Injury
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Fifth metatarsal fractures are common and the outcome has been reported; however, prospective studies reporting the functional outcome using validated questionnaires are lacking in the literature. The aims of this study were to determine whether fifth metatarsal fractures remain symptomatic in the medium term and whether the fracture type influences outcome. ⋯ While 25-33% of patients continue to experience pain at 1 year, <10% experience any limitation of their activities. At the final follow-up at 1 year, there were no significant differences in functional outcome by fracture type, gender or patient age. Patients should be advised about the likelihood of ongoing low-level symptoms, even after a year from injury in this previously presumed innocuous injury.
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A retrospective review of the use of the Dall-Miles plate for periprothetic femoral fractures was performed at our institution. Twenty-seven fractures around a hip replacement were fixed using a Dall-Miles plate within 34 months. The mean age at operation was 74 (33-90) years. ⋯ Similar complications were evident in nine series published between 1990 and 2012. Increased incidence of periprosthetic femoral fractures is anticipated in a population with significant co-morbidities. Cortical strut allograft, iliac autograft and orthobiological supplementation remain options where non-union is anticipated.
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Open reduction and internal fixation of the clavicle is used to treat displaced fractures of the midshaft of the clavicle. Complications of operative intervention include injuries to major neurovascular structures including the subclavian artery and vein. Unlike other surgical approaches, palpation or visualization of the deep neurovascular structures at risk is rarely performed and is not part of the routine approach. ⋯ At about the junction of the middle and second-thirds of the clavicle, all three structures were within 2cm of the clavicle. Moving laterally, these structures moved further away and at the acromioclavicular (AC) joint were at least 4.5cm away from the clavicle on average. This study reiterates that the medial third of the clavicle is closely associated with neurovascular structures and that care should be taken here when using drills, depth gauges, and clamps.
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To define the unique radiographic features, operative treatment, and complications of pertrochanteric fractures (AO/OTA 31-A1 and A2) which are not amenable to the usual closed reduction manoeuvres. ⋯ Pertrochanteric fractures, which are not amenable to closed reduction, are uncommon, but are heralded by unique radiographic features. These patients warrant special consideration in terms of recognition and management. The specific radiographic markers should alert the surgeon to this injury pattern and its related difficulty encountered during closed reduction. Once reduction is achieved, however, these fractures follow an uneventful course.
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Coagulation screening continues as a standard of care in many hip fracture pathways despite the 2011 guidelines from the Association of Anaesthetists of Great Britain and Ireland (AAGBI) which recommend that such screening be performed only if clinically indicated. This study aims to evaluate the use of pre-operative coagulation screening and explore its financial impact. ⋯ This study supports the hypothesis that routine pre-operative coagulation screening is unnecessary in hip fracture patients unless they take warfarin or have a known coagulopathy. Moreover, its omission represents significant cost-saving potential.