometric assay. Sample (or standard) is incubated with excess rabbit antiserum and 125I-labeled specific sheep antibodies directed against different antigenic determinants until equilibrium is reached. Then excess sheep anti-rabbit immunoglobulin G serum, covalently linked to magnetizable particles, is added. The radioactivity bound to these particles is directly proportional to the amount of ferritin present. The assay is reproducible and precise throughout the clinically important range for ferritin in serum. Late addition of second antibodies coupled to magnetizable particles is a novel, simple, rapid, and universally-applicable separation technique for two-site immunoradiometric assays. By this approach, the first immunological reaction can occur in liquid phase, which shortens the reaction time, maximizes sensitivity, and avoids the need for continuous mixing, as compared with methods in which one of the first antibodies is immobilized on a solid phase.

A novel immunoradiometric assay for human liver ferritin.

Rivanol, the cationic salt of an acridine base, has been used as a novel separation procedure in an immunoradiometric assay for human liver ferritin. The separation step is based on the differences in charge and molecular weight between the labelled antibody-ferritin complex and free labelled immunoglobulins. The resultant assay is simple, reproducible and sufficiently sensitive to determine serum concentrations of ferritin.