Irreducible acute anterior shoulder dislocation

Irreducible acute anterior dislocation of the shoulder has rarely been reported in the literature. This report describes a shoulder dislocation in a patient, which required open disimpaction of the humeral head from the glenoid before reduction of the glenohumeral dislocation could be achieved.

A new technique of fixation of radial head fractures using a modified tubular plate

Radial head fractures are fairly common, occurring in 17-44% of all elbow injuries. Mason Type 2 fractures may be fixed using mini fragment screws, this fixation often needing augmentation with a plate to make the construct rotationally stable. However, the drill holes needed to fix the plate to the radial head, carry the risk of inflicting more injury to the fractured fragments. In our case, the radial head fracture was fixed with a modified one-third tubular plate. The plate was cut through the distal hole and the two cut ends were bent into hooks. These two hooks were engaged into two breaches made on the margin of the radial head and this provided rotational stability to the head without causing further damage. The fracture healed well and the patient regained full movement in the elbow. We conclude that this method may be used to fix fractures of the radial head, which require additional support with a plate.

Fractures of the capitellum: a new method of fixation using a maxillofacial plate

Isolated capitellar fractures are rare, intraarticular fractures requiring an aggressive management regimen. Several treatment options have been described for the Type 1 fracture. A new technique of direct anatomic reduction and fixation of the fracture using a maxillofacial plate is reported. Advantages of this new technique are highlighted, and results with its use in treating patients of all ages are described.

The removal of metalwork in children

The post-operative complications in 57 children under the age of 16 years requiring removal of metalwork during a 12-month period are presented. The grade of surgeon performing the operation is also discussed. The overall complication-rate was 14 per cent. Minor complications such as transiently painful scars and superficial infection occurred in 7 per cent of cases. There was one intermediate complication following removal of Knowles pins of an unacceptable scar requiring revision by a plastic surgeon. The major complication (7 per cent of all cases) involved fracture with retention of the distal part of the screws during attempted removal of Knowles, Crawford-Adams or Moores pins used for the management of slipped upper femoral epiphysis. When considering this sub-group of patients, the actual complication rate for removal of metalwork from the hip was 27 per cent. So significant was this finding that the authors changed their practice to the use of a partially threaded single cannulated screw for the fixation of slipped upper capital epiphyses.