Purpose. This prospective, expertise-based randomized clinical trial compares arthroscopic to open shoulder stabilization by measuring the disease-specific quality of life outcome in patients with traumatic unidirectional anterior shoulder instability, and determining the incidence of recurrent instability at 2-years post-operatively. Method. One hundred and ninety-six patients were randomly allocated to arthroscopic (n=98) or open (n=98) repair using an expertise-based approach with a surgeon specializing in one type of surgery. Randomization was performed using computer-generation, variable block sizes and concealed envelopes. Outcomes were measured at baseline, 3 and 6 months, 1 and 2 years post-operatively. These outcomes included the Western Ontario Shoulder Instability (WOSI) Index quality of life outcome and the American Shoulder and Elbow Society (ASES) functional outcome. Both outcomes were measured on a visual analog scale from 0 to 100, where a higher score represents better quality of life or function. Recurrent instability was categorized as traumatic/atraumatic, and as a subluxation/dislocation. Analyses included ANOVA of repeated measures and independent t-tests. Bonferroni adjustments for pairwise contrasts were made for multiple comparisons. Chi-squared analyses were performed on recurrence. Statistical significance was reported at p < 0.05. Results. There were no statistically significant differences at baseline with respect to gender, involved dominant shoulders, age, WOSI or ASES scores. At 2-years post-operatively, 19 patients in the Open group and 14 patients in the Arthroscopic group were lost to follow-up. A comparison of the baseline characteristics of these lost to follow-up patients showed no statistically significant differences in WOSI and ASES scores, age, involved dominant shoulder, gender and presence of Hill Sachs lesions between the groups. Of the patients that completed 2-year follow-up, there was no difference in mean WOSI score between the two groups: Open = 85 (SD = 20; 95% CI = 81 89), Arthroscopic = 82 (SD = 20; 95% CI = 77 86), p = 0.31. The ASES score for the Open group at 2-years was 91 (SD = 13; 95% CI = 88 94) and 88 (SD = 16; 95% CI = 85 92) for the Arthroscopic group, p = 0.17. Recurrence rates at 2-years were statistically different with 11% in the Open (9/80) and 23% in the Arthroscopic (20/87) groups, p = 0.05. Conclusion. At 2-years post-operative follow-up, there was no difference in disease-specific quality of life between Open and Arthroscopic repair. Open repair had a significantly lower risk of recurrence

Aims. To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Methods. Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed. Results. A total of 93 patients were randomized (46 TM; 47 POLY). No significant or clinically important differences were found with patient-reported outcomes at 24-month follow-up. Regarding the glenoid components, there were no complications or revision surgeries in either group. Grade 1 metal debris was observed in three (6.5%) patients with TM glenoids at 24 months but outcomes were not negatively impacted. Conclusion. Early results from this RCT showed no differences in disease-specific QOL, radiographs, complication rates, or shoulder function between uncemented second-generation TM and cemented POLY glenoids at 24 months postoperatively. Revision surgeries and reoperations were reported in both groups, but none attributed to glenoid implant failure. At 24 months postoperatively, Grade 1 metal debris was found in 6.5% of patients with a TM glenoid but did not negatively influence patient-reported outcomes. Longer-term follow-up is needed and is underway. Cite this article: Bone Jt Open 2021;2(9):728–736

