For the clinical use of the LCP as a locked internal fixator in fractures with an interfragmentary gap of 1 mm, at least two to four plate holes near the fracture gap should be omitted to allow fracture motion and bone contact to occur. This will also achieve a larger area of stress distribution on the plate and reduce the likelihood of fatigue failure due to cyclic loading.

The overall quality of information regarding discectomy remains poor and variable despite an exponential increase in the number of users and Web sites, with a slight trend toward improvement, only 20% to 30% are of good quality, compared with that 10 years ago (<10%). Presence of Health on the Net code is a very reliable marker for health information quality.

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Good quality health information is certainly available on the Internet. However, it is not possible to predict with certainty which sites are of higher quality. We suggest clinicians should have a responsibility to educate their patients regarding the unregulated nature of medical information on the internet and proactively provide patients with educational resources and thus help them make smart and informed decisions.

Background & purpose The locking compression plate (LCP) system oVers a number of advantages in fracture Wxation combining angular stability through the use of locking screws with traditional Wxation techniques. However, the system is complex, requiring careful attention to biomechanical principles and good surgical technique. Methods From a series of clinical cases, where locking plate Wxation was used in fractures of long bones, three were selected. Patient-speciWc geometric information was obtained from AP and lateral plain radiographs, and the Finite Element (FE) models were generated manually. Results The Wrst case study highlighted the importance of the working length on the construct stability. By increasing the working length, the construct became more Xexible. The resulting increase in interfragmentary motion promoted indirect healing with the formation of callus. In the second case study, plate breakage occurred as a result of an inappropriate Wxation technique. The Wxation involved the use of locked screws at the level of the fracture passing the fracture line. This reduced the Xexibility of the implant which hindered the micro-motion needed for callus formation. Fatigue failure eventually occurred due to cyclic loading past the yield stress of the LCP. In the third case study, the long working length of the construct made it relatively Xexible. The larger area of stress distribution on the plate reduced the local strain, resulting in a protective eVect against fatigue failure of the implant. Interpretation In Conclusion, successful application of the LCP demands a good understanding of the biomechanics and careful preoperative planning.

Physicians should recommend the HONcode seal to their patients as a reliable indicator of Web site quality or, better yet, refer patients to sites they have personally reviewed. Supplying parents with a guide to health information on the Internet will help exclude Web sites as sources of misinformation.

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Background Compliance with postoperative sling immobilization after shoulder surgery has not been previously studied. In the present study, we examined the compliance with sling-wearing in patients who had had either undergone anterior stabilization or rotator cuff repair.Methods Patients who had undergone either an arthroscopic rotator cuff repair or shoulder stabilization anonymously answered a detailed standardized questionnaire regarding sling-wearing. Routine postoperative instructions require patients to wear a sling for 3 weeks after repair of a small or medium-sized rotator cuff tear, 4 weeks after anterior stabilization of the shoulder and 6 weeks after repair of a large or massive rotator cuff tear. All patients were contacted within 6 months of surgery. ResultsOlder patients were more likely to be compliant with postoperative instructions, as were patients who had longer periods of acute pain requiring oral analgesia. There was no difference in compliance between patients who had a small rotator cuff tear and those who had a large rotator cuff tear. Nor was there any difference between open and arthroscopic shoulder stabilization groups. DiscussionIn the present study, despite written instructions regarding sling-wearing, there were differences between patient groups with regard to compliance with sling-wearing instructions.