Cary Fletcher | The University of the West Indies, Mona, Jamaica (original) (raw)

Papers by Cary Fletcher

$Research paper thumbnail of Functional outcome of distal radius fractures, an implant based approach - Narrative review$

Journal of orthopaedic reports, 2023

Background: Management of distal radius fractures (DRFs) is still controversial and may be influe... more Background: Management of distal radius fractures (DRFs) is still controversial and may be influenced by the initial fracture classification. Even though numerous classification systems have been proposed in this regard, the evaluation and management of this fracture has remained problematic. Objectives: The purpose of this study was to evaluate the functional outcome of DRF managed on the basis of a new classification. This classification named as Barzullah Working Classification represents a modification of Melone classification, which is based on fracture stability. Patients and Methods: A total of 310 DRFs of patients skeletally matured referred to a tertiary care hospital at a period of 18 months were classified as per the new classification system into four types; metaphyseal stable, metaphyseal unstable, radiocarpal stable, and radiocarpal unstable fractures. They were managed and followed over a mean period of 15.10 ± 5.4 months, and the results were recorded at the final follow-up. Results: The mean age of the patients was 51.22 ± 20.58 years. Most of the patients were females (n=189, 64.19%). The minimal follow up was 6 months with a mean of 15.10 ± 5.4 months. Mean mayo wrist scores were 95 ± 4, 80 ± 7.4, 75 ± 7.4, and 70 ± 6.9, for stable metaphyseal fractures, unstable metaphyseal radial, stable radiocarpal fractures and unstable radiocarpal fractures, respectively. The overall mean mayo wrist functional score was 80.58 ± 12.3 (good results) at final follow up. Conclusions: Various modalities of treatment used differentially in different types of DRFs based on the Barzullah Working Classification give good results in spite of conflicting literature.

This is an important and highly relevant topic especially when you consider that road traffic cra... more This is an important and highly relevant topic especially when you consider that road traffic crashes continue to be an ongoing global problem affecting young persons who are necessary to contribute to their respective nations' development. This is particularly so in a study involving young professionals. The introduction is fairly solid and the objectives are clearly

Journal of orthopaedic reports, May 1, 2023

Abstract Objectives To review the literature regarding antibiotic protocols, indications for fo... more Abstract
Objectives
To review the literature regarding antibiotic protocols, indications for formal irrigation, timing of debridement, and outcomes following fixation for low and high velocity gunshot fractures. The limitations in the literature will also be discussed.

The Internet Journal of Orthopedic Surgery, 2008

Objective: To determine the incidence of pudendal nerve palsies following static interlocking nai... more Objective: To determine the incidence of pudendal nerve palsies following static interlocking nailing of the femur, and to relate its development to age, body mass index, amount of pre-operative shortening, timing of surgery, level and type of fracture, duration of intra-operative traction, and use of muscle relaxants during surgery. Method: Twenty-nine consecutive patients who were treated with intramedullary nailing for femoral shaft fractures were prospectively studied. The age, body mass index, level and type of fracture, pre-operative traction, timing of surgery, preoperative shortening, duration of intra-operative traction, and use of muscle relaxants were recorded. Post-operatively, each patient was examined for altered sensation in the perineum. Men were asked about erectile function. Results: Eight patients (27.6%) developed palsies. All patients regained normal sensation and function. No significant differences were found between pudendal nerve injury and age, body mass index, pre-operative shortening, timing of surgery, level of fracture, muscle relaxant use, and duration of intra-operative traction. Significantly more palsies were present in patients with comminuted fractures. Conclusion: Intramedullary nailing of the femur is associated with pudendal nerve palsy. There is a significant correlation between pudendal nerve palsy and comminuted fractures.

DOAJ: Directory of Open Access Journals - DOAJ, Feb 1, 2022

Orthopedics and Rheumatology Open Access Journal, 2017

Large bony defects usually occur following high energy open injuries or post debridement. The tib... more Large bony defects usually occur following high energy open injuries or post debridement. The tibial shaft is the commonest site of these defects. Historically, the treatment was primary amputation. Limb salvage techniques are the current standard of care and options include: staged procedures inclusive of dead space management, soft tissue coverage and subsequent bone grafting, vascularised bone grafting and distractraction osteogenesis. The simultaneous treatment of bone loss, infection, non-union, deformity and leg length discrepancy makes bone transport an extremely valuable treatment option. Due to prolonged treatment times and various potential complications, proper patient selection is mandatory. While it is not a panacea, it remains the most versatile treatment option for complex soft tissue with large bony defects.

