Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations
The long-term effect of distal radial fracture malunion on activity limitations is unknown. https://bit.ly/2qYgOMh #JBJS
Tags: Infographic, Orthopaedics, Orthopedics, Trauma, wrist
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Predicting the likelihood of a Gartland type IV supracondylar humerus fracture.
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In the latest issue of The Journal, Mitchell et al. performed a retrospective review of pediatric patients treated operatively for a Garland type III and IV supracondylar humerus fracture with the aim to: determine the prevalence of type-IV fractures, identify radiographic characteristics associated with these injuries, and assess operative treatment characteristics.
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The results of the study found type IV fractures to be relatively rare with an incidence of 1.3% (39/3,040).
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The 39 type IV fractures identified were compared against 156 type III fractures and the authors identified 5 radiographic parameters predictive of type IV fractures:
- Flexion angulation (OR = 17)
- Valgus angulation (OR = 5.6)
- Lateral translation of the distal fragement (OR = 4.1) - Osseous apposition between the proximal and distal fragments (OR = 4.0)
- Propagation of the fracture line toward the diaphysis (OR = 9.2)
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As expected, operative treatment of type IV fractures posed greater difficulty than type III fractures. Open reductions were necessary in 13% of type IV fractures (versus 3.8% in type III) and operative times were greater in the type IV fractures (82 minutes verses 63).
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This study should improve the surgeons' ability to identify type IV fractures which may be more difficult to treat. This will facilitate preoperative planning and pre-surgical counseling since type IV fractures are more likely to convert to an open reduction.
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"Is there a doctor on board the flight?"
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As an orthopedic surgeon, you would of course answer the call (while silently hoping to yourself someone just fell and dislocated a shoulder during that last bump of turbulence). But your confidence in managing an in-flight medical emergency may not be as high as your confidence in managing a surgical emergency in the OR.
In the latest issue of JBJS Reviews, Scollan et al. have produced an excellent review of the diagnoses and treatment algorithms for the most common in-flight medical emergencies.
Reviewed events include: syncope, acute coronary syndrome and cardiac arrest, acute neurologic deterioration, drug overdose, dyspnea, gastrointestinal distress, psychiatric emergencies, and obstetric emergencies.
This is a great article to review and keep handy when traveling! A fellow passenger may thank you someday...
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You can find this review article on jbjs.org
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