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need for rehabilitation services . J Trauma Acute Care Surg 2015 ; 78 : 1021 – 1025 . 23. Zettas JP Zettas P Thanasophon B . Injury patterns in motorcycle accidents . J Trauma 1979 ; 19 : 833 – 836 . 24
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
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trauma prevention, acute health services, rehabilitation and lifelong support of the severely disabled survivors. The effective management of these patients is one of the most difficult clinical quests influenced by a large spectrum of complex and
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primary goal of surgical treatment to regain an unrestricted elbow function. Thus, the surgeon carefully needs to address all aspects of the injury to allow early (active) rehabilitation and thereby prevent elbow stiffness. 4 An improper osseous
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anatomical reduction and internal fixation of fractures. 2 The objective of surgery is to achieve exact reduction to restore joint congruence, to adequately fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation
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patients after discharge. Appropriate rehabilitation programmes and orthogeriatric consultations can help to decide whether a patient can return home and continue independent living, or whether he/she will require permanent nursing. Predicting outcome
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iii) Total hip arthroplasty THA ostensibly allows superior post-operative rehabilitation, 6 better hip functional outcome scores 1 , 3 , 14 , 25 and superior quality of life. 39 The National Institute for Health and Care Excellence
King’s Global Health Partnerships, School of Life Course and Population Sciences, King’s College London, London, UK
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Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines
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The global burden of fracture-related infection (FRI) is likely to be found in countries with limited healthcare resources and strategies are needed to ensure the best available practice is context appropriate. This study has two main aims: (i) to assess the applicability of recently published expert guidance from the FRI consensus groups on the diagnosis and management of FRI to low- and middle-income countries (LMICs); (ii) to summarise the available evidence on FRI, with consideration for strategies applicable to low resource settings.
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Data related to the International Consensus Meeting Orthopaedic Trauma Work Group and the International Fracture Related Infection Consensus Group FRI guidelines were collected including panel membership, country of origin, language of publication, open access status and impact factor of the journal of publication. The recommendations and guidelines were then summarised with specific consideration for relevance and applicability to LMICs. Barriers to implementation were explored within a group of LMIC residents and experienced workers.
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The authorship, evidence base and reach of the FRI consensus guidelines lack representation from low resource settings. The majority of authors (78.5–100%) are based in high-income countries and there are no low-income country collaborators listed in any of the papers. All papers are in English.
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The FRI consensus guidelines give a clear set of principles for the optimum management of FRI. Many of these – including the approach to diagnosis, multidisciplinary team working and some elements of surgical management – are achievable in low resource settings. Current evidence suggests that it is important that a core set of principles is prioritised but robust evidence for this is lacking. There are major organisational and infrastructure obstacles in LMICs that will make any standardisation of FRI diagnosis or management challenging. The detail of how FRI consensus principles should be applied in low resource settings requires further work.
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The important work presented in the current FRI consensus guidelines is relevant to low resource settings. However, leadership, collaboration, creativity and innovation will be needed to implement these strategies for communities who need it the most.
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The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness.
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Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term.
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In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle.
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The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications.
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ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues.
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Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time.
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The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
Department of Orthopaedics and Trauma Surgery, Hospital San José – Clínica Santa María, Santiago, Chile
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Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland
Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland
Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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the traumatic event, any treatments undertaken, duration of immobilization, and subsequent physiotherapy rehabilitation. The physical exam is important. Careful assessment of function including accurate evaluation of range of motion in all planes
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, mechanical properties of plates and screws and postoperative rehabilitation. 11 Poor surgical technique not strictly adhering to principles of stability and fixation is another risk factor. Surgical technique is dependent on the fracture pattern and O
