Correlation between Magnetic Resonance Imaging and Arthroscopy in detecting shoulder pathology

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were reviewed. Case notes of those patients with more than 1 year follow up following fixation of their humeral fracture were retrospectively reviewed. Each patient was also sent an Oxford Shoulder Score in the post for completion. Results: 72 patients were identified for inclusion in the study from 2006 onwards, 53 in the S3 group and 19 in the PHILOS group. Patients with a two part fracture (n = 11) were excluded from the study. Patient demographics were well matched in the 2 groups. The re-operation rate was 3.7% in the S3 group and 22.1% in the PHILOS group. 2 patients in the PHILOS group required hemiarthroplasty for AVN. Oxford shoulder scores, one year following surgery were 38.4 and 38.1 respectively. Conclusions: This study shows that the newly designed S3 plate has similar outcome measures to the established PHILOS plate but has a much smaller complication and re-operation rate, with earlier time to discharge. As a result the two senior authors feel the results of the S3 plate are superior and will use it as their default system for comminuted proximal humeral fractures. Our complication rate is to our knowledge, lower than any published data for other proximal humeral plating systems. doi:10.1016/j.injury.2011.06.261 1B.10 The cadaveric anatomy of the distal radius—Implications for the use of Volar Plates P.A. McCann, D. Clarke, R. Amirfeyz, R. Bhatia Bristol Royal Infirmary, Bristol, UK Introduction: To clarify the safe margins of the flexor carpiiradialis (FCR) approach 10 matched pairs of human cadavers preserved in formalin were dissected. Methods: The location of the radial artery, the median nerve, the palmar cutaneous branch of the median nerve and the superficial branch of the radial nerve were measured with respect to the flexor carpiiradialis tendon. Measurements were taken on a centre to centre basis in the coronal plane at the watershed level of the distal radius. In addition, the relationship between the tendons of brachioradialis, abductor pollicislongus, flexorpollicislongus and the radial artery and median nerve were measured to create a complete picture of the anatomy of the FCR approach to the distal radius. Results: The structure most at risk was the palmar cutaneous branch of the median nerve. It was located on average 3.4 mm (SD 2.7 mm) from the FCR tendon. The radial artery and the main trunk of the median nerve were located 7.8 mm (SD 1.9 mm) and 8.9 mm (SD 2.5 mm) from the tendon respectively. The superficial branch of the radial nerve was 24.4 mm (SD 8.9 mm) from the FCR tendon. Conclusion: Operative intervention is not without complication. We believe a more accurate understanding of the surgical anatomy of the distal radius is key to the prevention of neurovascular damage arising from the surgical management of distal radial fractures. doi:10.1016/j.injury.2011.06.262

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1B.11 Subjective and functional outcomes following open reduction and internal fixation (ORIF) of distal radial fractures with the volar Winklestabile plate Z. Dahabreh, A.D. White ∗ , Z. Ali, L. Koch, P.D. Angus Dewsbury and District Hospital, Yorkshire, United Kingdom Aim: To assess subjective and objective outcomes following the use of the Winklestabile volar locking plate for ORIF of distal radius fractures. Methods: 21 patients who underwent ORIF of distal radius fractures using the Winklestabile plate with a minimum follow up of 12 months were assessed using the Patient Rated Wrist Evaluation (PRWE) questionnaire and the Disabilities of the Arm Shoulder and Hand (DASH) score. Range of wrist movement (ROM), grip strength and pinch grip strength were compared with the unaffected wrist. Results: Mean age was 64.34 years. The mean time from presentation to surgery was 2.0 days (median 1.0, interquartile range (IQR) 1.0–2.0). Mean time to radiological union was 83.3 days (median 83.0, IQR 83.0–90.0). Twenty fractures followed low energy trauma, 19 were closed and 11 were extra-articular. None to mild PRWE scores were achieved in 18 (86%) patients for pain, 15 (71%) for specific functions and 19 (90%) for usual functions. Six patients scored zero on the DASH score (mean 17.0, median 4.0, IQR 0.0–23.0). There was no difference in grip strength (pounds) in two patients (mean 10.6, median 6.0, IQR 4.0–15.0) and no difference in pinch grip strength in nine patients (mean 1.0, median 0.5, IQR 0.0–1.5). Sixteen patients (76%) reported no complications. One suffered EPL rupture. One reported generalised wrist pain. One reported difficulty pushing down with the affected hand. One reported pain on movement. None required revision surgery. Conclusion: In our institution, we believe that ORIF for distal radius fractures using the Winklestabile distal radius locking plate achieves satisfactory subjective and objective results with an acceptable rate of complications. doi:10.1016/j.injury.2011.06.263 1B.12 Correlation between Magnetic Resonance Arthroscopy in detecting shoulder pathology

