Joseph M. Queally

Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

Prevalence and impact of low body mass index on outcomes in patients with adolescent idiopathic scoliosis: a systematic review

Comparatively lower body mass index (BMI) has been reported in patients with adolescent idiopathic scoliosis (AIS)—a feature which may be an unrecognised symptom, or an organic consequence of the condition. The primary aim of this systematic review is to investigate the relationship between low BMI and AIS. A secondary aim is to investigate the effect of low BMI on outcomes of postsurgical correction in this patient group. The Cochrane Library, PubMed, SCOPUS, Web of Science and Ovid MEDLINE databases were searched up to December 2016 for relevant studies that reported prevalence of low preoperative BMI in patients with AIS and/or compared BMI between patients with AIS and healthy controls, as well as those that examined the relationship between low BMI and postoperative outcomes. Forty-five eligible studies were identified from the search strategy. Mean differences (MDs) were used with 95% confidence intervals (CI) in a random effects model to compare BMI in patients with AIS and controls in a pooled analysis of data from nine eligible studies (n = 3747 patients). In the meta-analysis, BMI of patients in the AIS group was significantly lower than those in the control group (MD −1.19, 95% CI −1.78 to −0.60). Low BMI in AIS can impact postoperative outcomes, including increased risk of ileus. This review demonstrates that patients with AIS are significantly more likely to have a low BMI compared to the general population. We advocate that closer attention be paid to AIS patients with low BMI both pre- and postsurgical correction.

Fix and replace: An emerging paradigm for treating acetabular fractures in older patients

Acetabular fractures in older patients are challenging to manage. The “fix and replace” construct may present a new paradigm for the management of these injuries. We present the current challenge of acetabular fractures in older patients. We present this in the context of the current literature. This invited editorial presents early results from our centre and the ongoing challenges are discussed.