Preliminary results of the 'Surgilig' synthetic ligament in the management of chronic acromioclavicular joint disruption.

BACKGROUND: Chronic instability of the acromiocavicular joint is relatively common and normally occurs following a fall onto the point of the shoulder. Reconstruction of the joint [Weaver-Dunn procedure] using the coracoacromial ligament is often required in service personnel, and a number of methods to augment this repair have been used. Many of these operative methods require a second operation to remove the metalwork, and in addition can be associated with a failure rate of up to 30%. The 'Surgilig' was originally designed for use in the revision of failed Weaver-Dunn procedures. However this study evaluates its use in the primary operation, reinforcing the autologous graft, in an attempt to reduce the failurerate. DATA COLLECTION AND ANALYSIS: We prospectively followed up the Modified Weaver Dunn procedures using Surgilig. The post-operative x-rays were reviewed at six weeks, three months and then six months to assess the radiological success of the procedure. Our patients were discharged at six months. RESULTS: We have performed this procedure in 11 patients. One of the 11 patients was excluded from the study as the Surgilig graft was used in addition to a hook plate. The remaining ten patients have all reached the six-month post-operative time with no incidence of radiological failure of the graft. After six months they were discharged from clinic follow-up asthe coracoacromial graft had sufficient strength to no longer rely on the augment for mechanical stability of the joint. All 10 patients had a good clinical and radiological result. One patient even had inadvertent stress/ weight-bearing x-rays taken at six weeks, with no discernable detrimental effect to outcome. CONCLUSION: Although a small study, these initial results for primary fixation of acromioclavicular joint disruption with Surgilig are extremely encouraging. The results suggest that Surgilig should continue to be used in its current role. As patient numbers increase, a follow-up study to evaluate these preliminary findings should be conducted.

Penetrating missile injuries during asymmetric warfare in the 2003 Gulf conflict.

BACKGROUND: War wounds produce a significant burden on medical facilities in wartime. Workload from the recent conflict was documented in order to guide future medical needs. METHODS: All data on war injuries were collected prospectively. This information was supplemented with a review of all patients admitted during the study period. RESULTS: During the first 2 weeks of the conflict, the sole British field hospital in the region received 482 casualties. One hundred and four were battle injuries of which nine were burns. Seventy-nine casualties had their initial surgery performed by British military surgeons and form the study group. Twenty-nine casualties (37 per cent) sustained gunshot wounds, 49 (62 per cent) suffered wounds from fragmentation weapons and one casualty detonated an antipersonnel mine. These 79 patients had a total of 123 wounds that were scored prospectively using the Red Cross Wound Classification. Twenty-seven (34 per cent) of the wounded were non-combatants; eight of these were children. Four patients (5 per cent) died. CONCLUSION: War is changing; modern conflicts appear likely to be fought in urban or remote environments, producing different wounding patterns and placing non-combatants in the line of fire. Military medical skills training and available resources must reflect these fundamental changes in preparation for future conflicts.

Ballistic fractures--the limited value of existing classifications.

We have assessed a number of ballistic fracture classifications but were unable to identify one that could adequately grade the severity of the injury, assist in determining the optimal treatment or predict outcome. Many of the existing classifications are based on experimental studies or radiological appearance and do not take into account the soft tissue injury, which is usually the main prognostic indicator. In addition few differentiated between different bones, and some were specific to only one bone. We would suggest that ballistic fractures are treated on an individual basis, specifically considering the soft tissue injury, the anatomical location of the injury and any involvement of joints. The specific weapon or muzzle velocity are not of prime importance, and classifications should not be based on these.

Functional outcome after hip fracture. A 1-year prospective outcome study of 275 patients.

Two hundred and seventy-five consecutive patients over the age of 50 years admitted with a hip fracture were prospectively studied in detail, to assess the impact of a hip fracture on their functional ability and their need for social support. One hundred and eighty-three (66.9%) patients survived to 1 year. Mortality was highest amongst those least able to perform the recorded activities. One hundred and fifty-eight (86%) of the survivors were resident in the same level of accommodation after 1 year. There was a reduction in mobility and related functions of 20-25% and a reduction of 5% in tasks not related to hip function. It is therefore estimated that in the year after a hip fracture there will be decline in functionally abilities of about 5% unrelated to the hip fracture and about 15-20% directly related to the hip fracture. There was an increase in the requirement for social support amongst survivors individually, but overall the total economic burden on social services and institutional care was not significantly changed by hip fracture.