Intra-Articular Risks of Suprapatellar Nailing.

Intra-articular risks of suprapatellar nailing.

Am J Orthop (Belle Mead NJ). 2012 Dec; 41(12): 546-50
Beltran MJ, Collinge CA, Patzkowski JC, Masini BD, Blease RE, Hsu JR,

To determine the risks to local anatomy near the starting point for tibial nailing during suprapatellar nailing, 15 fresh-frozen hemipelvis specimens were nailed using a suprapatellar technique. After nail passage, the menisci and articular surfaces, anterior cruciate ligament (ACL) insertion, intermeniscal ligament, and fat pad were assessed for injury. The distance from the entry portal to the menisci, articular surfaces, and ACL insertion was determined. Medial meniscus injury occurred in 1 (6.7%) specimen and medial articular injury in 2 (13%). Nails passed through the fat pad in all specimens; intermeniscal ligament injury occurred in 3 (20%) specimens. The ACL insertion and lateral structures were not injured in any specimen. The distance from the entry portal margin to the lateral and medial menisci was 6.46±2.47 mm and 4.74±3.17 mm, respectively. The distances to the lateral and medial articular margins measured 10.33±3.62 mm and 6.54±3.57 mm, respectively. The distance to the ACL insertion averaged 5.80±3.94 mm. Suprapatellar nailing is associated with a risk of injury to anterior knee structures comparable to other nailing techniques. Additional clinical studies are warranted to further define the role of this technique in the management of tibial fractures. HubMed – rehab

Returning to work after an injury.

Aust Fam Physician. 2013 Apr; 42(4): 182-5
Fenner P

Workplace injuries are common, cause significant morbidity for workers and have considerable economic impact. General practitioners can play an important role in facilitating early return to work, improving outcomes for all parties.This article provides guiding principles for the initial assessment and early treatment phase of injury with a primary focus on the rehabilitation and return to work process.A case management approach to assist injured workers return to work that involves collaboration between the injured worker, medical and rehabilitation providers, the employer and work insurers, achieves better outcomes. Efficient rehabilitation involves good initial assessment, effective early treatment, early mobilisation and good communication between all parties. General practitioners have an important role to play in facilitating this process. HubMed – rehab

Tendon injuries – Practice tips for GPs.

Aust Fam Physician. 2013 Apr; 42(4): 176-80
Paoloni J

Tendon inures are common, generally degenerative in nature, and can cause significant morbidity if not appropriately managed.This article outlines some key principles about tendon injuries with a particular focus on diagnosis and management.Diagnosis is made primarily on history and examination with imaging prescribed for unusual or recalcitrant cases. Examination elicits local tendon tenderness, pain with passive stretch, and pain with active contraction or specific provocative tests. Treatment involves pain control and musculotendinous rehabilitation. Pain control may include the application of ice, bracing and medications. Exercise rehabilitation is the mainstay of treatment for chronic tendon injuries and must include stretch and strengthening exercises. Generally, strengthening exercises for tendon injuries are eccentric in nature and should be performed relatively pain-free. Injectable modalities may be used as an adjunct to decrease pain and facilitate exercise rehabilitation, but should not be used in isolation. HubMed – rehab