The purpose of this study was to examine the interobserver agreement using Neer's classification system for fractures of the proximal humerus. A preliminary series of 28 fractures of the proximal humerus admitted to the hospital over a 5-year retrospective period was independently assessed by two radiologists and two orthopedic surgeons. The degree of agreement between paired observations was determined using a kappa statistic. The observations were assessed according to the number of fracture segments, as well as site of fracture segment. Most of the patients assessed were multisegment tuberosity fractures (n = 18). Results showed that the overall agreement between pairs of observers was 65% (average kappa = 0.45). It was also shown that, within the tuberosity group, the percentage agreement was 50%, with an average kappa = 0.35, indicating only fair interobserver agreement. Clinical implications of these findings are such that, as major surgical decisions are made dependent on Neer's classification, closer evaluation techniques--such as the computerized tomography scan and magnetic resonance imaging--should be used to classify the fracture segments accurately. This is particularly true with the fractured tuberosity subgroup.
A case of an arteriovenous fistula resulting from an air-rifle pellet injury to the scalp is reported. Traumatic arteriovenous fistulas of the scalp are rare lesions. A suggested pathogenesis is a disruption of the arterial wall and its vasa vasorum with endothelial proliferation to adjacent veins. Classically, these fistulas are described as single channels, but more commonly they consist of multiple connections. Angiography is necessary to delineate the full extent of the lesions unless they are extremely small. Careful complete excision is the definitive management, as recurrences are common.
BackgroundIntraarticular steroid injection has been widely used by orthopaedic surgeons as an alternative to surgery and as a diagnostic tool. An association between infection after total hip arthroplasty and intraarticular steroid injection has been reported, particularly when the injections occur within 6 weeks of the operation. Given that recent recommendations by the Osteoarthritis Research Society International continue to endorse the use of intraarticular steroid injection, this study was used to further analyze the risk of intraarticular steroid injection before total hip arthroplasty. MethodsNinety-six hips that underwent total hip arthroplasty were retrospectively reviewed. Matched cohorts were established; one in which patients received intraarticular steroid injection before total hip arthroplasty and one in which patients did not. ResultsNo significant difference was found between groups, and no correlation with regards to timing of injection was found. ConclusionsThese findings suggest that there is no contraindication for administration of intraarticular steroids before total hip arthroplasty.
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