Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2025.01.001
Adrian Ben Cresswell
{"title":"Test yourself: MCQ and single best answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.01.001","DOIUrl":"10.1016/j.mpsur.2025.01.001","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 127-128"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.12.007
Timothy G Bage, Matthew H Naeem, Andrew Titchener
Fractures of the proximal humerus are a common fracture pattern, particularly in the elderly, and as such represent a significant health burden in both the UK and international healthcare. There is notable contention in the literature on the optimal management options for these patients, in regard to both the clinical outcomes and financial considerations. In this article, the authors review diagnosis and management of these fractures, and discuss current and upcoming evidence on the subject.
{"title":"Proximal humeral fractures, current evidence including ProFHER","authors":"Timothy G Bage, Matthew H Naeem, Andrew Titchener","doi":"10.1016/j.mpsur.2024.12.007","DOIUrl":"10.1016/j.mpsur.2024.12.007","url":null,"abstract":"<div><div>Fractures of the proximal humerus are a common fracture pattern, particularly in the elderly, and as such represent a significant health burden in both the UK and international healthcare. There is notable contention in the literature on the optimal management options for these patients, in regard to both the clinical outcomes and financial considerations. In this article, the authors review diagnosis and management of these fractures, and discuss current and upcoming evidence on the subject.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 80-84"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.11.004
Simon Williams, Jonathan Hobby
Dupuytren's contracture is a common disorder in which proliferation of the palmar fascia leads to contractures of the fingers causing significant loss of hand function. In the early stages Dupuytren's presents with palmar nodules, which are best managed non-operatively, usually with observation. There is little evidence that any non-surgical intervention improves the long-term outcome. If the disease progresses to form cords with contractures that restrict hand function, surgical intervention is indicated. The surgical options range from percutaneous needle fasciotomy, through regional fasciectomy to dermofasciectomy and skin graft. The bigger procedures have a better chance of achieving a full correction of the deformity and a lower risk of recurrence, but the morbidity is greater and the recovery period longer. The choice of treatment is a balance between risks and benefits and should be a shared decision between the patient and surgeon.
{"title":"Dupuytren's disease","authors":"Simon Williams, Jonathan Hobby","doi":"10.1016/j.mpsur.2024.11.004","DOIUrl":"10.1016/j.mpsur.2024.11.004","url":null,"abstract":"<div><div>Dupuytren's contracture is a common disorder in which proliferation of the palmar fascia leads to contractures of the fingers causing significant loss of hand function. In the early stages Dupuytren's presents with palmar nodules, which are best managed non-operatively, usually with observation. There is little evidence that any non-surgical intervention improves the long-term outcome. If the disease progresses to form cords with contractures that restrict hand function, surgical intervention is indicated. The surgical options range from percutaneous needle fasciotomy, through regional fasciectomy to dermofasciectomy and skin graft. The bigger procedures have a better chance of achieving a full correction of the deformity and a lower risk of recurrence, but the morbidity is greater and the recovery period longer. The choice of treatment is a balance between risks and benefits and should be a shared decision between the patient and surgeon.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 120-126"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.12.001
Qamar Mustafa, Christopher Wilson, Timothy Crook
Distal radius fractures represent the most common fractures across the UK. In adults, there is a bimodal distribution of high energy trauma and low energy falls from standing height. The aim of treatment is to optimize functional recovery. Such a common fracture presentation demands an understanding of the anatomy, pathophysiology and clinical management. Guided by NICE and BOAST guidelines, the junior surgeon will be well placed to manage these injuries in adults.
