Kyle Kemp

An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years) undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES), Constant score) preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1) a major recurrence of instability, (2) a single episode of subluxation, (3) any postoperative episode of instability. Eight (20%) patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P < 0.001) and 12-month (P = 0.011) evaluations. The ASES showed improvement at 6 months (P = 0.003), while the Constant score did not report significant improvement until 12 months postoperatively (P = 0.001). Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID). Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair.

Closed reduction and early mobilization in fractures of the humeral capitellum.

Seven consecutive patients with an isolated fracture of the humeral capitellum were treated by a single surgeon at a Level II care facility according to a simple treatment algorithm. Closed reduction was attempted in all cases using a standard technique. After reduction, the arm was splinted at 90° of flexion and mobilized at 14 days. All patients completed a clinical and radiographic follow-up consisting of a radiographic evaluation of reduction, elbow range of motion, Disabilities of the Arm, Shoulder and Hand Questionnaire, and a subjective rating of patient satisfaction. None of the patients required conversion to open reduction internal fixation or excision. Disabilities of the Arm, Shoulder and Hand Questionnaire scores ranged from 6 to 13 points (out of 100; mean, 9). The mean flexion/extension arc of motion obtained was 126° with minimal loss of rotation. Patient satisfaction was rated as excellent in five patients and good in two. All fractures appeared united at the most recent clinical and radiographic review. Closed reduction and early mobilization appears to be a safe and effective method of treating displaced fractures of the humeral capitellum with clinical results comparable to that of open reduction internal fixation.

Population-based incidence of proximal radial and ulnar fractures among adults in a Canadian metropolitan area

Background The lack of North American population-based incidence studies of fractures of the proximal radius and ulna creates challenges in the assessment of outcomes and corresponding complication rates. Such data may help to establish consensus regarding optimal treatments. The present studys goal was to determine the population-based incidence of proximal radial and ulnar fractures in a large metropolitan area. Methods Over a 3-year period (April, 2002–March, 2005), cases of proximal radial and ulnar fractures were documented and classified according to the AO/OTA system. Overall, age-adjusted, age-specific, gender-specific, and fracture-specific rates were calculated according to patient demographic and 2001 Canadian census data. Rates were reported as per 10,000 persons per year. Results 1030 proximal radial and ulnar fractures were identified. Fractures occurred at an overall rate of 5.09 (95%CI: 4.78 to 5.40), while the age-adjusted incidence was 5.14 (95% CI: 5.05–5.23). The most common fracture types observed were B2.1 (simple articular fracture of radius, n=374), B1.1 (unifocal articular fracture of ulna, n=280), and A2.2 (simple extra-articular fracture of neck of radius, n=145). Fracture incidence was similar among all age groups (approximately five), with the exception of patients ages 80 years and older (8.70; 95% CI: 6.24–11.16). Males and females had similar fracture incidences at all ages. Conclusions As our results indicate similar incidences across age and gender groups, our data is likely generalizable to the general population, which may provide further insight into the assessment of outcomes and complication rates of such injuries.

Elbow Dislocations in a Canadian Metropolitan Health Region: A 3-Year Population-Based Incidence Study

Background There are no current North American population-based incidence studies of elbow dislocations. This creates further challenges in assessing associated outcomes and complication rates. The present study aimed to determine the population-based incidence of elbow dislocations in a large Canadian city. Methods From April 2002 to March, 2005, consecutive cases of elbow dislocation were documented. Age-specific, gender-specific and age-adjusted rates for simple and complex dislocations were calculated according to patient demographic and 2001 Canadian census data. All rates were reported per 10,000 persons per year. Results One hundred thirty-seven dislocations (53 simple and 84 complex) were identified. Simple dislocations occurred at a rate of 0.262 (95% confidence interval [CI] = 0.191 to 0.332). Fracture-dislocations occurred at a rate of 0.415 (95% CI = 0.326 to 0.504). The overall age-adjusted incidence was 0.671 (95% CI = 0.638 to 0.704). With the exception of the 18 years to 29 years (rate = 0.916, 95% CI = 0.648 to 1.183) and ≥80 years groups (rate = 0.906, 95% CI = 0.112 to 1.700), all age groups had an approximate rate of 0.600. Discussion The results obtained in the present study are similar to those obtained in a previous European study. True population-based estimates of elbow dislocation incidence are provided, which may facilitate the assessment of outcomes and complication rates of such injuries.

Does Topical Anesthetic Reduce Pain During Intraosseous Pin Removal in Children? A Randomized Controlled Trial.

Background: The purpose of this study was to determine the effectiveness of topical liposomal lidocaine in reducing the pain perceived by children undergoing percutaneous intraosseous pin (PP) removal in the outpatient orthopaedic clinic. Methods: A triple-blinded, randomized, placebo-controlled clinical trial comparing topical liposomal lidocaine to a placebo was conducted at the Stollery Children’s Hospital between September 2008 and February 2011. Subjects undergoing the removal of PP in the orthopaedic outpatient clinic between ages 3 and 16 years were recruited. A computer-generated variable-block randomization scheme was used to determine each subject’s group assignment. Pain was recorded just before randomization and immediately after the procedure using the Oucher Scale (for subjects) and a 10-cm Visual Analog Scale (for parents and an observing orthopaedic technician). In a subset of individuals, follow-up telephone calls were made 24 hours postprocedure to inquire about any adverse event from the use of the topical liposomal lidocaine. Data were analyzed using the Student t test. Results: Of a total of 296 recruited subjects, complete data were available on 281 subjects (140 intervention and 141 control). There were no significant differences between the 2 groups with regards to baseline characteristics, including preprocedure pain scores. Although postprocedure pain scores demonstrated an increase in pain in both groups (2.3 points in the treatment group and 2.0 points in the placebo group), no statistically significant difference was seen in postprocedure pain scores between groups (P=0.81). No adverse events were observed or reported. Conclusions: Topically applied liposomal lidocaine was not effective in reducing pain during this procedure, compared with a placebo. However, this study demonstrates that PP removal is a painful procedure in children. Given the large volume of patients who undergo this procedure and the long-term consequences of experiencing painful procedures in childhood, it is important to find safe and fast-acting methods to decrease procedural pain associated with PP removal. Level of Evidence: Level I—therapeutic trial.