The purpose of this study was to test the null hypothesis that patients with partial thickness rotator cuff tears do not suffer more pain or stiffness than those with full thickness tears. A power study determined that 68 partial thickness tears were required in the study in order to prove a clinically important difference (± = 0.05 and . 2. = 0.2). Consecutive patients undergoing arthroscopy and bursoscopy for rotator cuff related problems were assessed using a pain analogue scale and their shoulder movements were measured. Information was gained both pre- and intra-operatively about possibly relevant confounders including age, site size and thickness of tears, and endocrine disorders. Exclusion criteria included glenohumeral arthropathy, frozen shoulder, instability and major traumatic injuries, as well as the inability to understand the pain score. 439 shoulders (428 patients) were included in the study; 216 shoulders had no cuff tear, 95 had partial thickness tears (75 joint side, 1 intrasubstance, 19 bursal side), and 128 shoulders had full thickness tears. There was no significant difference (p< 0.05) in the pain scores or range of movement between full and partial thickness tears. Age was the only independent variable to have an effect on pain score. The null hypothesis has been upheld. This study contradicts the findings of previous research and challenges commonly held assertions on this topic. Neither pain nor stiffness can be used clinically as discriminators between partial and full thickness rotator cuff tears

Aims

Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.

The April 2014 Trauma Roundup³⁶⁰ looks at: is it safe to primarily close dog bite wounds?; conservative transfusion evidence based in hip fracture surgery; tibial nonunion is devastating to quality of life; sexual dysfunction after traumatic pelvic fracture; hemiarthroplasty versus fixation in displaced femoral neck fractures; silver VAC dressings “Gold Standard” in massive wounds; dual plating for talar neck fracture; syndesmosis and fibular length easiest errors in ankle fracture surgery; and dual mobility: stable as a rock in fracture.

The stress response to trauma is the summation of the physiological response to the injury (the ‘first hit’) and by the response to any on-going physiological disturbance or subsequent trauma surgery (the ‘second hit’).

Our animal model was developed in order to allow the study of each of these components of the stress response to major trauma. High-energy, comminuted fracture of the long bones and severe soft-tissue injuries in this model resulted in a significant tropotropic (depressor) cardiovascular response, transcardiac embolism of medullary contents and activation of the coagulation system. Subsequent stabilisation of the fractures using intramedullary nails did not significantly exacerbate any of these responses.