Injury
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This cadaveric study sought to evaluate the feasibility of applying a locking proximal humerus plate with a novel minimally invasive technique. A unique pre-contoured locking plate was placed on cadaveric proximal humeri through a described minimally invasive approach. Proximity of the plate and screws to the axillary nerve and their respective surgical tracks were quantified. ⋯ Placement of a locking proximal humerus plate via a minimally invasive lateral trans-deltoid approach is safe if the locking screws are limited to superior and inferior holes. This can be done safely without entrapment of the axillary beneath the plate. Plate fixation of proximal humerus fractures may now be more desirable with the use of this approach.
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Paediatric spinal injuries, although rare (1-2% of all paediatric fractures) are associated with the highest mortality rate of all orthopaedic injuries in children. The low incidence is due, not only to the plasticity of the paediatric spine, but also the difficulty of diagnosis and the usually severe if not fatal associated injuries. A 10-year (1995-2004) retrospective study was undertaken of all patients treated for a spinal injury at our institute, which functions as both an acute care centre and a tertiary referral centre for seriously injured children. ⋯ Treatment included closed reduction in two patients and posterior open reduction and stabilisation in two patients, with one of these also requiring decompression. Spinal injuries in children differ from adults due primarily to the biomechanical and anatomical features of the developing musculoskeletal system. When a spinal injury is identified on initial radiographic or clinical evaluation of an injured child, one should have a high index of suspicion that concurrent, potentially life-threatening injuries may be present.
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In the management of Type IIIb injuries, Gustilo's classification has the disadvantages of a poor intra and inter-observer agreement rate, low specificity and sensitivity to salvage and inability to predict functional outcomes. We propose here a validated score which assesses the severity of injury to the covering structures, skeletal structures and functional tissues of the injured limb separately along with providing weightage to the presence of co-morbid factors. ⋯ According to the total score, injuries were treated by 'Fix and close' protocol; 'Fix, Bone Graft and Close' protocol, 'Fix and Flap' protocol or 'Stabilise, Watch, Assess and Reconstruct' protocol. The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction.
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Direct or indirect trauma to the coccygeal bone can induce chronic coccygodynia. The aim of this study is a retrospective analysis of our patients surgically managed for traumatic coccygodynia and a critical review of the results obtained in comparison to the literature. ⋯ In patients with posttraumatic, conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option. We recommend total or partial coccygectomy using a longitudinal incision in carefully selected and well-informed patients.