Aims. Prior cost-effectiveness analyses on osseointegrated prosthesis for transfemoral unilateral amputees have analyzed outcomes in non-USA countries using generic quality of life instruments, which may not be appropriate when evaluating disease-specific quality of life. These prior analyses have also focused only on patients who had failed a socket-based prosthesis. The aim of the current study is to use a disease-specific quality of life instrument, which can more accurately reflect a patient’s quality of life with this condition in order to evaluate cost-effectiveness, examining both treatment-naïve and socket refractory patients. Methods. Lifetime Markov models were developed evaluating active healthy middle-aged male amputees. Costs of the prostheses, associated complications, use/non-use, and annual costs of arthroplasty parts and service for both a socket and osseointegrated (OPRA) prosthesis were included. Effectiveness was evaluated using the questionnaire for persons with a transfemoral amputation (Q-TFA) until death. All costs and Q-TFA were discounted at 3% annually. Sensitivity analyses on those cost variables which affected a change in treatment (OPRA to socket, or socket to OPRA) were evaluated to determine threshold values. Incremental cost-effectiveness ratios (ICERs) were calculated. Results. For treatment-naïve patients, the lifetime ICER for OPRA was $279/quality-adjusted life-year (QALY). For treatment-refractory patients the ICER was $273/QALY. In sensitivity analysis, the variable thresholds that would affect a change in the course of treatment based on cost (from socket to OPRA), included the following for the treatment-naïve group: yearly replacement components for socket > $8,511; cost yearly replacement parts OPRA < $1,758; and for treatment-refractory group: yearly replacement component for socket of > $12,467. Conclusion. The use of the OPRA prosthesis in physically active transfemoral amputees should be considered as a cost-effective alternative in both treatment-naïve and treatment-refractory socket prosthesis patients. Disease-specific quality of life assessments such as Q-TFA are more sensitive when evaluating cost-effectiveness. Cite this article: Bone Jt Open 2024;5(3):218–226

Our primary objective was to compare healing rates in patients undergoing arthroscopic rotator cuff repair for degenerative tears, with and without bone channeling. Our secondary objectives were to compare disease-specific quality of life and patient reported outcomes as measured by the Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score and Constant score between groups. Patients undergoing arthroscopic rotator cuff repair at three sites were randomized to receive either bone channeling augmentation or standard repair. Healing rates were determined by ultrasound at 6 and 24 months post operatively. WORC, ASES, and Constant scores were compared between groups at baseline and at 3, 6, 12 and 24 months post operatively. One hundred sixty-eight patients were recruited and randomized between 2013 to 2018. Statistically significant improvements occurred in both groups from pre-operative to all time points in all clinical outcome scores (p < 0 .0001). Intention to treat analysis revealed no statistical differences in healing rates between the two interventions at 24 months post-operative. No differences were observed in WORC, ASES or Constant scores at any time-point. This trial did not demonstrate superiority of intra-operative bone channeling in rotator cuff repair surgery at 24 months post-operative. Healing rates and patient-reported function and quality of life measures were similar between groups

The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) is a patient-reported disease-specific quality of life (QOL) outcome measure used to assess patients with recurrent lateral patellofemoral instability (LPI) both pre- and post-operatively. The purpose of this study was to compare the BPII 2.0 to four other relevant patient reported outcome measures (PROMs): the Tampa Scale-11 for kinesiophobia (TSK-11), the pain catastrophizing scale (PCS), a general QOL (EQ-5D-5L), and a return to sport index (ACL-RSI). This concurrent validation sought to compare and correlate the BPII 2.0 with these other measures of physical, psychological, and emotional health. The psychological and emotional status of patients can impact recovery and rehabilitation, and therefore a disease-specific PROM may be unable to consistently identify patients who would benefit from interventions encompassing a holistic and person-focused approach in addition to disease-specific treatment. One hundred and ten patients with recurrent lateral patellofemoral instability (LPI) were assessed at a tertiary orthopaedic practice between January and October 2021. Patients were consented into the study and asked to complete five questionnaires: the BPII 2.0, TSK-11, PCS, EQ-5D-5L, and the ACL-RSI at their initial orthopaedic consultation. Descriptive demographic statistics were collected for all patients. A Pearson's r correlation coefficient was employed to examine the relationships between the five PROMs. These analyses were computed using SPSS 28.0 © (IBM Corporation, 2021). One hundred and ten patients with a mean age of 25.7 (SD = 9.8) completed the five PROMs. There were 29 males (26.3%) and 81 females (73.6%) involving 50% symptomatic left knees and 50% symptomatic right knees. The mean age of the first dislocation was 15.4 years (SD = 7.3; 1-6) and the mean BMI was 26.5 (SD = 7.3; range = 12.5-52.6) The results of the Pearson's r correlation coefficient demonstrated that the BPII 2.0 was statistically significantly related to all of the assessed PROM's (p. There was significant correlation evident between the BPII 2.0 and the four other PROMs assessed in this study. The BPII 2.0 does not explicitly measure kinesiophobia or pain catastrophizing, however, the significant statistical relationship of the TSK-11 and PCS to the BPII 2.0 suggests that this information is being captured and reflected. The preliminary results of this concurrent validation suggest that the pre-operative data may offer predictive validity. Future research will explore the ability of the BPII 2.0 to predict patient quality of life following surgery