Case Report Comminuted lower pole patellar fractures requiring surgical intervention remains cont... more Case Report Comminuted lower pole patellar fractures requiring surgical intervention remains controversial in terms of the best surgical option. Current surgical options range from resection of the distal pole fragments with reattachment of the patellar tendon to the proximal fragment, to various forms of internal fixation. A case of a patient presenting with a comminuted distal patellar fracture is discussed below, followed by the pros and cons of the various surgical options. The current evidence is now in favour of fixation of the distal fragments with an implant which facilitates earlier rehabilitation.

The purpose of this review was to look at issues with varying opinions in the management of gunsh... more The purpose of this review was to look at issues with varying opinions in the management of gunshot injuries to the femur. These include the necessity for wound debridement, formal irrigation and intravenous antibiotics. Due to the increase in accessibility of high powered weapons by civilians, the civilian Orthopaedic surgeon must be able to diagnose and differentiate between low and high velocity gunshot injuries, as well as be aware of the management protocols of those different scenarios.

The purpose of this review is to describe the detailed elbow anatomy and the role of the radial h... more The purpose of this review is to describe the detailed elbow anatomy and the role of the radial head, as well as associated structures, in elbow stability. The roles of primary and secondary elbow stabilisers in the decision making of definitive treatment of Mason type II fractures are discussed. The classification systems of radial head fractures and their impact on treatment are also reviewed. A thorough literature review comparing conservative versus operative management of radial head fractures was performed and analysed to determine the superiority of one versus the other.

Peritalar dislocation is an uncommon injury which occurs in the talocalcaneal and talonavicular j... more Peritalar dislocation is an uncommon injury which occurs in the talocalcaneal and talonavicular joints [1,2]. It often results from high energy trauma, such as falls from a height, athletic injuries and motor vehicle accidents [1,3]. There are two major types of dislocation, medial and lateral [2]. In medial peritalar dislocations, the talar head is lateral to the rest of the medially dislocated foot [2]. Abstract Peritalar dislocations are uncommon injuries involving the talocalcaneal and talonavicular joints. A high energy mechanism of injury is typical. Dislocations are either lateral or medial. Early anatomic reduction, usually by closed means, is crucial for good outcome. This article will review the anatomy, pathoanatomy, mechanism of injury, diagnosis, initial management, and surgical intervention, period of immobilization/ rehabilitation, complications and prognosis of patients sustaining medial peritalar dislocations.

In modern Orthopaedics, the number of total knee replacements being performed continues to increa... more In modern Orthopaedics, the number of total knee replacements being performed continues to increase. As such, the absolute numbers of cases which become infected have also increased and hence, knowledge of the management of infected total joint replacements will continue to be of utmost importance. The choice of treatment depends on a variety of reasons including the chronicity of infection, virulence of the infecting organism and the host factors (e.g. age, health, immunologic compromise). The treatment goals aims to eradicate infection while preserving knee function and controlling pain. Surgical alternatives include arthrodesis, debridement and prosthesis retention, resection arthroplasty, single or two-stage exchange arthroplasty. In the majority of cases twostage exchange arthroplasty remains the gold standard of care. An articulated spacer plays an important role in this procedure in making the second operation technically easier while simultaneously achieving quicker return t...

Distal biceps tendon rupture is a fairly uncommon injury but the incidence has risen with the ass... more Distal biceps tendon rupture is a fairly uncommon injury but the incidence has risen with the associated increase in recreational activities in the 40 to 60 year old age group. The injury usually occurs from a single traumatic event whereby there is a forceful eccentric contraction of the biceps in the flexed elbow. Management considerations include conservative versus surgical management, and if surgery is chosen, the surgical approach: one-incision versus two-incision, and the choice of fixation technique which includes: suture anchors, bone tunnels or the endobutton. Surgery is indicated in patients who require maximum flexion and supination strength for vocational and recreational activities. The following article discusses the evolution of surgical management and the complications associated with the one and two incision approaches.

