The use of intramedullary devices for adult radial head and neck fractures. A systematic review.

The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.

The use of the internal joint stabiliser for elbow instability Report of two cases and systematic review.

The management of elbow fracture-dislocations is challenging. The internal joint stabiliser (IJS) (Skeletal Dynamics, Miami, FL) has been advocated as an alternative to traditional techniques. This article shares our initial clinical experience and provide a systematic review analysing the ability of the IJS to maintain radiographic joint reduction and the associated complication profile. Two cases of elbow fracture-dislocations treated at our centre using the IJS are presented. A systematic review of the literature was conducted using the online databases Medline, Scopus and EMBASE. Clinical studies reporting the maintenance of joint reduction after the use of IJS in patients with acute or chronic elbow instability were included. The two cases reported remained radiographically concentric at 6 months follow up without complications. 5 studies met the inclusion criteria and were included in the systematic review (total n=65). Only two patients across the studies had ongoing radiological instability (3%) and both were associated with coronoid insufficiency. The mean flexion-extension arc ranged from 106° to 135° and pronation- supination arc ranged from 138° to 151°. The mean DASH scores ranged from 16 to 37.3 and the mean Broberg and Morrey Functional score from 68.2 to 93. Complication rates in the case series ranged from 21% to 40%, the commonest complications were heterotopic ossification, neuropathy and infections. Initial reports into the use of the Internal Joint Stabiliser for elbow instability have shown a low incidence of residual radiological joint incongruency.

Long-term functional outcomes following paediatric traumatic elbow dislocation, a clinical retrospective cohort study.

BACKGROUND: Paediatric traumatic elbow dislocation occurs in 6 per 100,000 children per year and if not treated promptly can result in a poor outcome. Despite this, the long-term clinical and functional outcome of these injuries has not been well described using modern patient-reported outcome tools. The aim of our study was present the outcome of these injuries in the long term. METHODS: Twenty children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016 were included in our study. Patient demographics, management and complications were recorded from the clinical notes. Ten children had associated fractures and were managed surgically, while the remaining were managed with closed reduction and immobilisation. Functional outcomes were assessed with Kim's elbow performance score. RESULTS: The mean age was 12 years (7 -15) and follow-up was 8 years (4 - 13). There was one (5%) re-dislocation requiring surgery and one (5%) ulna nerve neurapraxia that resolved within one month. The average Kim's scores were 87.5 (65 - 100) and 77.5 (60 - 100) in the closed reduction and open reduction groups, respectively (P=0.08). 80% (16/20) reported good or excellent outcome with a Kim's score of greater than 75 points with no cases of poor functional outcome reported in our series. CONCLUSIONS: Traumatic elbow dislocations in children, with or without associated fracture, have a good long-term functional outcome with appropriate early management.

Cast Immobilisation versus Wire Fixation in the Management of Middle-aged and Elderly Patients with Distal Radius Fractures.

BACKGROUND: Distal radius fractures are common and traditionally these injuries are treated non-operatively. Percutaneous wiring has been recommended as simple method to provide extra stability in distal radius fractures but their exact role is uncertain. The aim of this study was to retrospectively compare the radiographic and functional outcomes following cast immobilisation and those following wire fixation in the management of distal radius fractures and investigate which method produced better outcomes. METHODS: A retrospective parallel case series was performed between April 2011 and April 2013 of patients over 50 years treated with either cast immobilisation or wire fixation. Both intra- and extra-articular fractures were included. Radiographic measurements were made pre-operatively and at three months follow up. The QuickDASH was recorded by postal questionnaire at a mean of 2 years. RESULTS: 159 patients were included; 85 cast immobilisation group and 74 wire fixation group. Improvement in radiological parameters was seen in both groups but this was significantly better after wire fixation ([Formula: see text]). QuickDASH scores were available in 64%; no significant difference in mean scores was seen after (p = 0.147); cast immobilisation 27.1 and wire fixation 26.6. CONCLUSIONS: Cast immobilisation can produce comparable functional results to wire fixation despite worse radiological outcomes.

Simultaneous closed rupture of flexor digitorum superficialis and flexor digitorum profundus tendons in the middle finger: a case report.

A 20-year-old man suffered a closed rupture of both flexor tendons in the middle finger while playing rugby. Primary repair of the flexor digitorum profundus and excision of the flexor digitorum superficialis was performed. At follow up he reported a Disabilities of the Arm, Shoulder and Hand score of 0 and unrestricted return to activities.

Volar locking plates versus Kirschner wires for distal radial fractures--a cost analysis study.

BACKGROUND: There is an increasing trend for managing dorsally angulated distal radial fractures with locked volar plate fixation in fractures that may have previously been managed with percutaneous Kirschner wire (K-wire) fixation. There has been no prospective randomised trial comparing locked volar plate fixation with percutaneous K-wire fixation. In the absence of data guiding management with regard to clinical effectiveness, we have examined the cost of each technique. METHODS: Patients' details were collected retrospectively between June 2007 and June 2008. Ten consecutive patients who underwent percutaneous K-wire fixation for a distal radius fracture and the 10 who were treated by locked volar plate fixation were identified and their hospital notes retrieved. All patients had a closed extra-articular distal radial fracture with dorsal angulation. The duration and type of operation, including number of wires or screws used, were recorded. RESULTS: The mean age of the patients was 54 years for the locking plate group and 34 years for the percutaneous K-wire group. The mean time taken to perform percutaneous K-wire fixation with an average of two K-wires was 56 min. The mean time for applying a volar locked plate was 121 min. The cost of a pack of 10 K-wires was 3 pounds. The total cost of a standard volar locking plate and screws used was 787 pounds. DISCUSSION: In the absence of research comparing clinical end points, cost must play a major factor in determining the type of operation offered. A 56-min operation to percutaneously fix a distal radial fracture with K-wires costs 662 pounds. This compares to a cost of 2212 pounds for a 121-min locked volar plate fixation. There is a calculated difference of 1549 pounds and 65 min. CONCLUSION: With use of a locked volar plate for patients under the age of 70 years there is a loss of 652 pounds for the Trust with the present NHS tariffs.