The original RCT demonstrated that a limitedly-supervised post-ACL reconstruction rehabilitation program was both clinically more effective and less costly than the traditional physiotherapy-supervised program. This study contacted patients from the original RCT a minimum of two years post-surgery to evaluate whether or not the clinical findings of the RCT were upheld over the long term. This study of eighty-eight patients has upheld the original findings in that the patients who performed the limitedly-supervised (home-based) program had a significantly higher mean disease-specific quality of life score compared to the patients who performed the physiotherapy-supervised rehabilitation program. To determine whether or not there were any differences in long-term outcome between those patients who performed a physiotherapy-supervised rehabilitation program (PT) and those who performed a primarily home-based rehabilitation program (H) in the first three months following ACL reconstruction. Patients were originally randomized, before ACL reconstruction surgery, to either the physiotherapy-supervised (seventeen physiotherapy sessions) or home-based program (four physiotherapy sessions). Eighty-eight of the original patients were able to return two to four years following surgery to assess their long-term clinical outcomes. Primary outcome: the Mohtadi ACL disease-specific quality of life questionnaire (ACL QOL). Secondary outcomes: bilateral difference in knee extension and flexion range of motion, sagittal plane knee laxity, relative quadriceps and hamstrings strength, and IKDC score. Unpaired t-tests were used to compare the two groups across the continuous variables. A Chi square test was used for the categorical data. The home-based group had a significantly higher (p = 0.02, 95% CI [18.4, 1.7]) mean ACL QOL score (80.0 ± 16.2) compared to the physiotherapy-supervised group (69.9 ± 22.0) a mean of forty months post-surgery. There were no significant differences between the two groups with respect to any of the secondary outcome measures. This long-term study upholds the short-term findings of the original RCT in that the home-based rehabilitation program is more effective than a more physiotherapy-intensive program for patients in the first three months following ACL reconstruction. Given the resource savings demonstrated in the original RCT, the home-based program is clearly economically-dominant (i.e., clinically more effective and less expensive). FUNDING: Calgary Health Region

Clinical management of patellofemoral (PF) instability is a challenge, particularly considering the wide range of contributing variables that must be taken into consideration when determining optimal treatment. An important outcome measure to consider in this patient population is disease-specific quality of life (QOL). The purpose of this study was to factor analyse and reduce the total number of items in the Banff Patellar Instability Instrument (BPII). Subsequent to the factor analysis, the new, item-reduced BPII 2.0 was tested for validity, reliability and responsiveness. Disease-specific QOL was measured in patients with a confirmed diagnosis of PF instability (n = 223) at the initial consultation with the original BPII. Data from these BPII scores was used to employ a principal component analysis (PCA) to factor analyse and reduce the total number of items in the original BPII, to create the new BPII 2.0. The BPII 2.0 underwent content validation (Cronbach's Alpha, patient interviews and reading-level); construct validation (ANOVA comparing the initial consultation, 6, 12 and 24 month post-operative, Eta squared); convergent validation (Pearson r correlation to the original BPII); responsiveness testing (Eta squared, anchor-based distribution testing); and reliability testing (intra-class correlation coefficient (ICC) 2,k). The original BPII was successfully reduced from 32 to 23 items. The new BPII 2.0 demonstrated excellent Cronbach's Alpha values: initial consult = 0.91; 6-months = 0.96; 12-months = 0.97; and 24-months post-operative = 0.76. Grade-level reading assessment for all items in the BPII 2.0 was below grade twelve. The ANOVA determined the BPII 2.0 was able to discriminate between the initial consultation, 6, 12 and 24 months post-operative assessments, with significant differences between each time-point (p < 0.05). Eta squared was 0.40, demonstrating a medium to large effect size. Convergent validity was established with the BPII 2.0 significantly correlated to the original BPII (initial consult = 0.82, 6-month = 0.90, 12-month = 0.90, and 24-month = 0.94). Anchor-based responsiveness was established with a significant correlation between the 7-point scale of patient-perceived improvement and 24-month post-operative BPII 2.0 scores. Strong reliability was established with an ICC (2,k) = .97. The BPII has undergone a critical step in its psychometric and clinimetric evolution: structural validation. With the work completed in this study, the BPII and BPII 2.0 have completed assessment of seven of the nine Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) properties including: 1) Internal consistency; 2) Reliability; 3) Standard error of measurement; 4) Content validation; 5) Structural validity; 6) Criterion validity; and, 7) Responsiveness testing. Completion of these assessments and the introduction of a structurally valid and shorter questionnaire, the BPII 2.0, provides a definitive level of credibility to this disease-specific outcome measure

