S Maqungo

Angular stable fixation of displaced distal-third clavicle fractures with superior precontoured locking plates

HYPOTHESIS We reviewed the outcome of angular stable plates in addressing displaced lateral-third clavicle fractures. We investigated union, shoulder function, request for implant removal, and return to sport. Our hypothesis was that these implants provide predictable union and return to sports without the negative consequence of leaving plates in situ, reducing the requirement for a second surgery. METHODS We undertook a retrospective review of a consecutive series of patients who underwent this surgery between 2007 and 2010. Nineteen patients with a mean follow-up of 25 months were included. Postoperative follow-up was performed at 2 weeks and monthly thereafter until union was assessed as achieved clinically and radiographically. Two telephone interviews at a mean of 7 months and 25 months postoperatively assessed shoulder function by Oxford Shoulder Score, presence of any plate or scar discomfort, need for implant removal, and return to sport. RESULTS Nineteen patients achieved union by 4 months (median, 12 weeks; range, 6-16 weeks). The mean Oxford Shoulder Score was 46 (range, 41-48) at a mean of 7 months (range, 3-18 months) and 47 (range, 44-48) at 25 months (range, 18-48 months). Initially, 2 patients requested implant removal; later, however, both declined surgery. No plates have been removed. Four patients complained of mild plate discomfort but did not wish removal. All patients had returned to sporting activities. CONCLUSION Angular stable plate fixation of Neer group II, type II clavicle fractures resulted in a 100% union rate with excellent return of function with no mandatory need for removal.

Distal interlocking screw placement in the femur: free-hand versus electromagnetic assisted technique (sureshot).

Objectives: To compare the free-hand (FH) technique of placing interlocking screws to a commercially available electromagnetic (EM) targeting system in terms of operating time, radiation dose, and accuracy of screw placement. Methods: Between September 2011 and July 2012, we prospectively randomized 100 consecutive femur shaft fractures in 99 patients requiring intramedullary nails to either FH using fluoroscopy (n = 43) or EM targeting (n = 38; Sureshot). Setting: Single Level 1 University Hospital Trauma Center. Main Outcome Measurements: The 2 groups were assessed for distal locking with respect to time, radiation, and accuracy. Results: Eight-one fractures had data accurately recorded (38 EM/43 FH). The average total operative time was 50 minutes (range, 25–88 minutes; SD, 13.9 minutes) for the FH group and 57 minutes (range, 40–103 minutes; SD, 16.12 minutes) for the EM group. The average time for distal locking was 10 minutes (range, 4–16 minutes; SD, 3.56 minutes) with FH and 11 minutes (range, 6–28 minutes; SD, 10.24 minutes) with EM. Average radiation dose for distal locking was significantly less (P < 0.0001) for EM at 230.54 &mgr;Gy (range, 51–660 &mgr;Gy; SD, 0.17 &mgr;Gy) compared with 690.27 &mgr;Gy (range, 200–2310 &mgr;Gy; SD, 0.52 &mgr;Gy) for FH. There were 2 misplaced drill bits in FH and 3 in EM. This was not statistically significant (P = 0.888). Conclusions: The electromagnetic targeting device (Sureshot) significantly reduced radiation exposure during placement of distal interlocking screws, without sacrificing operative time, and was equivalent in accuracy when compared with the FH technique. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Surgical hip dislocation for removal of retained intra-articular bullets

INTRODUCTION Surgical hip dislocation with trochanteric osteotomy was introduced for the treatment of femoroacetabular impingement and other intra-articular pathologies of the hip. We expanded the indications to include removal of retained bullets in the hip joint as an alternative to hip arthroscopy. PATIENTS AND METHODS We present a prospective case series of ten patients that were treated with a surgical hip dislocation for removal of retained bullets in the hip joint between January 2014 and October 2015 in a Level 1 trauma centre. The main outcome measurements were successful bullet removal, blood loss, surgical time and intraoperative complications. RESULTS There were 8 males and 2 females with a mean age of mean age 27.3 years (range 20-32). All patients had one whole retained bullet for removal (right side: 8; left side: 2). In all cases the bullet could be removed in its entirety. The average surgical time was 73min (range 55-125) and the average blood loss 255ml (range 200-420). CONCLUSIONS Surgical hip dislocation provides an unlimited view of the acetabulum and femoral head and neck and it therefore allows for easy removal of retained bullets. Osteocartilaginous lesions and concomitant fractures of the femoral head can be simultaneously evaluated and treated.

Double pathology, sarcoidosis associated with multiple myeloma: A case report

The association of sarcoidosis with multiple myeloma is not well known. Including this case report, 12 cases of patients with both sarcoidosis and multiple myeloma have been reported in the literature. The skeletal lesions of both conditions have many clinical and radiological similarities, and unless clinicians are aware of the association and the possibility of dual pathologies, the diagnosis of multiple myeloma in patients known with sarcoidosis may be missed. We present a case of a patient known with longstanding sarcoidosis who was found to have multiple lesions on magnetic resonance imaging (MRI) involving the pelvis and both proximal femurs. Histological analysis revealed the presence of both non-necrotising granulomas consistent with sarcoidosis, and sheets of plasma cells consistent with a plasma cell neoplasm.

Gunshot induced injuries in orthopaedic trauma research. A bibliometric analysis of the most influential literature

A growing burden of gunshot injuries demands evidence-based ballistic trauma management. No comprehensive systematic overview of the current knowledge is available to date. This study aims to identify and analyze the most influential publications in the field of orthopedic ballistic trauma research. All databases available in the Thomson Reuters Web of Knowledge were searched to conduct this bibliometrical study. The most cited orthopedic ballistic trauma articles published between 1950 and 2015 were identified by use of a multi-step approach. Publications with ten citations and more were analyzed for citations, journal, authorship, geographic origin, area of research, anatomical site, study type, study category, and level of evidence. Citations of the 128 included studies ranged from 113 to 10. These were published in fifty different journals between 1953 and 2011. Most publications (n=106; 83%) originated from the USA, were retrospective (n=85; 66.4%), level IV studies (n=90; 70.3%), reported on spinal gunshot injuries (n=49; 38.33%) and were published between 1980 and 2000 (n=111; 86.7%). This bibliometric study provides the first comprehensive overview of influential publications in the field of orthopedic ballistic trauma research. More prospective studies and high-quality systematic reviews are needed. Centres with a high burden of gunshot injuries from the developing world need to share their experience in form of international publications, to provide a more comprehensive picture of the global gun-related orthopedic injury burden. TYPE OF STUDY bibliometric analysis: level III.