Aims. The aim of this study was to investigate the association between fracture displacement and survivorship of the native hip joint without conversion to a total hip arthroplasty (THA), and to determine predictors for conversion to THA in patients treated nonoperatively for acetabular fractures. Methods. A multicentre cross-sectional study was performed in 170 patients who were treated nonoperatively for an acetabular fracture in three level 1 trauma centres. Using the post-injury diagnostic CT scan, the maximum gap and
Aims. The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. Methods. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. Results. The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and peroneal nerve injury incidence. The P-A screws, on the other hand, excelled in terms of VAS score improvements. Conversely, posterior buttress plate fixation showed the least incidence of osteoarthritis grade progression, postoperative articular
Aims. Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods. A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results. A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and
Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. A retrospective cohort study of patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013 with PM ankle fractures was performed. Inclusion criteria were that all patients must mobilise independently pre-trauma, have no pre-existing ankle pathologies, and had satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale, visual analogue scale (VAS) and patient satisfaction ratings. Osteoarthrosis was assessed using modified Kellgren-Lawrence scale on updated weightbearing ankle radiographs. 61 participants were included. Mean follow-up was 10.26 years. Average PM size was 16.19±7.39%. All participants were evaluated for clinical outcomes, demonstrating good functional outcomes (FAAM-ADL 95.48±7.13; FAAM-Sports 86.39±15.52) and patient satisfaction (86.16±14.42%), with minimal pain (VAS 1.13±1.65). Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthrosis in 36/52 (69.23%), mild osteoarthrosis in 14/52 (26.92%) and moderate osteoarthrosis in 2/52 (3.85%). Clinical outcomes were not associated with PM fragment size, post-reduction
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective cohort study and followed over a 12-month period. Post-operative computed tomography (CT) imaging of bilateral feet was obtained to assess surgical reduction using a combination of pre-determined parameters: Böhler's angle, calcaneal height, congruence and articular
Aims. To assess the proportion of patients with distal radius fractures (DRFs) who were managed nonoperatively during the COVID-19 pandemic in accordance with the British Orthopaedic Association BOAST COVID-19 guidelines, who would have otherwise been considered for an operative intervention. Methods. We retrospectively reviewed the radiographs and clinical notes of all patients with DRFs managed nonoperatively, following the publication of the BOAST COVID-19 guidelines on the management of urgent trauma between 26 March and 18 May 2020. Radiological parameters including radial height, radial inclination, intra-articular
Introduction. After total knee arthroplasty (TKA) with a PCL-retaining implant the location of the tibiofemoral contact point should be restored in order to obtain normal kinematics. The difficulty during surgery is to control this location since the position of the femur on the tibia cannot easily be measured from the back of the joint. Therefore, we developed a simple “spacer technique” to check the contact point indirectly in 90° flexion after all bone cuts are made by measuring the
Introduction: The magnitude of the initial chondral injury and the residual articular
Introduction: Outcome following intra-articular fractures is dependent on a myriad of variables, including the extent of the initial osteochondral and soft tissue injury. In the clinical setting it is impossible to control such variables, and studies are largely confined to radiographic and outcome based assessments. Therefore the effect of fracture line orientation has not been widely examined. Theoretically an incongruent intra-articular fracture results in a “low” side that is relatively unloaded, at the expense of a “high” side exposed to increased loads. Furthermore the orientation of the fracture may give rise to a narrow or broad swathe of wear on the opposing articular surface. Aim: To evaluate the effect of an incongruent intra-articular fracture of the medial femoral condyle on subsequent loading and wear patterns, using an in vitro model. Materials and Methods: 15 porcine stifle (knee) joints were harvested within three hours of death. Three groups of five joints were evaluated. Group S underwent a sagittal osteotomy of the medical femoral condyle that was then fixed in an incongruent position. In Group C the osteotomy was performed in the coronal plane. The third group acted as a control group and had no oseotomy performed. In all cases great care was taken to prevent injury to the menisci, articular surfaces and Ligamentous structures. The size of the