Imaging

and

V. Shetty, S. Dhotare, V. Selvaratnam, V. Sahni Southport and Ormskirk Hospital NHS Trust, UK Aim: The investigation of choice in most shoulder pathology is Magnetic Resonance Imaging (MRI). The aim of this study was to evaluate the correlation of MRI and shoulder arthroscopy in detecting shoulder pathology. Methods: Retrospective case notes analysis was performed. Between June 2008 and June 2009, 100 patients presented with shoulder complain that needed a MRI and subsequent shoulder arthroscopy. The age range was from 19 to 79 years. The male to female ratio was 63–37. Shoulder arthroscopic findings served as the standard of reference for comparison with pre-operative MRI findings. Results: Shoulder pathology was divided into 15 groups: Acromioclavicular Joint (ACJ) Arthritis (MRI-49, Arthroscopy (A) -28), Supraspinatous tear (MRI-47, A-38), Infraspinatous tear (MRI-4, A-15), Subscapularis tear (MRI-3, A-0), Subacromial Impingement (MRI-40, A-69), Superior Labral Anterior Posterior

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(SLAP) lesion (MRI-6, A-7), Anterior Labral lesion (MRI-16, A19), Posterior Labral lesion (MRI-2, A-4), Other labral lesions (MRI-1, A-2), Bony Bankart’s (MRI-2, A-5), Rotator Interval Laxity (MRI-7, A-2), Adhesive Capsulitis (MRI-3, A-7), Glenohumeral Osteoarthritis (MRI-5, A-GI-18, GII-14, GIII-5 = 37), Long Head of Biceps tendinopathy/tear (MRI-4, A-11) and HillSach’s lesion (MRI10, A-9). Discussion: MRI is sensitive in detecting ACJ arthritis and Subacromial Impingement but not in identifying the severity of grade. Supraspinatous tear was found in the MRI of 47 patients but only 38 were detected on arthroscopy. 10 of them underwent arthroscopic repair and six of them were unrepairable, remaining 12 patients had delamination or very superficial tear which did not require any repair procedure. MRI detected only four Infraspinatous tear while arthroscopy found 15 Infraspinatous tear. 10 of them underwent repair and five were unrepairable. Arthroscopy is said to be the best means by which SLAP lesions is diagnosed. It allows determination of grade of lesion and its stability. MRI cannot help us decide the grade of lesion and the exact extent of lesion. Although MR imaging is suitable for diagnosing some shoulder disorders, the MR imaging of SLAP lesions and labral tears does not give accurate results. Conclusion: Our study shows that although there is a discrepancy between MRI and arthroscopy in detecting shoulder pathology, MRI is a good investigation as a guide for pre-operative arthroscopic planning. doi:10.1016/j.injury.2011.06.264 1B.13 Simple elbow dislocations: Management, direct medical cost and clinical outcome D.J. Morell, N.K. Kanakaris, H.B. Tan, P.V. Giannoudis Academic unit of Trauma and Orthopaedics, Leeds Teaching Hospitals, UK Objectives: To evaluate the management, direct-medical-costs and clinical outcome profile of a large trauma unit with respect to simple elbow dislocations. Methods: All simple elbow dislocations that were defined as not requiring acute surgical intervention, postreduction, were considered between January 2008 and December 2010. Inclusion criteria consisted of age greater than 13; absence of major associated fractures, successful closed reduction, and follow-up as an outpatient. The management of these patients was classified in terms of immobilisation time into: short (<2 weeks), standard (2–3 weeks) and prolonged (>3 weeks). Direct-medical-costs were calculated based on current tariff rates associated with radiology, admission, theatre time (for reductions and recovery) and outpatient attendances. Clinical outcome was evaluated with respect to complications, secondary procedures, and time before discharge from clinic. Results: Of 81 patients in total, 6% required reduction in theatre, 17% admission, 9% were referred to a specialist or had a complication and 42% DNA their final appointment. The mean length-of-immobilisation was 2.25 weeks (range 0–6 weeks). The median direct-medical-cost was £893 per patient (range £418–£2693). The median duration of patients’ engagement with hospital services was 57 days (range 3–831). There was no statistically significant relationship between length-of-immobilisation and time-before-discharge (p = 0.42), or associated direct-medical-cost (p = 0.586). In terms of clinical outcome the prolonged immobilisation group had a statistically significant worse outcome in comparison to the short (p = 0.30) and the standard (p = 0.01). The comparison between standard immo-

