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Palamaris longus “rooftop” flap—Another use for a “useless” muscle
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Abstracts / Injury Extra 42 (2011) 95–169
Conclusions: Most radiographs taken were inadequate and this has to be communicated with the radiology department. Two different views are needed to accurately comment on radiographs. Patients have to be sent back to radiology department. This causes an increase in clinic time, radiation to the patient and inconvenience. doi:10.1016/j.injury.2011.06.377 10.3 Palamaris longus “rooftop” flap—Another use for a “useless” muscle A.J. Diver, C. Gilliland, K.J. Herbert Northern Ireland Plastic and Maxillofacial Service, The Ulster Hospital, Belfast, United Kingdom Introduction and aims: An opportunity arose to use palmaris longus muscle as a (previously not described) ‘rooftop’ flap for the antecubital fossa, and prompted the authors to perform a literature review which identified a multitude of uses for this apparent outsider. Methods: A 32 year old man sustained a degloving injury to the elbow and forearm in a traffic accident. The relevant problem was exposed bicipital tendon, brachial artery and repaired median nerve at the antecubital fossa. All three structures were neatly covered by a proximally based ‘rooftop’ flap of palmaris longus muscle belly, which was then covered by split skin graft. Subsequent review of the literature identified this as a unique use for palmaris longus, but also identified a plethora of uses previously described for this muscle, some well known, and some quite astounding. These will be presented including the year first described, numbers included and outcomes. Results: A series of excellent pre, intra and postoperative pictures of the new palmaris longus ‘rooftop’ flap will be shown. Over 100 articles dating from 1924 to 2011 contain descriptions of surgical uses for palmaris longus. Highlights of the muscle’s ‘career’ will be presented including the first description of each use, numbers studied and results (some being excellent). The intriguing list includes upper limb tendon transfers, joint reconstruction, palatoplasty, oropharyngeal reconstruction, facial slings, reconstruction and suspension of eyelids, lip augmentation, glans penis coronoplasty, and the management of anal and bladder incontinence. Conclusions: It is clear this muscle deserves more respect than it often gets. The palmaris longus ‘rooftop’ flap is a valuable tool in coverage of the antecubital fossa, if the patient is fortunate enough to have one. doi:10.1016/j.injury.2011.06.378 11.1 Functional outcome of unstable distal radius fractures treated with external fixation compared to open reduction and internal fixation. Systematic review M. Al-Najjim, M.U. Khattak University of Warwick and Scunthorpe General Hospital, Scunthorpe, UK Aims: The purpose of this study was to conduct a rigorous scientific evaluation of the available literature to provide evidence for comparison of the functional outcomes between external fixation and open reduction and internal fixation using the DASH score as
the primary outcome of interest, range of motion and grip strength as secondary outcome measure. Methods: Medline and EMBASE databases were searched for English language articles from 2005 to January 2010. Articles were considered for review if they satisfied the following inclusion criteria which were original articles on the treatment of unstable distal radius fractures in adult patients between 16 and 70 years of age including both genders, described treatment consisting exclusively of randomised controlled trials comparing external fixation and open reduction and internal fixation for unstable distal radius fractures. Critical appraisal of the selected studies was carried out using the Consolidated Standards of Reporting Trials (CONSORT) checklist. Results: Fifty-four studies were identified from searching databases; only three papers met the inclusion criteria. Primary outcome were measured against DASH scoring system and grip strength and range of motion were considered as secondary outcome measures. DASH scores were found to be better at 6 weeks to 3 months in the internal fixation group but there was no difference at 6–12 months in both groups. However grip strength and range of motion was better in the internal fixation group as compared to external fixation in all three studies. Conclusion: Both techniques can provide good functional outcome at one year but early functional recovery is very clear in patient treated with open reduction and internal fixation. This evidence indicates that open reduction and internal fixation may be advantageous for a patient who desires an accelerated return of function. doi:10.1016/j.injury.2011.06.379 11.2 Review of hip fracture care at a teaching hospital—A questionnaire study R. Bhattacharyya, Y. Agrawal, H. Elphick, C.M. Blundell Northern General Hospital, Sheffield, UK Introduction: In August 2010, a new model of care was implemented whereby the management of elderly fractured neck of femur patients is taken over by the orthogeriatric team 48 h post surgery in the orthopaedic wards with orthopaedic input if necessary. The previous model differed in that the orthogeriatricians provided medical input in the management of these patients but did not formally take over their care. Aim: To compare the two models of care as perceived by different members of staff. Method: Prospective data was collected using questionnaires from medical, nursing and allied health professionals. Opinions were obtained with regards to frequency of consultant review, communication with patients and family members, discharge planning, quality of care and their preference to the new or the old model. We used the Likert scaling system (1—strongly disagree to 5—strongly agree) to rate the responses. These were analysed using the Mann–Whitney U-test and cumulative frequencies were calculated. Results: We received 59 responses; 21 doctors (Group A) and 38 nurses, physiotherapists, occupational therapists and discharge coordinators (Group B). 91% of group A and 79% of group B responses agreed that the quality of patient care has improved compared to the previous model. (U = 311.50, p = .13, r = .19). 91% of group A and 84% of group B responses preferred working in this model. (U = 340.50, p = .31, r = .13). 62% of group A and 71% of group
