INTRODUCTIONNew knowledge, and improved surgical hardware and fixation techniques have changed surgical management. We review the evolving trends of surgically managed proximal humerus fractures.

METHODSPatients who underwent surgery for proximal humerus fractures from 1 January 2001 to 31 December 2010 were identified from the hospital's electronic diagnosis and operative coding database. Data extracted from the database included patient demographics, comorbidities, clinical and radiological findings, operative techniques, and complications.

RESULTSIn total, 95 patients with 97 surgically managed proximal humerus fractures were identified. The median age of the patients was 50 (range 12-85) years, and the male to female ratio was 1.2:1.0. Male patients tended to present at a younger age than female patients (peak age 30-39 years vs. 70-79 years, p < 0.001). Two-part surgical neck fracture was the most common type of fracture (n = 33, 34.0%). Plate osteosynthesis was predominantly used for two- and three-part surgical neck fractures involving the greater tuberosity (p = 0.03, p = 0.0002, respectively). Hemiarthroplasty was commonly performed for four-part fractures (p < 0.001). Wound infections, implant failure, avascular necrosis of the humeral head and nonunion were seen in 8 (8.3%) cases. Minimally invasive plate osteosynthesis (MIPO) had been in use since 2007 (p < 0.001).

CONCLUSIONSurgically managed proximal humerus fractures predominantly involved young men following high velocity injury and elderly women following osteoporotic fractures. Open plating was most commonly used for two- and three-part fractures, and hemiarthroplasty for four-part fractures. MIPO techniques have been practised in our institution since 2007.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Fracture Fixation, Internal ; trends ; Hemiarthroplasty ; trends ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Shoulder Fractures ; surgery ; Young Adult

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amputation ; economics ; Cerebrovascular Disorders ; epidemiology ; Cohort Studies ; Comorbidity ; Conservative Treatment ; Costs and Cost Analysis ; Diabetes Mellitus ; economics ; Diabetic Foot ; economics ; epidemiology ; therapy ; Female ; Foot Deformities, Acquired ; economics ; epidemiology ; therapy ; Foot Injuries ; economics ; epidemiology ; therapy ; Health Care Costs ; Hospitalization ; economics ; Humans ; Hypertension ; epidemiology ; Joint Diseases ; economics ; epidemiology ; therapy ; Length of Stay ; economics ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; epidemiology ; Peripheral Vascular Diseases ; epidemiology ; Retrospective Studies ; Singapore ; epidemiology ; Wound Infection ; economics ; epidemiology ; therapy ; Young Adult

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Age Distribution ; Bicycling ; injuries ; Child ; Child, Preschool ; Cohort Studies ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; statistics & numerical data ; Fractures, Bone ; diagnosis ; epidemiology ; surgery ; Humans ; Injury Severity Score ; Male ; Prevalence ; Radiography ; methods ; Registries ; Retrospective Studies ; Risk Assessment ; Sex Distribution ; Singapore ; epidemiology ; Tomography, X-Ray Computed ; methods ; Trauma Centers ; Treatment Outcome ; Wounds and Injuries ; diagnostic imaging ; epidemiology ; therapy

INTRODUCTIONDiabetic foot wounds are serious complications of diabetes mellitus. Surgical debridement is a very important part of the management of diabetic wounds. Sharp debridement using the scalpel is normally performed. Versajet II hydrosurgery system is an alternative technique for debridement. To our knowledge, this is the fi rst study conducted to evaluate the use of hydrosurgery debridement for diabetic foot wounds.

MATERIALS AND METHODSThis pilot study included 15 consecutive patients with diabetic foot wounds who were admitted to the National University Hospital (NUH) and were managed by the Diabetic Foot Team from June 2012 to December 2012. All wounds underwent hydrosurgery debridement. Patients' demographic details, clinical details on wound assessments, and outcome were recorded and analysed.

RESULTSThe Versajet II hydrosurgery system was found to show some advantages over standard surgical scalpel debridement. It allowed adequate debridement whilst preserving more viable tissue to promote rapid healing. It could be manoeuvred over complex wound terrain. The time required for debridement was short--an average of 9.5 minutes. Good wound healing was achieved in all 15 cases. Only 1 Versajet debridement was required in 13 cases and 2 required an extra debridement. Twelve wounds were healed by split thickness skin grafting (STSG) and 3 wounds by secondary healing. Two of the STSG were infected but they were subsequently healed by dressings via secondary healing.

CONCLUSIONAlthough good wound healing was achieved in all 15 cases, further study that uses a larger cohort and a randomised controlled trial is required to fully evaluate the effectiveness, or otherwise, of the Versajet II hydrosurgery system for the debridement of diabetic foot wounds.

Adult ; Aged ; Debridement ; methods ; Diabetic Foot ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Treatment Outcome ; Water ; Wound Healing

COVID-19/complications* ; Fracture Fixation ; Fractures, Bone/surgery* ; Humans ; Musculoskeletal Diseases/surgery* ; Time Factors

Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).
Adult ; Bone Screws ; Forearm Injuries ; surgery ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Radius Fractures ; Range of Motion, Articular ; Titanium ; Ulna Fractures ; surgery

We present five patients with vibrio necrotising fasciitis, a lethal and disabling disease. Two of these patients had a history of exposure to either warm seawater or raw/live seafood, three had underlying chronic liver disease, and four presented with hypotension and fever. There were three deaths and four patients required intensive care unit stays. Among the two survivors, one had high morbidity. Only one patient met the criteria of Laboratory Risk Indicator for Necrotising Fasciitis score > 6. A clinician should suspect possible vibrio necrotising fasciitis if the following are present: contact with fresh seafood/warm seawater, a known history of chronic liver disease and pain that is out of proportion to cutaneous signs. All patients must be managed via intensive care in high dependency units. We recommend a two-step surgical protocol for patient management involving an initial local debridement, followed by a second-stage radical debridement and skin grafting.
Aged ; Aged, 80 and over ; Debridement ; End Stage Liver Disease ; complications ; Fasciitis, Necrotizing ; diagnosis ; microbiology ; surgery ; Female ; Fever ; complications ; Hepatitis B ; complications ; Humans ; Hypotension ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Seafood ; Seawater ; Severity of Illness Index ; Singapore ; Skin Transplantation ; Vibrio ; Vibrio Infections ; diagnosis ; surgery

INTRODUCTIONTraumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODSThe data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTSThere were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53-99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSIONCemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.

Aged ; Aged, 80 and over ; Bone Cements ; Female ; Femoral Neck Fractures ; complications ; surgery ; Hemiarthroplasty ; adverse effects ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Management ; Singapore ; epidemiology ; Venous Thrombosis ; epidemiology ; etiology

Humans ; Femoral Fractures, Distal ; Fracture Fixation, Internal ; Femoral Fractures/surgery* ; Femur/surgery* ; Bone Plates ; Retrospective Studies