We developed a new type of bioactive bone cement, CAP (Hydroxyapatite composite resin; composed of 77% w/w hydroxyapatite granules and bisphenol-A glycidyl methacrylate-based resin) for bony defect filling. Elastic modulus of CAP is similar to a cortical bone, while it is injectable before hardening and physiologically bonding with bone in 4 to 8 weeks. We present a new method of treatment for unstable
The aim of this study was to assess patient-based outcome two years following non-operative management of displaced
Developments in plate technology have increased interest in the operative fixation of
Introduction: Fragility of the bone is widely regarded as a cause of
Purpose: This in-vitro study examined the effect of simulated
Osteoporosis has been implicated as one of the causative factors for
Introduction. The classical
Aim: To assess the adequacy of reduction of
Introduction: Displaced
A postal questionnaire was sent to 225 GPs and 225 Orthopaedic Surgeons (Consultant and Specialist Registrars) in 20 hospitals in North West England. They were asked to give their routine clinical practice with regard to investigation of underlying osteoporosis in 3 clinical scenarios :. 55 year old lady with a low trauma
The purpose of this study is to review the current treatment of
53 patients underwent closed reduction and longitudinal k-wiring of displaced
Background. One of the prime concerns when managing patients in plaster casts is loss of reduction. There have been studies showing that proper moulding of the plaster cast is critical in maintaining reduction. Recent studies have negated concerns that fibreglass (FG) casts do not allow swelling, when compared to plaster of Paris (POP) casts. However, their potential in maintenance of reduction has not been investigated. Materials and methods. We compared the three-point bending properties of FG casts with POP casts over the first 48 hours. The effect of splitting the casts, at one hour and 24 hours, was studied. Three identical jigs with hinged metal rods were designed to simulate a
Purpose of the study: Within the framework of a regional study, we compared the efficacy of pinning using the PY technique and the Kapandji method for the treatment of fractures of the distal radius with posterior displacement. Material and methods: This was a prospective study designed as a phase III randomised therapeutic trial in parallel groups. An open monocentric study with multiple operators compared the PY and Kapandji techniques. Two comparable groups were established: the PY group and the Kapandji group (K) for which we measured: quality of reduction using the radiographic frontal and sagittal radial inclination (FRI and SRI), radial length and inferior radioulnar index. Objective and subjective functional outcome assessed range of motion and the DASH and Jakim scores. The quality of the intra-articular reduction of articular fractures was assessed arthroscopically at the time of implant removal during the sixth week. Results: The series included 97 patients followed for one year. The preoperative FRI was 15.17 with mean posterior shift of −19.2. At one year, the RI was 25.5 in the PY group versus 22.6 in the K group (p=0.009) and the SRI 10.5 in the PY group versus 3.7 in the K group (p=0.04). For fractures with a posteromedian fragment and Gerard-Marchand fractures, the DASH at one year was 2 in the PY group versus 32 in the K group. The Jakim score was 71 in the PY group versus 58 in the K group (p=0.03) for posteromedian fragment fractures. The arthroscopic control at six weeks of articular fractures did not reveal any significant difference in intra-articular reduction. There were no tendon tears in this series. Discussion: This series shows the quality of pin fixation for wrist fractures, comparable with plating. It emphasizes the importance of adapting the type of pinning to the fracture type and the patient. Conclusion: Treatment of fractures of the distal radius with posterior displacement with pin fixation remains a treatment of choice, reserving PY osteosynthesis for fractures with a posteromedian fragment and Gerard-Marchand fractures and Kapandji osteosynthsis for simple
Aim: There are more than 50 methods for the treatment of Reflex Sympathetic Dystrophy Our aim is to test how effective is the treatment of patients with Reflex Sympathetic Dystrophy with guanethidine. Method: 15 patients (F=12, M=3, Mean age 59.9) were seen in the chronic pain clinic with Reflex Sympathetic Dystrophy. 13 patients had sustained a
Practice variation may occur when there is no standardised approach to specific clinical problems and there is a lack of scientific evidence for alternative treatments. Practice variation suggests that a segment of the patient population may be managed sub-optimally, and indicates a need for further research in order to establish stronger evidence-based practice guidelines. We surveyed Australian orthopaedic surgeons to examine practice variation in common orthopaedic presentations. In February 2009, members of the Australian Orthopaedic Association were emailed an online survey, which collected information regarding experience level (number of years as a consultant), sub-specialty interests, state where the surgeon works, on- call participation, as well as five common (anecdotally controversial) orthopaedic trauma cases with a number of management options. Surgeons were asked to choose their one most likely management choice from the list provided, which was either surgical or non-surgical in nature. A reminder was sent two weeks later. Exploratory regression was modeled to examine the predictors of choosing surgical management for each case and overall. Of 760 surgeons, 358 (47%) provided responses. For undisplaced scaphoid fractures, respondents selected short-arm cast (53%), ORIF (22%), percutaneous screw (22%) and long-arm cast (3%). Less experienced (0 to 5 years) (p=0.006) and hand surgeons (p=0.008) were more likely to operate. For a displaced mid-shaft clavicle fracture, respondents selected non-operative (62%), plating (31%) and intramedullary fixation (7%). Shoulder surgeons were more likely to operate (p<0.001). For an undisplaced Weber B lateral malleolus fracture, respondents selected plaster cast or boot (59%), lateral plating (31%), posterior plating (9%) and no splinting (2%). For a displaced
The burden of non vertebral fractures on the National Health Service is enormous. Osteoporotic fractures have an associated morbidity and mortality and as a consequent incur heavy financial burden with a current cost to the National Health Service of some £1.7 billion per year, hip fractures accounting for the greater part. We know from our own local experience in the North of Ireland that this previous service had failed to target these fracture patients for secondary prevention of osteoporosis (Northern Ireland