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Introduction: There is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. Methods: 20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1-10 analogue scoring). Results: The greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n = 6; p = 0.02) and left arm spica casts (n = 5; p = 0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2 ±1.9; p< 0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2 5 ± 1.6;p > 0.05).There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization. Conclusions: Drivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint, significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity. [ABSTRACT FROM AUTHOR]

There is a significant need for orthopaedic care in developing countries. For the past 10 years, the United States Army has supported annual orthopaedic hand surgery humanitarian missions to Honduras. The goal of this article is to compare the premission planning to the realities of mission execution to provide a template for future missions. Premission planning began 1 year before the mission. Based on previous missions, supplies were brought for 50 surgical cases. The mission began with 1 preoperative clinic day followed by 8 operative days and 1 postoperative clinic day. Of the 99 prescreened patients, 65 were indicated for surgery. A total of 58 surgeries were performed using innovative methods to stretch available supplies. A multidisciplinary and multination concerted effort is required for a successful humanitarian medical mission. A premission plan is critical prior to arrival and a contingency plan must be in place for missing mission-critical items.

Due to the nature of the wounds and environment, internal fixation in battlefield treatment facilities is discouraged despite the lack of data. The purpose of this review is to describe the outcomes of fractures that were internally fixed in the combat environment. The records of patients who had internal fixation performed in the theater of combat operations were reviewed. Demographics, injury characteristics, procedure history, and outcomes were recorded and analyzed. Forty-seven patients had internal fixation performed on 50 fractures in a combat theater hospital. Hip, forearm, and ankle fractures made up the majority of cases with 14 (28%), 14 (28%), and 10 (20%), respectively. Sixteen (32%) fractures were open. The average Injury Severity Score was 11.4 +/- 1.1 (range, 4-34). Thirty-nine fractures (78%) healed without incidence. There was one (2%) infection and one (2%) acute surgical complication. Ten (20%) fractures, including the one infection, required additional procedures. Because internal fixation in the combat environment was used judiciously, complications were not higher than previously reported.

An unusual case of a close-range, low-velocity gunshot wound to the knee is presented. Arthroscopic debridement was accomplished using standard anterior portals as well as the existing entry and exit wounds. All bullet fragments were successfully removed from the joint by arthroscopy and tractoscopy. A minimally displaced marginal, lateral tibial plateau fracture was observed and treated with restricted weight bearing and active motion. The patient recovered uneventfully and maintained full knee range of motion and a normal gait.