Glenoid and coracoid dimensions and their implications in the latarjet operation: a dry bone study

Background: The coracoid process is widely used as a graft in patients with recurrent anterior shoulder instability with significant glenoid bone defects. However, no local studies have determined the coracoid dimensions and correlated them to the glenoid dimensions.Objective: To measure the widest anteroposterior (AP) diameter of the glenoid cavity, the length, width and thickness of the coracoid process, compare these with other populations, determine the amount of coverage the thickness and width of the coracoid process can afford in case of bony glenoid deficiency and the adequacy of the coracoid process to safely accommodate fixation screws used in the Latarjet and congruent-arc Latarjet procedures.Methods: The dimensions were measured using digital vernier callipers on dried scapulae that were not deformed. The ratio between coracoid thickness and width to the glenoid AP diameter was determined as the percentage cover that particular dimension can provide to the deficient glenoid.Results: A total of 26 scapulae were obtained. Average AP diameter and height of the glenoid was 25.1mm and 36.2mm respectively. Average coracoid length, width and thickness was 22.3mm, 13.3mm and 7.7mm respectively. There was no significant difference between the right and left sides in all the dimensions. The average coverage provided by the coracoid thickness (Latarjet procedure) was 30% with coracoid width providing average coverage of 50% (congruent-arc Latarjet procedure). The coracoid width could safely accommodate the 3.5mm and 4.5mm screws while coracoid thickness offered a very thin margin round the screws.Conclusion: The coracoid process can cover glenoid defects of between 30% and 50% and while it may safely accommodate the 3.5mm and 4.5mm screws if oriented for the classic Latarjet operation, care is needed especially if the congruent-arc Latarjet is planned as coracoid thickness may not be adequate to accommodate the fixation screws.Keywords: Coracoid process, Glenoid, Latarjet, Congruent-arc Latarje

Prevalence of Malaria Parasitemia and Purchase of Artemisinin-Based Combination Therapies (ACTs) among Drug Shop Clients in Two Regions in Tanzania with ACT Subsidies.

Throughout Africa, many people seek care for malaria in private-sector drug shops where diagnostic testing is often unavailable. Recently, subsidized artemisinin-based combination therapies (ACTs), a first-line medication for uncomplicated malaria, were made available in these drug shops in Tanzania. This study assessed the prevalence of malaria among and purchase of ACTs by drug shop clients in the setting of a national ACT subsidy program and sub-national drug shop accreditation program. A cross-sectional survey of drug shop clients was performed in two regions in Tanzania, one with a government drug shop accreditation program and one without, from March-May, 2012. Drug shops were randomly sampled from non-urban districts. Shop attendants were interviewed about their education, training, and accreditation status. Clients were interviewed about their symptoms and medication purchases, then underwent a limited physical examination and laboratory testing for malaria. Malaria prevalence and predictors of ACT purchase were assessed using univariate analysis and multiple logistic regression. Amongst 777 clients from 73 drug shops, the prevalence of laboratory-confirmed malaria was 12% (95% CI: 6-18%). Less than a third of clients with malaria had purchased ACTs, and less than a quarter of clients who purchased ACTs tested positive for malaria. Clients were more likely to have purchased ACTs if the participant was <5 years old (aOR: 6.6; 95% CI: 3.9-11.0) or the shop attendant had >5 years, experience (aOR: 2.8; 95% CI: 1.2-6.3). Having malaria was only a predictor of ACT purchase in the region with a drug shop accreditation program (aOR: 3.4; 95% CI: 1.5-7.4).\ud Malaria is common amongst persons presenting to drug shops with a complaint of fever. The low proportion of persons with malaria purchasing ACTs, and the high proportion of ACTs going to persons without malaria demonstrates a need to better target who receives ACTs in these drug shops

Chronic ankle instability: Current perspectives

Ankle sprain is reported to be among the most common recurrent injuries. About 20% of acute ankle sprain patients develop chronic ankle instability. The failure of functional rehabilitation after acute ankle sprain leads to the development of chronic ankle instability. Differentiation between functional and anatomical ankle instability is very essential to guide the proper treatment. Stability testing by varus stress test and anterior drawer test should be carried out. Subtalar instability is an important pathology that is commonly by passed during the assessment of chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability might require surgical intervention. The surgical and conservative management options can be very much developed by in-depth knowledge of the ankle anatomy, biomechanics, and pathology. Anatomical repair, augmentation by tendon, or both are the basic methods of surgical intervention. Arthroscopy is becoming more popular in the management of chronic ankle instability