A less invasive distal osteotomy of the radius for malunited dorsally displaced extra-articular fractures

A less invasive corrective osteotomy for symptomatic post-traumatic deformity of the distal radius was done in 12 patients. They were followed up for an average of 3.7 years. The indications for correction were based on the patients' level of activities, pain, functional limitations, loss of grip strength or deformity occurring with an extra-articular rotational malunion of the distal end of the radius. The procedure included a dorsal open wedge osteotomy through a dorsal incision in which the fulcrum of rotation, or hinge, was located at the palmar cortex, and stabilized with an extra- and intramedullary fixed angle device. The bone defect was replaced with autologous morsellized iliac bone graft. The final outcome was graded as very good in eight patients, good in two and fair in two. Level of evidence: IV.

Fatal bilateral lower-limb deep vein thrombosis and pulmonary embolism following single digit replantation

Venous thromboembolism in hand surgery is rare. There is no report in the literature on postoperative mortality from venous thromboembolism following microsurgery in upper limbs. We report the case of a 56-year-old Chinese man who died from pulmonary embolism as a result of bilateral lower-limb deep vein thrombosis following prolonged surgery under general anaesthesia after replantation of a finger. This case raises awareness of the need for precautions against venous thromboembolism following prolonged microsurgery and identification of high-risk patients.

The accuracy of sizing of the femoral component in total knee replacement

PURPOSE

Femoral sizing in total knee replacement is important. Either undersizing or oversizing may result in deleterious effects to the clinical outcome after the surgery. There has been no study on the precision and accuracy of femoral sizing and the effect of measurement at different landmarks over the distal femur. This study assesses the intra-observer and inter-observer error of femoral sizing and identifies the effect of the placement site of the anterior referencing tool on femoral sizing.

METHODS

Five investigators with different clinical experience measured the femoral size of 10 cadaveric specimens twice using three anterior referencing tool. The measurement of the femoral size was repeated at nine designated points on the anterior cortex of the cadaveric femora.

RESULTS

Excellent intraobserver and interobserver agreements were obtained using the three anterior referencing tools. When the size on which the majority agreed was regarded as the actual size of the specimen, measurement at the nine designated points on the anterior cortex showed a deviation from the actual size from 6.2 to 46.2 %. Placing the femoral sizer stylus at the middle and 2 cm above the proximal margin of the anterior femoral condyle yielded the highest precision and accuracy.

CONCLUSION

Regardless of the experience of the surgeons, measurement of the femoral size using the three anterior referencing tools is very accurate. Placing the stylus of the femoral sizer at the middle and 2 cm above the proximal margin of the anterior femoral condyle best reflects the actual size of the femur.

LEVEL OF EVIDENCE

Experimental study.

Volar plate fixation of intra-articular distal radius fractures: a retrospective study

Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series.

Autologous osteochondral graft for traumatic defects of finger joints

Finger joint defects in 16 adults were treated with an autologous osteochondral graft from the base of the second metacarpal, the radial styloid, the base of the third metacarpal or the trapezoid and these patients were followed up from between 12 and 62 months. There was no donor site morbidity. One patient had resorption of the graft and developed pain. The joint was subsequently fused. The mean range of movement was 55.8% of the opposite normal joint. At follow up, 15 patients had no discomfort or mild discomfort. Three had mild narrowing of the joint space and two had slight joint subluxation. Only two patients with concomitant severe injury to the same limb had difficulty performing daily activities. Ten were open injuries and these had poorer outcomes. A hemicondylar defect of a finger joint can be treated using an osteochondral graft obtained from the same hand.

Osteoporosis: public awareness, commitment, and perspectives

OBJECTIVE

To explore public awareness of osteoporosis and willingness to manage the problem, with reference to a variety of socio-economic factors.

DESIGN

Cross-sectional questionnaire study.

SETTING

A public hospital and a private health care clinic in Hong Kong.

PATIENTS

Two hundred and fifty postmenopausal women consisting of five equal cohorts recruited at random. The cohorts consisted of: patients with fragile fracture, their next-of-kin, patients (without fragile fractures) from a government primary health care clinic, patients from a government orthopaedic clinic, and patients from a private primary health care clinic.

RESULTS

Only 81% of those interviewed had heard of the disease. Among these, 92% believed that the government was responsible for managing osteoporosis. Most (83%) were willing to self-finance treatment; a higher percentage were willing to do so among those with relatives having osteoporotic fractures. Most (87%) of the subjects underestimated the cost. Less than 40% expected to pay more than HK$ 1,200 annually. Given the current market price, only 66% would still consider undertaking the treatment. Notably, 99% of interviewees would commence treatment provided the cost was lower.

CONCLUSION

Direct costs of managing osteoporosis deter the public from commencing treatment. If the cost of treatment could be lowered and publicised, a dramatic increase in self-financed treatment can be anticipated.