RETHINKING OF THE METHOD OF CONSERVATIVE TREATMENT OF PRIMARY TRAUMATIC SHOULDER DISLOCATION

Тhe authors of the article studied the evolution of views on the treatment of primary traumatic shoulder dislocation. In two research groups, including 103 patients, an attempt was made to eliminate the shortcomings of the generally accepted method of conservative treatment of this pathology: after atraumatic dislocation reduction, immobilization was performed in a mass-produced sling, and from the first day after the injury, an individually selected course of physical therapy for the immobilized limb was started, in accordance with age and physical development. The proposed approach to treatment was a reinterpretation of all stages of the existing method of conservative treatment of primary traumatic shoulder dislocation and allowed to improve the subjective feelings of patients on the VASH scale, as well as indicators of objective evaluation of function on the Rowe scale. In the conditions of a trauma center in a large district of a multi-million city, screening ultrasound of the shoulder joint is promising for all patients who have suffered a primary traumatic dislocation of the shoulder immediately after the dislocation is set and three weeks after the injury. This study allows us to conduct additional diagnostics and identify a group of patients with specific injuries to the anatomical structures of the shoulder joint, which in the future may initiate the development of post-traumatic instability. The functional method of immobilization of the upper limb after reduction of traumatic primary shoulder dislocation effective and simple to implement, easy for the patient and allows the doctor to monitor the results obtained at each stage of treatment.

Re-Admission Rates within 28 Days of Total Hip Replacement

INTRODUCTION The aim of the study was to identify the reasons for the higher than expected emergency re-admission to hospital within 28 days of total hip replacement (THR) for Stepping Hill Hospital, Stockport. PATIENTS AND METHODS Over a 42-month period, 65 (8.5%) of 769 patients were re-admitted within 28 days of discharge following primary THR. Case notes for 61 patients were available for retrospective review to assess premorbidity, initial postoperative complications and reason for re-admission. RESULTS The main reasons for re-admission were complications related to the procedure. These included thrombo-embolic disease 2.5%, atraumatic dislocation 1.4%, wound complications 1.2% and swollen limb 1.8%. Other causes such as admission to another department for problems not related to THR accounted for 0.8%. CONCLUSIONS Our findings are comparable with the published literature for early complications following THR. The three main reasons for re-admission were atraumatic dislocation, thrombo-embolic and wound complications such as superficial infection and haematoma are the commonest world-wide. The re-admission rate to hospital within the first 28 days following THR was a clinical indicator suggested by the UK Department of Health. It has subsequently been incorporated in a group of indicators used by the CASPE Healthcare Knowledge Systems (CHKS), a private healthcare consultancy and analysis company, for peer benchmarking. Our re-admission rates are inflated by admissions for non-THR-related reasons. The level of post-THR complications leading to re-admission were acceptable compared with the available published literature regarding 28-day re-admission. We anticipate that this study may act as a benchmark for other trusts.

Atraumatic Dislocation of the Trapeziometacarpal Joint Secondary to Osteoarthritis

We report a case of atraumatic dislocation of the trapeziometacarpal joint secondary to osteoarthritis. An attritional rupture of the anterior oblique carpometacarpal ligament is thought to have occurred, allowing complete dislocation which has led to a reduction in the patient’s pain.