Defining the upper extremity range of motion for safe automobile driving.

BACKGROUND: There are no guidelines for return to driving following upper extremity injury. A greater comprehension of the role of the upper extremity in driving is required to assist clinicians in their fitness-to-drive assessments. This research aims to assist clinicians by analyzing the motion at the upper extremity in safe automobile driving. METHODS: Thirty-six participants were recruited to the Monash University Accident Research Centre's driving simulator. They were tested in a realistic driving simulation using highway scenarios and traffic hazards. An OptiTrack™ motion tracking system recorded participants' upper limb movements. FINDINGS: The following ranges of motion were recorded (left and right arm mean whole numbers): The shoulder flexed from 14 to 54°, abducted to 18°and adducted to 9°. Shoulder rotation ranged from 6° external to 32° internal rotation. Elbow flexion ranged from 35° to 72°. Pronation reached 77° and supination to 24°. Wrist flexion reached 34° and extension reached 23°. The wrist deviated to 17°radially and 38° ulnar. To avoid simulated hazards, the steering wheel revolved 57.2° (SD 19.2). The key movements in hazard avoidance are shoulder flexion, shoulder rotation, forearm rotation and wrist deviation. INTERPRETATION: Shoulder flexion, internal rotation and forearm rotation have been shown to be key upper extremity movements in safe driving. Clinicians can refer to the ranges of motion recorded in this investigation, or the driving task at hand in their fitness-to-drive assessments. The ability to revolve the steering wheel 100° exceeds the 95th percentile of the steering wheel revolution angle required to avoid simulated traffic hazards.

Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture.

INTRODUCTION: Tibial plafond fractures represent a small but complex subset of fractures of the lower limb. The aim of this study was to describe the health related quality of life, pain and return to work outcomes 12 months following surgically managed tibial plafond fracture. METHODS: The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) database was used to identify patients with tibial plafond fractures. All patients captured by VOTOR with a tibial plafond fracture between September 2003 and July 2009, were identified consecutively and comprised the initial cohort. The radiographs of all identified patients were classified using the AO/OTA fracture classification. A review of the included patient's medical records was performed. Data were collected on the injury event, management and complications. Outcomes at 12 months were prospectively collected by telephone interview and included return to work, a numerical rating scale for assessment of pain and the Short Form 12 (SF-12). RESULTS: There were 98 unilateral tibial plafond fractures; 91 fractures were managed operatively, 4 non-operatively and 3 underwent amputation. The 91 operatively managed patients were the focus of this study. A two-stage management approach, involving temporary external fixation, followed by definitive open reduction and internal fixation, was the most common operative treatment. The follow-up rate at 12 months was 70%. 57% had returned to work by 12 months post-injury, the median (IQR) pain score was 2 (0-5) and 27% reported moderate to severe persistent pain. Mean PCS-12 scores were significantly lower than Australian norms (p=0.99), 38.2 for males and 37.5 for females. CONCLUSIONS: The presence of persistent pain, loss of physical health and a low return to work rate highlights the profound impact of tibial plafond fractures on patients' lives. Although this study looked at the early 12 month results, it is expected these outcomes will continue to improve over time. Further studies, with larger patient numbers, must focus on how to improve not only the operative management of these fractures, but also patient's mental and overall physical health in the long term. Improved management techniques and early identification of injury patterns known to perform poorly may help long-term outcomes.

Axillary artery injury after an anterior shoulder fracture dislocation and "periosteal sleeve avulsion of the rotator cuff" (SARC). Case report and review of the literature.

We present the rare complication of an axillary artery injury associated with an anterior dislocation of the humerus and what we believe to be the first reported periosteal sleeve avulsion of the entire rotator cuff (SARC). We review the literature and discuss the cause of this unusual injury pattern.

Complete closed brachioradialis tendon rupture: a case report.

A complete brachioradialis tendon rupture, as an isolated incident, is extremely rare. Consequently, there is little to no literature on how this can occur and how to treat it. We present the case of a 44-year-old male with a complete, closed brachioradialis tendon rupture following a waterskiing accident. The clinical, imagining and operative findings are outlined alongside management and final outcomes. Our case highlights the effectiveness of a combined surgical and staged physiotherapy approach, for the management of a complete, closed brachioradialis tendon rupture, in an otherwise healthy man.