{"title":"Distal radius fractures, current evidence including DRAFFT trial","authors":"Qamar Mustafa, Christopher Wilson, Timothy Crook","doi":"10.1016/j.mpsur.2024.12.001","DOIUrl":"10.1016/j.mpsur.2024.12.001","url":null,"abstract":"<div><div>Distal radius fractures represent the most common fractures across the UK. In adults, there is a bimodal distribution of high energy trauma and low energy falls from standing height. The aim of treatment is to optimize functional recovery. Such a common fracture presentation demands an understanding of the anatomy, pathophysiology and clinical management. Guided by NICE and BOAST guidelines, the junior surgeon will be well placed to manage these injuries in adults.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 96-101"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.12.008
Neil R Marshall, Matthew R Randell, Alex J Nicholls
The elbow joint is a complex articulation vital for upper limb function, combining stability with a wide range of motion in multiple planes. The joint consists of the three articulations: the ulno-humeral, radio-humeral and proximal radio-ulnar joints. These articulations are supported by several soft tissue stabilizers, which form the medial and lateral collateral ligaments, in addition to the joint capsule and annular ligament. The elbow joint is controlled by four main muscle groups: flexors, extensors, supinators and pronators. Numerous important structures cross the elbow joint: the brachial artery supplying the forearm, wrist and hand, and branches of the brachial plexus, principally the median, radial and ulnar nerves. The biomechanics of the elbow allow not only for flexion and extension of the elbow joint, but also supination and pronation of the forearm. The stability of the elbow joint whilst performing these movements is provided by the static and dynamic elbow stabilizers. The elbow joint is commonly assessed in OSCE examinations, and is assessed systematically through look, feel, move, and special tests.
{"title":"Elbow anatomy, biomechanics and clinical examination","authors":"Neil R Marshall, Matthew R Randell, Alex J Nicholls","doi":"10.1016/j.mpsur.2024.12.008","DOIUrl":"10.1016/j.mpsur.2024.12.008","url":null,"abstract":"<div><div>The elbow joint is a complex articulation vital for upper limb function, combining stability with a wide range of motion in multiple planes. The joint consists of the three articulations: the ulno-humeral, radio-humeral and proximal radio-ulnar joints. These articulations are supported by several soft tissue stabilizers, which form the medial and lateral collateral ligaments, in addition to the joint capsule and annular ligament. The elbow joint is controlled by four main muscle groups: flexors, extensors, supinators and pronators. Numerous important structures cross the elbow joint: the brachial artery supplying the forearm, wrist and hand, and branches of the brachial plexus, principally the median, radial and ulnar nerves. The biomechanics of the elbow allow not only for flexion and extension of the elbow joint, but also supination and pronation of the forearm. The stability of the elbow joint whilst performing these movements is provided by the static and dynamic elbow stabilizers. The elbow joint is commonly assessed in OSCE examinations, and is assessed systematically through look, feel, move, and special tests.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 85-90"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.11.006
Lucy C Walker, Duncan Avis
The wrist is a complex joint with multiple articulations allowing a multi-planar range of movement. This review will focus on the role of the radiocarpal and midcarpal joint in wrist function and subsequent consequences of pathological instability. Instability of the wrist is most commonly seen in the proximal carpal row, which is inherently more mobile and therefore has a higher propensity for injury to its stabilizing ligaments. This then alters the biomechanics of the wrist and leads to uneven loading through articular surfaces. If left untreated this progresses to predictable patterns of arthritis. Treatment options for instability are dependent on the chronicity of the instability and whether the affected ligaments are reparable or require a reconstruction. Any established arthritic changes make addressing the ligament issue alone futile and management should focus instead on the pain generating degenerative joints. Management algorithms have been formulated to aid decision making for surgical treatment of both wrist instability and arthritis.
