Although clavicle fractures are common, fracture dislocations of the medial end are rare. We report on a case of a 17-year-old patient who presented with a fracture of the medial clavicle with an associated anterior dislocation of the sternoclavicular joint. The patient underwent successful surgical management resulting in fracture union, restoration of shoulder stability and full functional range of motion at latest follow-up.

Objective:To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in injuries related to anterior cruciate ligament and menisci and compare its effectiveness with that of arthroscopy.Methods:This retrospective cross-sectional study was conducted in the department of Radiology & Medical Imaging of Dallah Hospital, Riyadh, Kingdom of Saudi Arabia from September 2012 to March 2014. Fifty four patients (including 30 men and 24 women) with internal derangement of knee referred from the orthopedic consulting clinics underwent MR imaging followed by arthroscopic evaluation. The presence of meniscal and ligamentous abnormality on the imaging was documented by two trained radiologist. Findings were later compared with arthroscopic findings.Results:The sensitivity, specificity and accuracy of MR imaging for menisci and ACL injury were calculated: 100% sensitivity, 88.4% specificity, 90% positive predictive value, 100% negative predictive value, and 94.4% accuracy were noted for medial meniscal injury. Similarly, MR had sensitivity of 85.7%, specificity of 95%, positive predictive value of 85.7%, negative predictive value of 95%, and accuracy of 92.5% for lateral meniscal injuries. Likewise, anterior cruciate ligament had 91.6% sensitivity, 95.2% specificity, 84.6% positive predictive value, 97.5% negative predictive value, and 94.4% accuracy.Conclusion:MRI is extremely helpful in identifying meniscal and anterior cruciate ligaments tears. MR imaging has high negative predictive value making it better choice as screening tool compared to diagnostic arthroscopic evaluation in most patients with soft tissue trauma to knee.

A retrospective analysis was carried out on the loss of position after initial manipulation of the distal radius fractures at Dallah Hospital, Riyadh. Forty patients, above 60 years old, were selected from 2013-2015. Three measurements were taken on the X-rays of the injured wrist at three different occasions. Radial length and radial inclination were measured on the AP and volar tilt was measured on the lateral X-ray. X-rays were measured at the time of injury, soon after manipulation and at first follow-up at about a week. Assessment was done only from the patients X-rays and notes.The criteria used to label loss of position were loss of 10 degrees in volar tilt, loss of 5 degrees in radial inclination and loss of 2mm in radial length. The total number of patients who lost position after manipulation was 23(57.5%). All the three measurements were lost in 4 (10%) patients. Volar tilt was lost in 17 (42.5%) cases, radial length was lost in 15 (37.5%) cases and radial inclination was lost in 7 (17.5%) cases. Statistical tests showed p < 0.0001 for volar tilt and radial length and p < 0.05 for radial inclination.Patients who were given a complete cast within twenty four hours lost position in 7 (23.3%) cases. The ten patients whose cast was completed later than twenty four hours but within a week had all lost their positions.We concluded that the elderly patients should be manipulated and not left alone as most of the time we can achieve good reduction. The reason for lost reduction is more likely to be the dorsal slab and that they should be given a complete cast / Charnley method of radial slab.

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