Injury
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Scapulothoracic dissociation is an infrequent injury with potentially devastating outcomes. Knowledge of this injury is based on small patient series and case reports. The aim of this article is to review the evaluation, management and functional outcomes following scapulothoracic dissociation. ⋯ In the acute setting, the timely diagnosis of the associated neurovascular injuries is crucial. Severe neurovascular and soft tissue compromise often requires an early above-elbow amputation. Further, complete brachial plexus avulsions are associated with a limited potential for functional recovery.
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The majority of midshaft clavicle fractures unite uneventfully. Although the indications for operative intervention are limited and reported complication rates high, there are circumstances in which surgery is required. ⋯ There was one case of deep infection and one of non-union, both of which resolved with further treatment. These results compare very favourably with previously published series and we submit that this operative approach allows safe management of an otherwise potentially hazardous procedure.
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National guidelines recommend that hospitals dealing with acute orthopaedic trauma should have daily, consultant led trauma lists, performed in dedicated trauma theatres. This study examined the availability and organisation of orthopaedic trauma lists in the United Kingdom using a postal survey. ⋯ Twenty-one percent of responding hospitals did not have a dedicated trauma theatre. Our results suggest that most units have a long way to go in meeting national standards regarding the availability of orthopaedic trauma lists.
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Comparative Study
Unstable diaphyseal fractures of both bones of the forearm in children: plate fixation versus intramedullary nailing.
This retrospective study evaluated the results of plating versus intramedullary fixation in the management of unstable, diaphyseal fractures of both bones of the forearm in children. Of the 64 children included, 45 were treated with intramedullary fixation, 19 with plating. Only A3 forearm fractures of the middle third or the transition zones were included; Galeazzi, Monteggia, and Greenstick fractures were excluded. ⋯ In the plate group, there were two major complications (refractures) and one minor complication (thumb neuropathy). Plating resulted in significantly worse results for surgical approach, operating times, frequency and duration of hospitalisation, and cosmetic outcome. In conclusion, intramedullary fixation of an unstable forearm fracture in skeletally immature patients is a safe, child-friendly, minimally invasive technique that allows early functional treatment with an excellent functional and cosmetic outcome.