Purpose: To assess the change in disease-specific quality of life associated with operating on patients with AIS, compared to non operative patients. Methods: The Climent Quality of Life for Spinal Deformities Scale (QLPSD)was administered prospectively to 119 patients undergoing scoliosis surgery and 42 patients followed for bracing or observation. Change in quality of life after two years (adjusted for baseline quality of life) was used to estimate the short term benefit of scoliosis surgery. Bracing status was also analyzed at baseline as a covariate to determine its effect on improvement in quality of life. Results: The operated group experienced an increase in quality of life of 4.3 points (95% C.I. 0.69, 7.88) on the 105 point Climent scale. Although statistically significant, this increase was lower than the 5.5 point cutoff we had defined a priori as clinically significant. Among the operative patients, there was no difference in the quality of life score between those braced at baseline (91.2) and those not (90.5) (p=0.73). In non operative patients, those braced had a baseline quality of life score of 88.2, and those not braced 83.3, this difference was also not significant (p=0.13). Conclusions: Scoliosis surgery results in a small increase, of questionable clinical significance, in spine-related quality of life at two years. Funding: Commerical funding. Funding Parties: This trial was funded by (in alphabetical order) Canadian Institutes of Health Research, DePuyAcroMed-Johnson & Johnson Medical Products, and Synthes, Canada

A reliable and valid measurement tool, The Western Ontario Meniscal Evaluation Tool (WOMET) was developed to assess the benefit of conservative and surgical interventions for meniscal pathology. A methodologic protocol designed by Guyatt was used for the development. This measurement tool can be used as the primary outcome tool in clinical trials evaluating the outcome of patients in this population. It can also be used to monitor a patients’ progress in private practice. The purpose of this study was to develop a measure of quality of life, which is reliable and valid, to assess the benefit of conservative and surgical interventions for meniscal pathology. Health-related quality-of-life measurement tool development. A modified methodologic protocol designed by Guyatt was used to develop the Western Ontario Meniscal Evaluation Tool (WOMET) a disease-specific quality of life measurement tool for patients with meniscal pathology. The stages were: 1) item generation, 3) item selection, 4) pretesting. Evaluation of the WOMET included testing reliability, responsiveness and validity. The final instrument, the Western Ontario Meniscal Evaluation Tool has sixteen items representing the domains of physical symptoms (nine items), sports, recreation/work/lifestyle (four items), and emotions (three items). The instrument proved to be valid by demonstrating predicted correlations with previously published knee measurement tools. Reliability at two weeks was high with an intraclass correlation coefficient of 0.833. The new instrument was also more responsive than other knee measurement tools. Since the patients own perception of changes in their health status is the most important indicator for success of a treatment, this measurement tool can be used as the primary outcome tool in clinical trials evaluating the outcome of patients in this population. It can also be used to monitor a patients’ progress in private practice