{"title":"Wrist instability and arthritis","authors":"Lucy C Walker, Duncan Avis","doi":"10.1016/j.mpsur.2024.11.006","DOIUrl":"10.1016/j.mpsur.2024.11.006","url":null,"abstract":"<div><div>The wrist is a complex joint with multiple articulations allowing a multi-planar range of movement. This review will focus on the role of the radiocarpal and midcarpal joint in wrist function and subsequent consequences of pathological instability. Instability of the wrist is most commonly seen in the proximal carpal row, which is inherently more mobile and therefore has a higher propensity for injury to its stabilizing ligaments. This then alters the biomechanics of the wrist and leads to uneven loading through articular surfaces. If left untreated this progresses to predictable patterns of arthritis. Treatment options for instability are dependent on the chronicity of the instability and whether the affected ligaments are reparable or require a reconstruction. Any established arthritic changes make addressing the ligament issue alone futile and management should focus instead on the pain generating degenerative joints. Management algorithms have been formulated to aid decision making for surgical treatment of both wrist instability and arthritis.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 102-108"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.11.005
Ryan L Hillier-Smith, Henry B Colaço
The rotator cuff muscles include supraspinatus, infraspinatus, subscapularis and teres minor. The action of their tendons enables the complex movement of the shoulder joint. Rotator cuff disorders are common and can result in significant shoulder dysfunction and pain. Supraspinatus is the most frequently affected tendon. Subacromial impingement syndrome (SIS) represents a spectrum of pathology including subacromial bursitis, rotator cuff tendinopathy, partial thickness and full thickness tears. These are investigated using ultrasound or magnetic resonance imaging. Rotator cuff tears are not always related to SIS and can be divided into traumatic and degenerative. Treatment for tendinopathy and partial tears is normally non-operative through physiotherapy and corticosteroid injections. Full thickness and some partial thickness tears may require surgical repair, which is commonly performed arthroscopically. This involves mobilizing the torn or detached tendon and repairing it back to the native footprint with bone anchors or transosseous sutures. Repairs can be achieved using single or double row anchor techniques. Where tendon repair is not possible, other surgical solutions can be considered. These include patch repair augmentation, superior capsular reconstruction or tendon transfers. Cases of chronic rotator cuff tears can lead to cuff tear arthropathy, which ultimately can be treated with reverse total shoulder replacement.
{"title":"Shoulder impingement and the rotator cuff","authors":"Ryan L Hillier-Smith, Henry B Colaço","doi":"10.1016/j.mpsur.2024.11.005","DOIUrl":"10.1016/j.mpsur.2024.11.005","url":null,"abstract":"<div><div>The rotator cuff muscles include supraspinatus, infraspinatus, subscapularis and teres minor. The action of their tendons enables the complex movement of the shoulder joint. Rotator cuff disorders are common and can result in significant shoulder dysfunction and pain. Supraspinatus is the most frequently affected tendon. Subacromial impingement syndrome (SIS) represents a spectrum of pathology including subacromial bursitis, rotator cuff tendinopathy, partial thickness and full thickness tears. These are investigated using ultrasound or magnetic resonance imaging. Rotator cuff tears are not always related to SIS and can be divided into traumatic and degenerative. Treatment for tendinopathy and partial tears is normally non-operative through physiotherapy and corticosteroid injections. Full thickness and some partial thickness tears may require surgical repair, which is commonly performed arthroscopically. This involves mobilizing the torn or detached tendon and repairing it back to the native footprint with bone anchors or transosseous sutures. Repairs can be achieved using single or double row anchor techniques. Where tendon repair is not possible, other surgical solutions can be considered. These include patch repair augmentation, superior capsular reconstruction or tendon transfers. Cases of chronic rotator cuff tears can lead to cuff tear arthropathy, which ultimately can be treated with reverse total shoulder replacement.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 74-79"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.12.002
Niyati Jain, Hari Iyer, Sukhdeep Gill
Forearm fractures are seen by the orthopaedic team either in the emergency department or in the fracture clinic. Injuries which include the more proximal or distal joints are rare but can lead to disabling consequences if missed. In this article we discuss the anatomy, classifications systems and management of these less common upper limb fractures.
