Currently Kaplan's criteria on examination are used as the gold standard diagnostic tool for complex dorsal dislocations of the index finger Metacarpophalangeal joint. Our case report reveals a situation when the diagnosis was obscure and when conventional X-rays were not beneficial.With the use of CT imaging we were able to confirm the diagnosis of complex dorsal dislocation of the index finger Metacarpophalangeal joint and also reveal multiple other injuries. We feel that CT imaging should be performed on every individual who has been diagnosed with this injury or where the diagnosis cannot be confirmed with conventional methods.CT can be useful in diagnosis of index finger Metacarpophalangeal joint dislocations and also in diagnosing other fractures that may have been sustained in this high energy/impact injury.
Introduction: Periacetabular osteotomy (PAO) is increasingly being used to treat young adults with symptomatic hip dysplasia. Currently there is a lack of evidence to guide return to driving after this procedure. This study aimed to identify the length of time required after a Periacetabular Osteotomy procedure before a patient can safely return to driving. Methods: All patients undergoing PAO were assessed for suitability for the study. Inclusion criteria were: currently driving with a valid licence; and being able to attend follow-up assessment. Baseline driving reaction time was assessed using a driving simulator preoperatively. The simulation was repeated 5 times for each patient and reaction times recorded (Thinking time, Action time and Total reaction time for braking at 30 mph). The driving simulation was repeated using the same methods at 6 weeks and 12 weeks postoperatively. Pre- and postoperative times were compared. Results: 26 patients were included (24 females, 2 males) with a mean age of 32 (range 19–50) years. The mean preoperative times were: Thinking time 0.48, Action time 0.21, Total time 0.69 seconds. At 6 weeks postoperatively, mean Action time increased to 0.26 seconds ( p = 0.012) and mean Total time increased to 0.78 seconds ( p = 0.013). By 12 weeks post procedure, there was no significant difference in reaction times compared to baseline (mean Thinking time 0.47 seconds, Action time 0.23, Total time 0.72; p > 0.05). Conclusions: Most patients may not be safe to drive at 6 weeks following PAO procedures but should be safe to drive at 12 weeks postoperatively. Individual patient factors should also be taken into consideration.
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