Objective: The Quebec shoulder dislocation rule is a recently derived clinical decision rule to guide physicians on the selective use of radiography in patients with shoulder dislocation. The aim of this study was to validate the Quebec shoulder dislocation rule. Methods: This was a secondary analysis of data collected in a retrospective cohort study. All patients presenting to the emergency department (ED) between January 1, 2003, and October 31, 2008, with a diagnosis of shoulder dislocation or fracture-dislocation were identified from ED management databases. Data collected included demographics, mechanism of injury, and presence of fracture. The outcome of interest was predictive performance of the Quebec shoulder dislocation rule for patients aged under 40 years on this cohort. Data analysis is descriptive. Results: Of the 346 patients identified, 196 were aged under 40 years, and 174 (89%) were male; the median age was 25 years (interquartile range 21-29 years), and 58 were recurrent dislocations. One hundred sixteen patients (59%) met the Quebec high-risk criteria, and 80 (41%) were classified as low risk. In the 196 patients aged less than 40 years, 12 fractures as defined were identified (6%). When applied to this cohort, the Quebec clinical decision rule had a sensitivity of 0.42 (95% CI 0.16-0.71), a specificity of 0.40 (95% CI 0.33-0.47), and a negative predictive value of 0.91 (95% CI 0.82-0.96). Conclusion: The Quebec shoulder dislocation rule had poor sensitivity for clinically significant fractures associated with shoulder dislocations in young patients (aged 16-39 years) presenting to an Australian emergency department. Its use cannot be recommended. RÉ SUMÉObjectif : La rè gle de dislocation de l'é paule en vigueur au Qué bec est une rè gle de dé cision clinique ré cemment adopté e pour guider les mé decins quant à l'utilisation sé lective de la radiographie chez les patients ayant subi une dislocation de l'é paule. Le but de cette é tude é tait de valider la rè gle de dislocation de l'é paule en vigueur au Qué bec. Conclusion : La rè gle de dislocation de l'é paule en vigueur au Qué bec avait une faible sensibilité sur le plan clinique pour les fractures importantes associé es aux dislocations de l'é paule chez les jeunes patients (de 16 à 39 ans) qui se sont pré senté s aux urgences en Australie. Son utilisation ne peut pas ê tre recommandé e.

The purpose of this article is to review clinical outcomes and propose a new classification scheme for combined use of Ilizarov Method with free tissue transfer for limb salvage. This is an Institutional Review Board-approved retrospective review of 62 patients treated with free tissue transfer and Ilizarov method over the past 15 years at a single institution. The surgical management of these patients is classified into 4 distinct approaches. The mean age was 37 years with the most common injury being Gustillo IIIB tibial fractures (61%). Eighty-seven percent of patients had failed prior fixation and 63% had osteomyelitis with a draining wound. The overall flap survival rate was 97%. The mean duration of Ilizarov fixation was 6.9 months with a mean limb length correction of 3 cm. The overall rate of primary bony union was 74%. With a mean follow-up of 42 months, the combined techniques resulted in limb salvage for 84% of cases. Failure of primary bony union was the only predictor of limb amputation. This multidisciplinary approach to limb salvage combines reconstructive microsurgery and the Ilizarov method.