Complications following palmar plate fixation of distal radius fractures: a review of 665 cases.

INTRODUCTION: Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series. METHOD: Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures). RESULTS: The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases. CONCLUSION: Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.

Biomechanical assessment of a novel tendon junction.

The Pulvertaft weave has been the standard tendon junction technique used both in tendon transfers and tendon grafts. A limitation of this repair is the sequential failure of stabilizing sutures, rather than the tendon. A novel loop weave is described and compared with the Pulvertaft weave in biomechanical performance. Ovine deep flexor and extensor tendons were used to simulate Pulvertaft or loop weaves (n = 11) for tensile testing. The Pulvertaft weaves failed at the stabilizing sutures, whereas the loop weaves repairs failed by longitudinal splitting of the motor tendon. The loop weave demonstrated significantly higher mean initial failure and ultimate strengths. Tensile loads required to elongate the loop weave by 4, 6, and 8 mm were significantly higher, while more displacement was associated with the Pulvertaft repair under the application of 50, 75, and 100 N tensile loads. This study demonstrates favourable biomechanical characteristics of the new loop weave technique.

Introducing nurse telephone triage into primary care.

In this article, the authors describe the changes required to introduce a nurse telephone triage system into a large primary care practice in York. 'Whole systems' changes were necessary in that not one element of the primary healthcare team (PHCT) system has remained unaffected. The introduction of nurse triage has changed working practices, professional working relationships and job satisfaction. Far from being just a workload management solution, it has fundamentally altered the way that nurses, doctors and reception staff work together and with patients.