It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer fracture redisplacements and better one-year outcomes compared to plaster splinting. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure.Aims
Methods
Introduction:. Bicondylar tibial plateau fractures are serious periarticular injuries. We investigated outcomes in injuries managed with Ilizarov external fixators. Methods:. We retrospectively reviewed bicondylar tibial plateau fractures treated with Ilizarov fixators in a major trauma centre from 2008–2012. Radiological parameters were measured from standardised weight-bearing radiographs. A subset (n=34) had patient-related outcome measures. Results:. Of 80 injuries, all fractures united. Two developed septic arthritis and one osteomyelitis. 76.3% were graded a good-excellent outcome (Rasmussen radiological score). 30.3% had evidence of osteoarthritis (Kellgren Lawrence>1). Neither parameter correlated significantly with lower functional scores. Referrals from neighbouring hospitals had longer times to surgery, which associated with increased condylar widening (p=0.0214) and posterior tibial slope (p=0.0332). Risk of developing osteoarthritis correlated with lower joint line congruency angle (JLCA) (p=0.0017) and increased articular
Summary Statement. Objectifying postoperative recovery of patients with comminuted tibial plateau fractures treated with a unilateral plate trough the use of a gait analysis system. Introduction. Gait analysis has been a proved method for assessing postoperative results in patients with different orthopedic afflictions of the lower limb such as hallux valgus, ankle instabilities, knee osteoarthritis and arthroplasties but it has rarely been used for postoperative assessment of proximal tibial fractures. The more traditional means of quantifying postoperative articular
This study investigates the efficacy of the AO Pi-plate in the treatment of complex, unstable, intra-articular fractures of the distal radius. A retrospective study of 17 patients was carried out who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. All patients were assessed clinically and radiologically post-operatively. The final functional outcome was assessed using the Gartland &
Werley scoring system. The average follow-up period was 34.3 months. 94% (16 patients) of the fractures were classified as AO type C fractures. The wrist movement was restored to a near normal range in all cases. The mean grip strength was 67% of the uninjured hand. The functional outcome as measured by the Gartland &
Werley scoring system showed excellent and good results in 88% of the patients. Radiographic assessment revealed an average articular
Introduction and purpose: Distal radius fractures often affect the joint surface; their reduction is difficult and may be incomplete. In these cases the use of an arthroscope may help reconstruct the joint surface of the radius and allow the diagnosis of ligament injuries. The purpose of this study is to analyze the results of this type of fractures by means of this technique. Materials and methods: Between November 2001 and January 2007 we reduced 24 fractures of the distal extremity of the radius that involved the joint surface with arthroscopic control. The mean age of the patients was 36 years (range: 21–55). We used Barbieri and Geissler’s classification. We recorded the approach route, arthroscopic ports, ligament injuries observed and complications. Also both radiological and functional results were assessed. Results: In 18 of the 24 patients some sort of ligamentous or osteochondral lesion was found (lunate-pisiform ligament, scaphoid-lunate ligament or triangular cartilage). All achieved union after a mean period of 8 weeks. By means of x-rays we measured a mean intraarticular
Introduction: The value of arthroscopy, fluoroscopy, and e-learning courses (focusing on minimally invasive surgical techniques) for the treatment of intra-articular distal radius fractures (I-ADRF), remains controversial. This study compares the outcomes after fluoroscopically assisted (FA) reduction and external fixation of distal radius fractures, with or without concomitant arthroscopic evaluation. Materials and Methods: Forty-seven patients with I-ADRF underwent FA external fixation and percutaneous pinning. Among them 23 had additional arthroscopic evaluation of their wrist. For teaching purposes procedures with the use of fluoroscopy and arthroscopy were recorded and adapted as a course for the On-line Performance Support Environment for Minimally Invasive Orthopaedic Surgery (“OnLineOrtho” EU- sponsored project). The context of these courses was incorporated in an intelligent medical performance support environment. The duration of the procedure, the surgical findings and the outcomes were recorded. Results: The follow-up period ranged from 24 to 62 months and the patients were evaluated at 3, 6, 12 and 24 months. The addition of arthroscopy prolonged the procedure by 25 minutes but diminished the number of images obtained by the image intensifier by 5. After arthroscopic evaluation the placement of subchon-dral pins was changed, because of
