Interobserver reliability and intraobserver reproducibility of the Fernandez classification for distal radius fractures

We have evaluated the clinical application of the Fernandez classification without questioning the scientific validity, by assessing the interobserver reliability and intraobserver reproducibility. A set of 25 radiographs of distal radius fractures were given to six assessors along with details of Fernandez classification. The assessors classified the fractures on two different occasions 3 months apart. The outcome was assessed using kappa statistics and demonstrated poor interobserver reliability and intraobserver reproducibility. Caution should be exercised when using this classification for clinical practice and research.

Compression forces generated by Mini bone screws--a comparative study done on bone model

The compressive forces generated by the AO/ASIF 3.0 mm cannulated cancellous and 2.0 mm cortical screws, Mini-Acutrak and Herbert/Whipple small bone cannulated screws were measured in the laboratory with the use of simulated cancellous bone and a load cell washer as a means of quantifying their fixation capabilities. The Herbert/Whipple screw and the Mini-Acutrak screw were found to have nearly identical compression capabilities and provided more compression than the cortical screw. The AO/ASIF cannulated screw when used with a support screw demonstrated a compressive capacity twice that of the 2.0 mm cortical screw and higher than the headless Mini-Acutrak and Herbert/Whipple screws. The Mini-Acutrak screw produced about 70% of compression of the cancellous screw in spite of having a diameter almost half that of the cancellous screw. The Herbert/Whipple screw in spite of its larger size compared to the Mini-Acutrak produced almost the same amount of compression.

Irreducible elbow dislocation associated with a radial neck fracture: a case report

A rare case of an irreducible elbow dislocation is described. We discuss the causes of irreducibility and the treatment options. Intraoperative assessment of joint stability, repair of the lateral collateral ligament and appropriate postoperative management led to an excellent 5-year outcome, obviating the need for an external fixator or a radial head replacement.

Imaging the problem scaphoid

Scaphoid fractures can be difficult to diagnose on X-ray, even at 2 weeks. We have compared prospectively bone scanning versus MRI scanning in 22 patients with persistent signs and symptoms suggestive of a scaphoid fracture at 2 weeks and found both methods to be sensitive, but MRI to be more specific, particularly in diagnosing soft tissue injuries like scapho-lunate ligament ruptures and triangular fibrocartilage tears. An early MRI scan at 2 weeks allows the clinician to make the appropriate decision in this group of patients whose diagnoses include; occult scaphoid fractures, other occult carpal and radial fractures, ligamentous injuries and those without apparent injuries. MRI has also been useful in defining the group of injuries which may imitate a clinically occult scaphoid fracture.