bilisation and short resulted in a marginally (p = 0.08) significant advantage of the first. Conclusion: Prolonged elbow immobilisation is generally associated with increased stiffness and a higher rate of complications. For simple elbow dislocations time-to-mobilisation was variable, as well as the mode of follow-up. The use of standardised protocols of treatment is essential in this type of injuries that are usually managed in an outpatient basis, to minimise the variability between clinical teams, improve outcome, and minimise costs. doi:10.1016/j.injury.2011.06.265 1B.14 Outcome of 62 clavicle fracture fixations with locked compression plate: Is this the right way to go? N. Modi, A.D. Patel, P. Hallam Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK Aim: To determine the union rate of displaced, mid-shaft clavicle fractures fixed through an infraclavicular approach using a Locked Compression plates. Introduction: Fractures of the clavicle are common with an annual incidence of 29.3 per 100,000 adult populations of which 69% are mid-shaft. It is generally accepted that undisplaced midshaft fractures can be treated non-operatively but non-operative treatment of displaced fractures can lead to a non-union rate of 15%. The rationale for fixing displaced mid-shaft fractures is to decrease non-union and reduce symptomatic malunions. Patients and methods: The absolute indications for fixing midshaft fractures in our institution are: open fractures, fractures associated with skin compromise and neurovascular injury. Relative indications are: fractures with >20 mm shortening, wide displacement of fragments (>1 cm), associated chest injuries, floating shoulder and established non-union. Between April 2003 and October 2009, 62 clavicle fractures underwent internal fixation using LCP plates through infraclavicular approach. 9 patients were lost to follow-up. All patients were followed up until clinical and radiological union was achieved (radiological union was determined by the presence of bridging callus and absence of fracture lines). The type of fixation device, time to union, complications and re-operation rate were determined. Results: At the final follow-up 53 patients were available for review. There were 42 male and 11 female patients with an average age of 45 years. The fractures were classified using the system described by CM Robinson (28 Type B1 fractures and 25Type B2 fractures). The average union time was 4.6 months. In our series there was 1 superficial infection treated with oral antibiotics. There was 1 stress fracture medial to the plate which was treated non-operatively and the fracture united. There were 2 plate failures which required revision, one at 8 days post-op and other at 6 weeks. Our preference is to use LCP plate for clavicle fracture fixation using infraclavicular approach as described by the senior author. Conclusion: In a large number of complex clavicle fractures a satisfactory outcome is possible with a low complication rate using a Locked Compression Plate. doi:10.1016/j.injury.2011.06.266