Surgeons must explain the risk of complications to prospective patients and get informed consent. If a complication that occurred was omitted in the process or given the wrong risk level, culpability of the surgeon is judged in court against what a “reasonable patient” would like to know to give or refuse consent. ObjectivesThe concept “reasonable patient” is widely used, no attempt has been made to define it objectively. We assessed insight of patients, presumed “reasonable”, about risks of certain complications after they underwent one of five orthopaedic procedures. Questionnaire was administered with procedures: femur IMN, tibia IMN, ankle ORIF, distal radius ORIF and hip arthroplasty. Four common/serious complications were chosen per procedure, and matched against life events with documented risk levels. There were 230 participants 163 males and 67 females. We found 19.1% of patients above age 40 and 33.3% with tertiary education wouldn't accept nerve injury as reported in literature. With infection risk, 18.1% above 40 and 52.9% with pre-tertiary education would not accept. All patients below 40 and 7.4% pre-tertiary education wouldn't accept the risk of death as reported. However, 37.1% above 40 and 76.9% with pre-tertiary education would accept that risk at a higher level. It is hard to predict what risk of complication a patient may accept. This study highlights that some patients will not accept risks as reported in literature, even though they need the procedure. Therefore, surgeons need to explain complications fully, so that patients knowingly accepts or refuses consent. The subset of patients who are not willing to accept any level of risk, should be the subject of another study.
Glomus tumours of the hand are rare benign vascular tumours. The literature shows a limited number of case series with few patients treated over several years. Patient records and the literature were reviewed.Background:
Methods:
Fracture of the clavicle is common and comprise 4% of all adult fractures. The incidence appears to be increasing owing to several factors, including the occurrence of many more high velocity vehicular injuries and an increase in popularity of contact sports. The most common side site for occurrence of fracture in clavicle is the middle third and the medial fractures are rare. We did our retrospective study during 2003–2005. We review 13 patients with fracture of the clavicle. There were 10 males and 3 females and 11 were left side and 2 were right side. Patients ages ranged between 15–49 years (average 29.6). The majority of fractures were caused by motorbike and quads bike accidents. 10 were classified as Neer type 1 (midshaft) and 3 were Neer type 1 (distal third). All these patients were treated with an Acumed congruent anatomical plate. The patients were followed up for 6 months to 1 years. Post-operatively patients were treated for 3 weeks in a sling, and then had physiotherapy for the next 3 weeks. All fractures were united by 7 weeks. Our complications were 1 superficial wound infection, 1 delayed union at 9 weeks, and 1 non union at 12 weeks. All patients had a full range of movement of the shoulder by the end of the 6th week. In the past fractures of the clavicle were treated conservatively. Currently patients want to mobilise their limbs early, and get back to work. The clinical results of the congruent anatomical plate appear to be good in terms of fracture union and early return to function in young patients. The principal advantage of this method of treatment is an anatomical reduction of the fracture and early rehabilitation with return to normal function.
In this outcome-based study, we reviewed the results of the modified Woodward procedure performed on 10 patients over the last 15 years in our unit. The indication for surgery was a unilateral Sprengel’s deformity, Cavendish grade II or III, in children aged 3 to 6 years. Follow-up times ranged from 1 to 15 years. The patients were assessed according to patient and relatives’ satisfaction, cosmesis and functional results. The modified Woodward procedure entailed a midline longitudinal incision over the spinous processes from C1 to T8. The origins of the trapezius and rhomboids were released from the spinous processes, the scapula lowered and derotated, the superomedial portion of the scapula resected and the trapezius and rhomboids reattached two vertebral levels lower. The clavicle was not osteotomised in any patient. A Velpeau sling was used for four weeks, after which physiotherapy was started. There were no brachial plexus complications. There were two cases of winging of the scapulae. One patient had a cosmetically ugly scar. Our results showed a cosmetic improvement by an average of one grade and a mean functional improvement of 30° of abduction and flexion. Those patients where an omovertebral body was found and resected had the best cosmetic and functional results. All the patients were satisfied with their operations. We feel that the pessimism regarding surgical results is unwarranted.
