Treatment of Injuries and Conditions of the Distal Clavicle: A Review

Several trauma-related injuries and degenerative conditions affect the distal end of the clavicle. Fractures of the distal clavicle and separations of the acromioclavicular (AC) joint are common, resulting from direct impact onto the shoulder region. Osteolysis and osteoarthritis of degenerative processes of the AC joint are caused by repetitive activity and overuse of the shoulder. To help identify options for treating the distal end of the clavicle, this review highlighted notable anatomical locations and biomechanics; findings of physical examinations; classification systems of injuries; and standard operative and nonoperative methods used for treatment. Although distal clavicle fractures, AC joint separations, osteolysis, and AC joint osteoarthritis can be treated nonoperatively, severe injuries may be successfully treated using operative techniques

Splinting Method for Preventing Thermal Injuries in Patients with Malleolar Fractures of the Ankle after Operative Treatment Performed Under Regional Anesthesia

After performing open reduction and internal fixation (ORIF) for treating malleolar fractures of the ankle, surgeons typically use plaster splints during postoperative recovery of patients. Use of regional anesthesia during ORIF has been noted as a risk factor for burns in patients using plaster splints, possibly owing to inability to feel pain after undergoing regional block. We describe a successful postoperative splinting technique used for preventing thermal injuries in this patient population. We reviewed medical records of patients between 2011 and 2013 at our institution with malleolar ankle fractures who had underwent ORIF under general anesthesia, peripheral nerve block, or a combination of both. Patients without follow-up were excluded; therefore, 154 were included. No thermal injuries were noted, operative reduction of the fracture was maintained, and the cost of each splint was $13.19. Use of the current technique in applying plaster splints may help effectively prevent postoperative thermal injuries

Estimation of Simulated Blood Loss by Orthopaedic Residents Before and After Brief Training

Background: Accurate estimation of blood loss (EBL) may be helpful for patient safety during certain operative procedures; however, medical students and residents are rarely instructed in EBL. In a series of two tests, we attempted to reveal any significant improvement in accuracy of EBL after a brief training session. Methods: Fourteen orthopaedic residents were recruited. Participants estimated the amounts of simulated blood before and after a training session that involved a visual of 110 cm3 of the spilled fluid. Three volumes of 50, 237, and 531 cm3 of simulated blood were spilled on a lap sponge, blanket, and trash bag, creating nine stations total for estimating blood loss. Results: The EBL for each surface was inaccurate, particularly on the absorbent material (ie, sponge and blanket). Of the 126 initial estimates, a total of 13 (10%) were within 20% of the true value. After a brief training session, a total of 43 estimates (34%) were within 20% of the true value spilled. Individual estimates maintained a wide range in both tests. Conclusions: Although EBL is a difficult skill to learn, training may result in significant improvement of accuracy. Healthcare professionals should be aware of the complications in estimating blood loss and possible benefits of formal instruction