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IntroductionIsolated spinal accessory nerve dysfunction has a major detrimental impact on the functional performance of the shoulder girdle, and is a well-documented complication of surgical procedures in the posterior triangle of the neck. To the best of our knowledge, the natural course and the most effective way of handling spontaneous spinal accessory nerve palsy has been described in only a few instances in the literature.Case presentationWe report the case of a 36-year-old Caucasian, Greek man with spontaneous unilateral trapezius palsy with an insidious course. To the best of our knowledge, few such cases have been documented in the literature. The unusual clinical presentation and functional performance mismatch with the imaging findings were also observed. Our patient showed a deterioration that was different from the usual course of this pathology, with an early onset of irreversible trapezius muscle dysfunction two months after the first clinical signs started to manifest. A surgical reconstruction was proposed as the most efficient treatment, but our patient declined this. Although he failed to recover fully after conservative treatment for eight months, he regained moderate function and is currently virtually pain-free.ConclusionClinicians have to be aware that due to anatomical variation and the potential for compensation by the levator scapulae, the clinical consequences of any injury to the spinal accessory nerve may vary.

We found that the posteromedial approach to the ankle for the surgical treatment of Haraguchi type 2 posterior malleolar fractures is a safe technique that enables good visualisation and reduction of the individual fracture fragments with promising early outcomes. Cite this article: 2017;99-B:1496-1501.

Objectives Paediatric displaced supracondylar fractures of the humerus are unstable injuries and if not reduced and stabilized in optimal position can lead to serious residual deformity. We report the results of reduction and stabilization of displaced supracondylar fractures using the Sauvé-Kapandji technique. Material and methods Eight males and five females, age ranging from 2 to 8 years with acute extension-type displaced supracondylar fractures of distal humerus, treated between January 2009 and March 2011 in our department were included in the study. The fracture was reduced using the Sauvé-Kapandji technique. The first wire was passed posteriorly through the fracture site under fluoroscopic control and was used to reduce the fracture. The fracture was then stabilized with two or three cross Kirschner wires, passed percutaneously under X-ray control. Results Each patient was followed up for 2 months to 1 year. There was clinical and radiological evidence of healing at 6 weeks postoperatively in all cases. One patient had neurapraxia of anterior interosseous nerve and made full recovery. All patients except for one had full range of movements at the elbow joint at 6 weeks. One patient had loss of 15°extension but gained full range of movements at 1-year review. All patients had normal carrying angle, and no gunstock deformity was noted. All patients had normal function at the elbow joint at the final follow-up visit. Conclusion The management of acute, displaced supracondylar fractures of the humerus in children using the Sauvé-Kapandji technique has shown excellent results in terms of healing of the fracture and functional outcome. We recommend this technique as an alternative in cases of encountering difficulties in fracture reduction prior to proceed with open reduction.

Introduction Ankle fractures treatment aims to restore joint stability and alignment to achieve full functional recovery. Current quality of care in Stoke Mandeville Hospital was compared to the gold-standard management approach as described in BOAST-12 guidelines. Method This closed loop audit looked at closed malleolar and syndesmotic ankle injuries in skeletally mature patients under Trauma and Orthopaedics. In the first audit cycle, 16 patients were included over a one-month period and 53 cases, with similar management, were identified over a three-month period for the second audit cycle. Results The initial audit cycle revealed that the main aspects of management that required improvement were the timing of reduction and splinting, as well as the documentation of neurovascular status post-reduction. We discussed our findings at the clinical governance meeting and interventional posters were distributed around the hospital. Documentation of the timing of reduction and splinting significantly increased from 6% to 85% post-interventions, and neurovascular examination post-reduction improved from 17% to 43%. All other quality assessment criteria recorded more than 90% documentation rates after implementation of changes. Conclusions Quality of care significantly improved post-interventions, which indicates that BOAST-12 gold-standard is achievable. The introduction of a proforma was suggested to further facilitate appropriate documentation.

Median nerve entrapment is a rare complication of posterior elbow dislocation and medial epicondyle fracture. In the event of delayed diagnosis, this injury pattern may result in significant and sometimes irreversible nerve damage. As such, a high degree of clinical suspicion and early imaging is indicated in patients with persistent nerve deficits following reduction of elbow dislocation. Here, a case of intraosseous type 2 median nerve entrapment that was diagnosed on ultrasound in an eight-year-old patient following ulnohumeral dislocation is discussed. This article reviews the key imaging findings of median nerve entrapment and discusses the subsequent MRI and surgical findings of this rare condition.