The Journal of medical research, 2018

Over time the anatomy, clinical assessment, imaging, surgical techniques and implants, as well as... more Over time the anatomy, clinical assessment, imaging, surgical techniques and implants, as well as the use of scoring systems has improved our ability to understand and treat complex injuries which result from intra-articular fractures of the calcaneus. The following article discusses the changing trends of management which ranged from non-operative management to open reduction and fixation to percutaneus fixation. The pros and cons of each option is discussed and why surgical management fell out and then in favour and is now considered standard of care for most cases.

$Research paper thumbnail of Traumatic Hip Dislocation with a Transphyseal fracture: A Case Report$

Introduction: Traumatic hip dislocations are very uncommon in children. A unique combination of i... more Introduction: Traumatic hip dislocations are very uncommon in children. A unique combination of injuries consisting of a traumatic hip dislocation in combination with an ipsilateral transphyseal fracture of the femoral head is presented in a 12-year-old child who was involved in a motor vehicle accident. It was unclear as to whether these injuries occurred simultaneously during this single traumatic event, or if the dislocation occurred at the time of the accident and the transphyseal injury occurred during closed reduction. The emergent open surgical management, short term follow up, and the factors which affect the prognosis of this patient are all discussed. Case presentation: A 12-year-old girl was an unrestrained backseat passenger in a motorcar, involved in a head on collision. Severe right hip pain as well as an inability to weight bear was her major complaints. She presented initially to another health facility and was subsequently transferred to our institution some nine ho...

The acromioclavicular joint (ACJ) is a diarthrodial joint which is stabilized by static and dynam... more The acromioclavicular joint (ACJ) is a diarthrodial joint which is stabilized by static and dynamic stabilizers. Acromioclavicular (AC) ligaments and the coracoclavicular (CC) ligaments (trapezoid and conoid) and the coracoacromial ligament make up the static stabilizers. The dynamic stabilizers are the deltoid and trapezius muscles. The principles of various surgical techniques involve reduction of the AC joint and were historically classified into two groups: those that focus on primary healing of the CC ligaments and those meant to reconstruct the CC ligaments. Ligament reconstruction must have sufficient immediate stability to prevent acute redisplacement or be protected temporarily until the region heals. The biomechanical basis for reconstructing the CC ligaments in the management of acromioclavicular type 3 injuries

The purpose of this review was to describe the kinematics of the wrist including a detailed anato... more The purpose of this review was to describe the kinematics of the wrist including a detailed anatomical description of the intrinsic and extrinsic carpal ligamentous supports, carpal instability, the mechanism of injury of perilunate dislocations and surgical treatment options. The surgical treatment options discussed included closed reduction and pinning and open treatment plus or minus ligamentous repair. For open treatment the arguments for and against a dorsal approach, volar approach and a combined approach are all discussed. It is now universally accepted that early surgical intervention gives the best results however the most efficacious approach remains debatable. It does appear however, that the volar only approach with an associated ligamentous repair is gaining acceptance as the most optimal approach.

Orthopedics and Rheumatology Open Access Journal, Nov 3, 2017

The objective of this comprehensive review assesses research analysing the nutraceutical qualitie... more The objective of this comprehensive review assesses research analysing the nutraceutical qualities and bioactive compounds within turmeric that contribute to human nutrition, health promotion and chronic disease prevention. Curcuma longa L. (root and rhizome), commonly known as turmeric, is a plant of high medicinal and economic value globally, where it is mainly used as a spice and food supplement. The major active ingredients of turmeric include three curcuminoids; curcumin (diferuloylmethane, the primary constituent responsible for yellow color of turmeric), demethoxycurcumin, and bisdemethoxycurcumin. In addition, volatile oils (tumerone, atlantone, and zingiberene) also have pharmacological activity. In addition, carbohydrates, proteins, and resins are also present in turmeric. Turmeric has excellent anti-inflammatory properties and is a superior antioxidant. The anticancer property of turmeric may be closely related to its anti-inflammatory property.

We report a rare injury involving volar fracture dislocations of the second to fifth carpometacar... more We report a rare injury involving volar fracture dislocations of the second to fifth carpometacarpal dislocations. Carpometacarpal dislocations are usually dorsally displaced and most commonly only involve the fourth and fifth joints. An associated carpal tunnel syndrome adds another dimension to the complexity and rarity of the injury in this index case. A high index of clinical suspicion and subsequent emergent management is of utmost importance to treat this unusual combination of injuries in order to avoid significant morbidity.