A 33-year-old farmer attended casualty with a painful right shoulder following a mains electric shock sustained whilst wiring the kitchen. He gave a history of touching some live wires with his right hand and then complained of severe pain up his right arm and into his right shoulder and upper back. He was in contact with the wiring for no longer than 5-10 s. He had no chest pain or palpitations. There was no direct injury to the scapula.On examination, there were three small entry wounds at the tip of the thumb and on the radial side of the index and middle fingers, all were less than 5 mm in diameter. No exit wounds were noted. There was no neurovascular deficit; he was in sinus rhythm with a normal ECG. He had a painful right shoulder with very minimal movement. Radiographs revealed a fracture to the blade of the right scapular (Fig. 1a,b). There were no associated fractures of the shoulder, which was in joint. He was admitted for cardiac monitoring and analgesia. Computerised tomography was performed to assess the extent of the fracture and to rule out extension into the glenoid. He was discharged 24 h later with a broad arm sling and physiotherapy exercises to mobilise the shoulder as pain allowed.Review in fracture clinic at 10 days revealed a substantial periscapular haematoma but his range of movements had greatly improved. Clinically, at 3-month review, the scapula was fully healed with no residual tenderness and a return to normal function. Discussion
Femoral head fractures often result in damage to the articular cartilage. This article describes a patient who sustained a femoral head fracture-dislocation with significant damage to the articular cartilage of the weight-bearing portion of his femoral head (A). After anatomic reduction of the fracture, a 2×4-cm osteochondral articular defect existed at the weight-bearing portion of the femoral head (B). The femoral head fragment was rotated such that the superior weight-bearing surface was congruent (C). This created a small gap at the inferior aspect of the femoral head, which was filled using a small corticocancellous graft harvested from the greater trochanter. The femoral head fragment was fixed with countersunk 3.5-mm screws. At 18-month follow-up, the patient had returned to full-time construction work with no limitations. He reported no pain in his hip or any activity limitations, and his Harris Hip Score was 91 points. Radiographs obtained 18 months postoperatively showed healing of the femoral head and preservation of the hip joint.
Figure 1 Radiograph of the left elbow demonstrating undisplaced supracondylarfracture of the humerus.An 1 1 year old boy fell off a swing onto an outstretched left hand. He attended the accident and emergency department with a painful, swollen left elbow. Radiography of the injured elbow confirmed the undisplaced supracondylar fracture (fig 1). He was treated with a broad arm sling.A week later the child was seen in the fracture clinic and overall evaluation revealed tenderness over the left scaphoid. Radiography of the wrist confirmed fracture of the waist of the scaphoid (fig 2). He was treated in an above elbow scaphoid cast for three weeks followed by short arm scaphoid cast for another three weeks. W'hen evaluated at four months, both fractures united with an excellent functional result.
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