Abstracts / Injury Extra 42 (2011) 95–169
Conclusions: Most radiographs taken were inadequate and this has to be communicated with the radiology department. Two different views are needed to accurately comment on radiographs. Patients have to be sent back to radiology department. This causes an increase in clinic time, radiation to the patient and inconvenience. doi:10.1016/j.injury.2011.06.377 10.3 Palamaris longus “rooftop” flap—Another use for a “useless” muscle A.J. Diver, C. Gilliland, K.J. Herbert Northern Ireland Plastic and Maxillofacial Service, The Ulster Hospital, Belfast, United Kingdom Introduction and aims: An opportunity arose to use palmaris longus muscle as a (previously not described) ‘rooftop’ flap for the antecubital fossa, and prompted the authors to perform a literature review which identified a multitude of uses for this apparent outsider. Methods: A 32 year old man sustained a degloving injury to the elbow and forearm in a traffic accident. The relevant problem was exposed bicipital tendon, brachial artery and repaired median nerve at the antecubital fossa. All three structures were neatly covered by a proximally based ‘rooftop’ flap of palmaris longus muscle belly, which was then covered by split skin graft. Subsequent review of the literature identified this as a unique use for palmaris longus, but also identified a plethora of uses previously described for this muscle, some well known, and some quite astounding. These will be presented including the year first described, numbers included and outcomes. Results: A series of excellent pre, intra and postoperative pictures of the new palmaris longus ‘rooftop’ flap will be shown. Over 100 articles dating from 1924 to 2011 contain descriptions of surgical uses for palmaris longus. Highlights of the muscle’s ‘career’ will be presented including the first description of each use, numbers studied and results (some being excellent). The intriguing list includes upper limb tendon transfers, joint reconstruction, palatoplasty, oropharyngeal reconstruction, facial slings, reconstruction and suspension of eyelids, lip augmentation, glans penis coronoplasty, and the management of anal and bladder incontinence. Conclusions: It is clear this muscle deserves more respect than it often gets. The palmaris longus ‘rooftop’ flap is a valuable tool in coverage of the antecubital fossa, if the patient is fortunate enough to have one. doi:10.1016/j.injury.2011.06.378 11.1 Functional outcome of unstable distal radius fractures treated with external fixation compared to open reduction and internal fixation. Systematic review M. Al-Najjim, M.U. Khattak University of Warwick and Scunthorpe General Hospital, Scunthorpe, UK Aims: The purpose of this study was to conduct a rigorous scientific evaluation of the available literature to provide evidence for comparison of the functional outcomes between external fixation and open reduction and internal fixation using the DASH score as
the primary outcome of interest, range of motion and grip strength as secondary outcome measure. Methods: Medline and EMBASE databases were searched for English language articles from 2005 to January 2010. Articles were considered for review if they satisfied the following inclusion criteria which were original articles on the treatment of unstable distal radius fractures in adult patients between 16 and 70 years of age including both genders, described treatment consisting exclusively of randomised controlled trials comparing external fixation and open reduction and internal fixation for unstable distal radius fractures. Critical appraisal of the selected studies was carried out using the Consolidated Standards of Reporting Trials (CONSORT) checklist. Results: Fifty-four studies were identified from searching databases; only three papers met the inclusion criteria. Primary outcome were measured against DASH scoring system and grip strength and range of motion were considered as secondary outcome measures. DASH scores were found to be better at 6 weeks to 3 months in the internal fixation group but there was no difference at 6–12 months in both groups. However grip strength and range of motion was better in the internal fixation group as compared to external fixation in all three studies. Conclusion: Both techniques can provide good functional outcome at one year but early functional recovery is very clear in patient treated with open reduction and internal fixation. This evidence indicates that open reduction and internal fixation may be advantageous for a patient who desires an accelerated return of function. doi:10.1016/j.injury.2011.06.379 11.2 Review of hip fracture care at a teaching hospital—A questionnaire study R. Bhattacharyya, Y. Agrawal, H. Elphick, C.M. Blundell Northern General Hospital, Sheffield, UK Introduction: In August 2010, a new model of care was implemented whereby the management of elderly fractured neck of femur patients is taken over by the orthogeriatric team 48 h post surgery in the orthopaedic wards with orthopaedic input if necessary. The previous model differed in that the orthogeriatricians provided medical input in the management of these patients but did not formally take over their care. Aim: To compare the two models of care as perceived by different members of staff. Method: Prospective data was collected using questionnaires from medical, nursing and allied health professionals. Opinions were obtained with regards to frequency of consultant review, communication with patients and family members, discharge planning, quality of care and their preference to the new or the old model. We used the Likert scaling system (1—strongly disagree to 5—strongly agree) to rate the responses. These were analysed using the Mann–Whitney U-test and cumulative frequencies were calculated. Results: We received 59 responses; 21 doctors (Group A) and 38 nurses, physiotherapists, occupational therapists and discharge coordinators (Group B). 91% of group A and 79% of group B responses agreed that the quality of patient care has improved compared to the previous model. (U = 311.50, p = .13, r = .19). 91% of group A and 84% of group B responses preferred working in this model. (U = 340.50, p = .31, r = .13). 62% of group A and 71% of group