INTRODUCTION: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, with brace (BT, n=127; 122 females and 5 males) were followed at least twenty years after completion of the treatment. Methods: One hundred and nine patients were reexamined as part of an unbiased personal follow-up, including a clinical examination, radiographs, validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms. An age- and sex-matched control group (CTR) of 100 persons was randomly selected and subjected to the same examinations. Results: Curve size (major curve) was mean 38 degrees with a mean increase of 8 degrees from end of treatment to present follow-up. Significantly more patients complained of back pain (77%) in comparison to the control group (58%, p=0.0012), more often lumbar or thoracic pain. Significant but numerically small differences could be found for Oswestry Disability Index and other scores reflecting general back funtion and more patients had been on sick-leave due to the back (38% vs 19%). No differences were found in sociodemographic variables or in general quality of life (SF-36) between the groups. No correlation could be found between pain and its localization and curve size, increase since end of treatment or curve type. Conclusion: Patients with brace treatment for adolescent idiopathic scoliosis were found to have approximately the same back function as the general population. A few were physically severely disabled due to the back

Introduction: A consecutive series of patients with adolescent idiopathic scoliosis (AIS), treated between 1968 and 1977 before 21 years of age, with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) were followed at least twenty years after completion of the treatment. Methods: One hundred and thirty-nine patients were reexamined as part of an unbiased personal follow-up, including a clinical examination, radiographs, validated questionnaires in terms of general and disease-specific quality of life aspects as well as present back and pain symptoms. An age- and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. Results: Curve size was mean 36 degrees and nine of the patients (6%) had undergone any additional curve-related surgical procedure due to complications. Significantly more patients complained of back pain (78%) in comparison to the control group (58%, p=0.0012), mainly lumbar but mild pain. Significant but numerically small differences could be found for Oswestry Disability Index but not for sociodemographic variables or general quality of life (SF-36) between the groups. No correlation could be found between pain and its localization and curve size, increase since end of treatment or curve type. No differences were found between patients fused to L3/higher versus L4/lower. Discussion and conclusion: Patients surgically treated for adolescent idiopathic scoliosis were found to have approximately the same quality of life and back function as the general population and only a few were physically severely disabled

Today several therapeutic options exist for the management of early degenerative lesions in the knee. These include marrow stimulation techniques (abrasion arthroplasty, sub-chondral drilling, microfracturing), periosteal and perichondral graft interposition, the implantation of synthetic matrices (collagen, carbon fibres, or glycosaminoglycan gel), autologous chondrocyte transplantation, osteochondral mosaic autografts or allografts, or simple arthroscopic lavage and debridement. It appears that some of these techniques are moderately successful in the short-term, especially in younger patients with relatively recent localised chondral lesions or erosion, and in joints with normal stability and alignment. In these optimal conditions, it is possible to achieve repair in 70% of the diseased area. However, the cartilage remains substandard, with a one-third decrease in stiffness and increased tissue permeability. In the early degenerative knee, conservative treatment options include unloader bracing and the use of chondroprotective agents. Unloader braces have been shown to improve the disease-specific quality of life and the functional status of patients with varus osteoarthritis in prospective randomised clinical trials. However, patients often find braces uncomfortable and of doubtful effectiveness. Current information about the use of chondroprotective agents in the treatment of osteoarthritis suggests that intra-articular hyaluronic acid improves lubrication in the joint and helps to decrease swelling and inflammation. Used as dietary supplements, oral glucosamine and chondroitin sulphate appear to work synergistically together to cause a net increase in the amount of healthy articular cartilage, hereby slowing the progression of osteoarthritis. Convenient and safe, these intra-articular and oral chondroprotective agents present an exciting new approach in the treatment of early degenerative knee lesions