{"title":"Forearm fractures in adults","authors":"Niyati Jain, Hari Iyer, Sukhdeep Gill","doi":"10.1016/j.mpsur.2024.12.002","DOIUrl":"10.1016/j.mpsur.2024.12.002","url":null,"abstract":"<div><div>Forearm fractures are seen by the orthopaedic team either in the emergency department or in the fracture clinic. Injuries which include the more proximal or distal joints are rare but can lead to disabling consequences if missed. In this article we discuss the anatomy, classifications systems and management of these less common upper limb fractures.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 91-95"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.11.002
Rhian Bevan, Kim Pearce, Rebecca Mills
Rheumatoid arthritis (RA) is a chronic autoimmune disorder resulting from a T-cell-mediated immune response against soft tissues. Among the various joints affected, the hands are particularly susceptible, leading to joint destruction, deformity, significant disability and decreased quality of life for those affected. In the hands, RA predominantly affects the wrist joint and metacarpophalangeal (MCP) joints. In the early stages signs can be subtle, including joint pain and morning stiffness; however, as the disease progresses more severe symptoms and complications can occur, such as deformities of the hand and tendon ruptures. Significant advances in pharmacological treatments has meant there is less need for surgical intervention. With research still ongoing for pharmacological interventions, there are many promising treatments for RA.
{"title":"Rheumatoid arthritis in the hands","authors":"Rhian Bevan, Kim Pearce, Rebecca Mills","doi":"10.1016/j.mpsur.2024.11.002","DOIUrl":"10.1016/j.mpsur.2024.11.002","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a chronic autoimmune disorder resulting from a T-cell-mediated immune response against soft tissues. Among the various joints affected, the hands are particularly susceptible, leading to joint destruction, deformity, significant disability and decreased quality of life for those affected. In the hands, RA predominantly affects the wrist joint and metacarpophalangeal (MCP) joints. In the early stages signs can be subtle, including joint pain and morning stiffness; however, as the disease progresses more severe symptoms and complications can occur, such as deformities of the hand and tendon ruptures. Significant advances in pharmacological treatments has meant there is less need for surgical intervention. With research still ongoing for pharmacological interventions, there are many promising treatments for RA.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 109-114"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.mpsur.2024.12.006
Joseph Hanger, Joanna Higgins
The anatomy of the hand is a marvel of functional complexity, combining intricate skeletal, muscular, and neurovascular structures to facilitate a wide range of precise and powerful movements. As the primary tool for interaction with the environment, the hand's ability to perform fine motor tasks, from power gripping to delicate dexterity, is essential for daily activities and performing higher cognitive functions such as writing, manipulating tools, and communicating through gestures. This functional versatility is possible due to the unique arrangement of bones, muscles, tendons, and ligaments, and a highly specialized network of sensory and motor nerves. Understanding the detailed anatomy of the hand is crucial not only for the diagnosis and treatment of injuries and disorders, but also for advancing surgical techniques. Moreover, disruptions to its complex structures, whether through trauma, disease, or congenital conditions, can have profound implications on hand function and overall quality of life.
{"title":"Anatomy of the hand","authors":"Joseph Hanger, Joanna Higgins","doi":"10.1016/j.mpsur.2024.12.006","DOIUrl":"10.1016/j.mpsur.2024.12.006","url":null,"abstract":"<div><div>The anatomy of the hand is a marvel of functional complexity, combining intricate skeletal, muscular, and neurovascular structures to facilitate a wide range of precise and powerful movements. As the primary tool for interaction with the environment, the hand's ability to perform fine motor tasks, from power gripping to delicate dexterity, is essential for daily activities and performing higher cognitive functions such as writing, manipulating tools, and communicating through gestures. This functional versatility is possible due to the unique arrangement of bones, muscles, tendons, and ligaments, and a highly specialized network of sensory and motor nerves. Understanding the detailed anatomy of the hand is crucial not only for the diagnosis and treatment of injuries and disorders, but also for advancing surgical techniques. Moreover, disruptions to its complex structures, whether through trauma, disease, or congenital conditions, can have profound implications on hand function and overall quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 2","pages":"Pages 115-119"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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