Free radial forearm flap reconstruction in surgery of the oral cavity and pharynx: surgical complications, impairment of speech and swallowing

The first 100 consecutive free radial forearm flaps used in reconstruction for oral and pharyngeal cancer were investigated. Seven re-operations took place due to circulatory impairment of the flap. Two flaps underwent partial, and four total necrosis, one of those patients died of massive haemorrhage. Post-operative infection was significantly correlated to increased time between the last radiotherapy session and surgery. All but eight patients had post-operative impairment of swallowing and all but five patients had impairment of speech articulation or hypernasality. Post-operative time spent in hospital was a range of 12-122 days (mean 37 days). The 2-year survival rate was 70% and the 5-year survival rate was 45%.</p

Paediatric olecranon fractures: a systematic review

The optimal management and long-term outcomes of olecranon fractures in the paediatric population is not well understood. This systematic review aims to analyse the literature on the management of paediatric olecranon fractures and the long-term implications. A systematic review of several databases was conducted according to PRISMA guidelines. English-language studies evaluating the management of isolated paediatric olecranon fractures were included. Data extracted included demographics, classifications, conservative and operative treatment methods and outcomes. Fifteen articles fitting the inclusion criteria were included. There were 11 case series and four retrospective comparative series. The reported studies included 299 fractures in 280 patients. The mechanism of injury was predominantly low energy. Fractures displaced &lt; 4 mm were treated non-operatively with almost universally good results, with the majority being treated with cast immobilization. Fractures displaced &gt; 4 mm were commonly treated operatively with generally good results, with tension band wire and suture fixation being the most common treatment modalities. Weight &gt; 50 kg was associated with failure of suture fixation. In those studies that reported olecranon fractures with associated elbow injuries (e.g. radial head fractures) outcomes were poorer. Forty-six fractures were in patients with osteogenesis imperfecta, who sustained a higher rate of re-fracture after removal of metalwork and contralateral olecranon fracture. Despite a relatively low evidence base pool of studies, the aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results, and support the operative treatment of fractures displaced ≥ 4 mm. Cite this article: EFORT Open Rev 2020;5:280-288. DOI: 10.1302/2058-5241.5.190082 </jats:p

Reporting of glenoid bone loss measurement in clinical studies and the need for standardization

Aims The amount of glenoid bone loss is an important factor in deciding between soft-tissue and bony reconstruction when managing anterior shoulder instability. Accurate and reproducible measurement of glenoid bone loss is therefore vital in evaluation of shoulder instability and recommending specific treatment. The aim of this systematic review is to identify the range methods and measurement techniques employed in clinical studies treating glenoid bone loss. Methods A systematic review of the PubMed, MEDLINE, and Embase databases was undertaken to cover a ten-year period from February 2011 to February 2021. We identified clinical studies that incorporated bone loss assessment in the methodology as part of the decision-making in the management of patients with anterior shoulder instability. The Preferred Reporting Items for Systematic Reviews (PRISMA) were used. Results A total of 5,430 articles were identified from the initial search, of which 82 studies met the final inclusion criteria. A variety of imaging methods were used: three studies did not specify which modality was used, and a further 13 used CT or MRI interchangeably. There was considerable heterogeneity among the studies that specified the technique used to quantify glenoid bone loss. A large proportion of the studies did not specify the technique used. Conclusion This systematic review has identified significant heterogeneity in both the imaging modality and method used to measure glenoid bone loss. The recommendation is that as a minimum for publication, authors should be required to reference the specific measurement technique used. Without this simple standardization, it is impossible to determine whether any published paper should influence clinical practice or should be dismissed. Cite this article: Bone Joint J 2022;104-B(1):12–18. </jats:sec

CT estimation of glenoid bone loss in anterior glenohumeral instability

Aims Recurrent dislocation is both a cause and consequence of glenoid bone loss, and the extent of the bony defect is an indicator guiding operative intervention. Literature suggests that loss greater than 25% requires glenoid reconstruction. Measuring bone loss is controversial; studies use different methods to determine this, with no clear evidence of reproducibility. A systematic review was performed to identify existing CT-based methods of quantifying glenoid bone loss and establish their reliability and reproducibility Methods A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of conventional and grey literature was performed. Results A total of 25 studies were initially eligible. Following screening, nine papers were included for review. Main themes identified compared 2D and 3D imaging, as well as linear- compared with area-based techniques. Heterogenous data were acquired, and therefore no meta-analysis was performed. Conclusion No ideal CT-based method is demonstrated in the current literature, however evidence suggests that surface area methods are more reproducible and lead to fewer over-estimations of bone loss, provided the views used are standardized. A prospective imaging trial is required to provide a more definitive answer to this research question. Cite this article: Bone Jt Open 2022;3(2):114–122. </jats:sec