Summary Results of this two-group parallel design randomised controlled trial indicated one and two year outcomes following ACL reconstruction were not different in one hundred and fifty patients using either an ACL functional knee brace or neoprene knee sleeve. Introduction: The primary objective of this study was to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve. One hundred and fifty patients were randomised to receive an ACL functional knee brace (n=76) or a neoprene sleeve (n=74) at their six week postoperative visit following primary ACL reconstruction. Patients were instructed to wear the knee orthosis during participation in all physical activities. Patients were assessed preoperatively, six weeks, six, twelve, eighteen and twenty-four months postoperatively. Outcome measures included disease-specific quality of life (ACL QOL), KT 1000 and single limb forward hop test administered by a blinded research assistant. One and two-year outcomes were compared after adjusting for baseline scores. A priori directional subgroup hypotheses based on time from injury to surgery, pre-operative KT 1000 scores, and one and two-year compliance scores were evaluated using tests for interactions. Analysis was completed on an intention-to-treat basis. There were no significant between-group differences for any of the outcomes at one and two-year follow-ups. Mean between-group differences at two years were: 2.87% (95% CI: −3.85 – 9.60) for the ACL QOL, 0.07mm (95% CI: −0.80 – 0.93) for KT 1000 side-to-side difference, and 2.64% (95% CI: −4.57 – 9.85) for hop limb symmetry index. There were no significant subgroup findings and adverse events were similar between groups. Confidence intervals for between-group differences are narrow and exclude clinically important differences. These findings suggest a functional knee brace does not result in superior outcomes over a neoprene sleeve following ACL reconstruction

Purpose. Electrothermal arthroscopic capsulorrhaphy (ETAC) was a technology introduced for orthopaedic surgery without good scientific clinical evidence supporting its use. This multicentre randomized clinical trial provides the scientific clinical evidence comparing ETAC to Open Inferior Capsular Shift (ICS), by measuring disease-specific quality of life at 2-years post-operatively, in patients with shoulder instability due to capsular redundancy. Method. Fifty-four subjects (37 females and 17 males; mean age 23.3 years (SD = 6.9; 15–44 years) with multidirectional instability (MDI) or multidirectional laxity with antero-inferior instability (MDL-AII) were randomized intra-operatively to ETAC (n = 28) or Open ICS (n = 26) using concealed envelopes, computer-generated, variable block randomization with stratification by surgeon and type of instability. Outcomes were measured at baseline, 3 and 6 months, 1 and 2 years. The Western Ontario Shoulder Instability (WOSI) Index is a quality of life outcome measure that is scored on a visual analog scale from 0 to 100, where a higher score represents better quality of life. Two functional assessments included the American Shoulder and Elbow Society (ASES) Score and the Constant Score. Post-operative recurrent instability and surgical time were also measured. Analyses included ANOVA of repeated measures with Bonferroni adjustments for multiple comparisons, Chi-square and independent t-tests (p < 0.05). Results. At 2-years post-operatively, mean WOSI scores were not statistically different between the groups (p=0.61): ETAC = 74 (SD = 24; 95% CI = 64 84); Open ICS = 77 (SD = 20; 95% CI = 68 86). There was no difference between groups for mean ASES scores (p=0.34): ETAC = 81 (SD = 20; 95% CI = 73 90); Open ICS = 87 (SD = 18; 95% CI = 79 95), mean Constant scores (p = 0.35): ETAC = 83 (SD = 7; 95% CI = 80 86); Open ICS = 85 (SD = 11; 95% CI = 80 − 90), and recurrent instability (p = 0.41): ETAC = 2; Open ICS = 4. Mean surgical time was 23 minutes for ETAC and 59 minutes for Open ICS (p = 0.00). Three subjects (1 ETAC, 2 Open ICS) had stiff shoulders; however, no major complications were observed. Conclusion. Patient outcomes improved from baseline to all follow-up periods. There was no difference between the ETAC and Open ICS groups in quality of life, functional outcomes, and recurrent instability at 2 years post-operatively

Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

The February 2015 Hip & Pelvis Roundup³⁶⁰ looks at: Hip arthroplasty in Down syndrome; Bulk femoral autograft successful in acetabular reconstruction; Arthroplasty follow-up: is the internet the solution?; Total hip arthroplasty following acetabular fracture; Salvage arthroplasty following failed hip internal fixation; Bone banking sensible financially and clinically; Allogenic blood transfusion in arthroplasty.

The August 2014 Trauma Roundup³⁶⁰ looks at: On-table CT for calcaneal fractures; timing of femoral fracture surgery and outcomes; salvage arthroplasty for failed internal fixation of the femoral neck; screw insertion in osteoporotic bone; fibular intramedullary nailing on the ascendant; posterior wall acetabular fractures not all that innocent; bugs, plating and resistance and improving outcomes in olecranon tension band wiring.