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This study assessed rotation control elastic strapping as a treatment for proximal phalanx spiral fractures in adults, with good clinical outcomes. This is a cheap, simple and reliable management technique that avoids potential operative complications.

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Background: The aim of this study is to compare the surgical and non-operative management of displaced radial head fractures via a network meta-analysis of randomised controlled trials (RCTs). Methods: RCTs comparing management of isolated, displaced radial head fractures in adults were included in our review and statistical analysis. A systematic review of electronic databases (Medline, Embase and Cochrane Library) were screened for comparative RCTs reporting on the management of displaced radial head fractures in August 2021. Two investigators independently reviewed studies for eligibility and an assessment of bias was performed for each study. A Bayesian network meta-analysis of the included RCTs was performed. Results: Five RCTs (326 patients) were included in our meta-analysis. Treatment methods included radial head arthroplasty (RHA), open reduction internal fixation (ORIF) with metal implants (ORIF-M), ORIF with biodegradable implants (ORIF-B) and non-operative management. In our network meta-analysis of 'good' or 'excellent' patient-reported outcome measures (PROMs), RHA was significantly favourable to ORIF-M (OR: 0.04, CrI: 0.0011, 0.87), ORIF-B (OR: 0.1 CrI: 0.00076, 6.37). Nonoperative treatment was not shown to be significantly worse than RHA (OR: 0.01 CrI: 2.5e-0.5, 3.61). Conclusions: This network meta-analysis shows that in displaced radial head fractures, RHA is associated with significantly superior functional PROMs than ORIF-M based on the evidence available. Nonoperative management has not been shown to be significantly worse. Level of Evidence: Level III (Therapeutic).

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Fracture malunion alters wrist and distal radioulnar joint (DRUJ) biomechanics, resulting in incongruence and instability of the DRUJ. Selected patients with painful functional limitation and significant deformity of the radius, but without advanced degenerative joint disease, may benefit from corrective distal radial osteotomy. Non-union and complications arising from metalwork are the most common reasons for reoperation. Surgeons should have a good understanding of risks and complications in order to fully inform their patients and manage expectations. This article reviews the biomechanical effects of radial malunion and the current concepts for treatment. Distal radial osteotomy is suitable for symptomatic patients with angular radial deformity and shortening. Evidence supports a volar approach without bone grafts for modest corrections. Bone grafts or synthetic bone substitutes are appropriate for larger corrections. Functional improvements are reported regardless of technique. Despite a high complication rate, patient satisfaction with the corrective radial osteotomy is high.

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AIMS: Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies. PATIENTS AND METHODS: The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration's tool for assessing risk of bias (ROBINS-I) was used. RESULTS: Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1-41 months. Mean duration of symptoms prior to presentation ranged from 8.3-23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data. CONCLUSION: This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies.

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The largest (M8+) known earthquakes in the Himalaya have ruptured the upper locked section of the Main Himalayan Thrust zone, offsetting the ground surface along the Main Frontal Thrust at the range front. However, out-of-sequence active structures have received less attention. One of the most impressive examples of such faults is the active fault that generally follows the surface trace of the Main Boundary Thrust (MBT). This fault has generated a clear geomorphological signature of recent deformation in eastern and western Nepal, as well as further west in India. We focus on western Nepal, between the municipalities of Surkhet and Gorahi where this fault is well expressed. Although the fault system as a whole is accommodating contraction, across most of its length, this particular fault appears geomorphologically as a normal fault, indicating crustal extension in the hanging wall of the MHT. We focus this study on the reactivation of the MBT along the Surkhet-Gorahi segment of the surface trace of the newly named Reactivated Boundary Fault, which is ~ 120 km long. We first generate a high-resolution Digital Elevation Model from triplets of high-resolution Pleiades images and use this to map the fault scarp and its geomorphological lateral variation. For most of its length, normal motion slip is observed with a dip varying between 20° and 60° and a maximum cumulative vertical offset of 27 m. We then present evidence for recent normal faulting in a trench located in the village of Sukhetal. Radiocarbon dating of detrital charcoals sampled in the hanging wall of the fault, including the main colluvial wedge and overlying sedimentary layers, suggest that the last event occurred in the early sixteenth century. This period saw the devastating 1505 earthquake, which produced ~ 23 m of slip on the Main Frontal Thrust. Linked or not, the ruptures on the MFT and MBT happened within a short time period compared to the centuries of quiescence of the faults that followed. We suggest that episodic normal-sense activity of the MBT could be related to large earthquakes rupturing the MFT, given its proximity, the sense of motion, and the large distance that separates the MBT from the downdip end of the locked fault zone of the MHT fault system. We discuss these results and their implications for the frontal Himalayan thrust system.

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BACKGROUND: Malunited proximal radius fractures causing dislocation of the radio-capitellar joint are rare. We present a case of a two-year-old female patient with such an injury who was treated with a proximal radius osteotomy with good long-term outcomes. METHOD/RESULTS: Case study of a single patient with a malunited proximal radius fracture which was identified as causing radio-capitellar dislocation who underwent corrective osteotomy with a good result. CONCLUSION: Our opinion is that a corrective osteotomy for a malunited proximal radius fracture causing radio-capitellar dislocation is a sound treatment option and that no supplementary soft tissue reconstruction such as annular ligament exploration/reconstruction is necessary.

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