The risk of fellow eyes in patients with rhegmatogenous retinal detachment

PURPOSE OF REVIEW: A review of the current literature regarding the risk of nontraumatic rhegmatogenous retinal detachment in the fellow eye and prophylaxis of predisposing lesions is presented. RECENT FINDINGS: Although reports vary in study design and inclusion/exclusion criteria, the risk of retinal detachment in fellow eyes is similar to prior findings. Studies on prophylactic therapy also treated different cohorts. This makes drawing definitive conclusions difficult. SUMMARY: Rhegmatogenous retinal detachment poses a significant threat to the fellow eye. Risk factors specifically relevant to the fellow eye are discussed. There is insufficient evidence to recommend prophylactic therapy for prevention of retinal detachment in the fellow eye. To date, no prospective, randomized clinical trial on the prevention of retinal detachment in the fellow eye has been published.     

Dual plating for fractures of the distal third of the humeral shaft

In this study, we present a novel method for performing dual plating of extra-articular fractures of the distal third of the humerus. Since 2006, we have treated 15 such fractures with dual plates from a single posterior midline incision. In the first part of the study, we provide the surgical protocol we have used in addressing these fractures. In the second part, the charts of these patients were reviewed retrospectively to examine their clinical and radiographic outcomes. Using this technique, we have achieved an excellent union rate without significant complications while allowing early and aggressive range of motion.     

Management of nonunions of the proximal humeral diaphysis

It has been reported that the majority of nonunions of the humeral shaft evaluated are within the proximal one-third of the diaphysis. We are not aware of any reported series of humeral nonunions dealing specifically with the proximal diaphysis. We therefore sought to identify patients with a humeral shaft nonunion from an orthopaedic trauma service database, determine the frequency of those within the proximal one-third and review our treatment strategy and resulting clinical outcomes for these difficult fractures. Clinical and radiographical follow-up was available for 19 patients with a mean age of 70 years (range 29–94 years). This represented 46% of all humeral shaft nonunions treated during the study period. Dual plating was used in 11 cases to get adequate fixation in the proximal segment. Post-operative alignment was within 5° of anatomic in all cases. All nonunions healed at an average of 15.2 weeks (range 8–36 weeks). The mean length of follow-up was 12.5 months (range 6–122 months). All patients reported significant improvement in pain. The mean range of motion following fracture union was forward flexion 137°, external rotation 41° and internal rotation 30°. There were two minor complications and neither required a secondary surgery. The surgical technique we have used emphasising a thorough debridement of the nonunion site, correction of the deformity, fracture site compression with a rigid construct and bone grafting provides excellent rates of union and clinical outcomes.