Although the majority of adult distal humeral fractures are successfully treated with ORIF, the management in frail patients, often elderly with multiple co-morbidities and osteoporotic bone, remains controversial. Elbow replacement is frequently recommended if stable internal fixation cannot be achieved, especially in low, displaced, comminuted fractures. The “bag-of-bones” method ie early movement with fragments accepted in their displaced position, is rarely considered as there has been little in the literature since 10 successful cases were reported by Brown & Morgan in 1971 (JBJS 53-B(3):425–428). We present the experience of three units in which conservative management has been actively adopted in selected cases. 44 distal humeral fractures were initially treated conservatively - 2004–2010. Mean age 73.9 yrs (40–91) and 34 F: 10 M. Clinical and radiological review at a mean follow-up of 2 years (1–6).Introduction
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The association of occupation and carpal tunnel syndrome (CTS) is unclear. Population based studies have failed to prove causal relationships between certain types of work and the onset of CTS. The aim of this study was to compare the incidence of CTS with the underlying regional occupational profile and assess differences in disease severity. The study took place from 2004 to 2010 in a regional hand unit that was the sole provider of hand services to a health board. Occupation was classified according to the SOC2000 classification as published by the Office for National Statistics and compared with the National Census 2000 statistics. 1564 patients were diagnosed with CTS during the study period of which 852 were aged 16 to 74, in full time employment.Introduction
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