Aims: To simulate intra-articular fracture healing, this study investigated the regeneration of identical osteochondral gaps within step-offs or on congruous articular surfaces. Methods: Twenty-nine rabbits received either half-millimetre coronal step-offs separated by 0.5X2mm osteochondral gaps (n=16) or identical osteochondral defects alone (n=13) on the medial femoral condyles. After 6, 12 and 24 weeks survival, subchondral bone density about the lesion was measured by pQCT. Cartilage regeneration/degeneration was evaluated with histology and immunostaining for collagen type I and II. Results: Subchondral bone re-establishment was complete in gaps within step-offs by 24 weeks however, showed delayed restoration in defects on congruent surfaces. Repair cartilage quality showed some differences in the two groups producing better results on the low side of
Liquiband is a new tissue adhesive: It works like super glue – it is attached to the wound edges, it sets within seconds and lasts for about two weeks. The glue then flakes off automatically as the skin regenerates. There is no need for suture removal. A second step forms a waterproof layer over the wound. We compared in a prospective randomized trial the Liquiband glue to skin staples. Over a 9 month period (May 2005 to January 2006) we enrolled a total of 80 patients, 40 in each group. The patients were booked for elective limb surgery and agreed to participate in the study. The surgical wounds were closed in layers. The skin was then either closed with Liquiband or skin staples. A follow up was a weeks 2, 6 and 18. The wound healing was photographically documented. The wounds were assessed according to the Hollander wound scoring system and a patient satisfaction score. Ethical approval was obtained. The two groups were matched for sex, age, body-mass index and smoking. There was a similar total wound length in both groups. All wounds healed. In the Liquiband group 4 superficial infections occurred, one dehiscence due to glue removal by the patient. In the skin staples group we had 6 superficial infections. The patient satisfaction score was lower in the skin staple group (7.0 compared to 8.3 in the Liquiband group) and on the Hollander wound scoring system there were 10% more
Aims: In prospective study the author asked, what are the results of ORIF (open reduction, internal fixation) in displaced intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the sub-talar joint influence these results. Methods: Forty-three displaced intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV; Sanders) were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed (median: day 7). Motion was encouraged immediately, partial weight-bearing after 5–6 weeks, and full weight-bearing after 3–4 month. Following surgery subtalar joint was congruent in 33 (77%) and non-congruent (within 2mm) in ten fractures. Results: Thirtysix fractures were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86%) and not satisfactory in five. All fractures with unsatisfactory results were comminutive (Type III or IV). Four fractures with congruent subtalar joint had unsatisfactory, whereas eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse (p=0,002). However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint. Conclusions: ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. Comminution in the subtalar joint is a negative prognostic factor; furthermore, comminution is a negative prognostic factor irrespectless of the postreduction congruity in the subtalar joint, if
We utilized a dry-bone model of the pelvis and proximal femur, set upon transparent Lucite plates with four mounting screws and adjustable struts, allowing measurable and reproducible pelvic tilt and rotation. Our protocol for osteotome placement at each of the osteotomy sites strictly followed the technique described by Ganz. A 30°, 15 mm bifid osteotome was used for imaging at the initial ischial osteotomy at the infracotyloid groove. A 30°, 2 cm straightedge osteotome was placed 4 cm below the pelvic brim to image the retroacetabular osteotomy on the quadrilateral plate. Various osteotome placements were imaged with the C-arm image intensifier to better define the risks of inferior and posterosuperior intraarticular osteotomies at each of these sites, respectively. A 600 osteotome oriented at 500 to the quadrilateral plate was also utilized. In addition, violation of the inferior quadrant of the joint as well as posterolateral slipping of the osteotome blade along the posterior column, were appreciated on all images of pelvic flexion and rotation. The false-profile view always confirmed the perpendicular orientation of the osteotome blade. The false-profile view allowed for accurate evaluation of the positioning of the 30°, 2-cm straightedge osteotome along the retro-acetabular osteotomy site. In the views obtained, the blade could be seen aligned parallel to the posterior surface of the acetabulum, while respecting the posterosuperior joint space with optimal