Aims. Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results. Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. Conclusion. The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis. Cite this article: Bone Jt Open 2024;5(1):37–45

Aim. Clavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand. Methods. A retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS). Oxford Shoulder Score (OSS) and a Simple Shoulder Test (STT) were used to assess functional outcomes and were compared with the reported literature. Operative times and Complications were reviewed. Results. 66 patients were included in the study. 33 patients in the OS group and 33 in the N-OS group. No difference in age, sex, indications for operative intervention and the surgery provided was identified. No significant difference in operative time between groups (N-OS 121 minutes; OS 128 minutes). No clinically significant difference was identified in the OSS (N-OS; mean 38 vs OS 39) or the STT (N-OS 8.3 vs OS 9). The outcomes scores of both groups are in keeping with published literature. Two post operative clavicle fractures, one prominent surgical knot occurred in the OS that required further surgical intervention. Two cases of localized pain over the clavicle and one case of the prominent lateral clavicle were reported in the OS group. Two cases of localized pain over clavicle reported in the N-OS group. Conclusion. Use of clavicular osteotomy is not associated with inferior patient reported. The osteotomy introduces specific risks, however, the study provides evidence that these complications are infrequent and avoidable. Surgeons should feel confident in using this adjunct when exposure to the shoulder is difficult

Aims: To determine pre and post-op patient satisfaction and to document complications. Methods: A questionnaire based study of a consecutive series of 71 Birmingham Hip Resurfacings performed by a single surgeon over a two year period. Mean age 54 (range 29 to 70 years). Outcome measures used were the Oxford Hip Score and Short Form 36 Results: There was a signiþcant improvement in outcome scores following surgery. Oxford hip score improved from 41.1 to 16.6 (signiþcant p< 0.05) SF36 score improved from 24.8 to 48.2 (signiþcant p< 0.05) Complications were 2 femoral nerve palsies, 1 lateral popliteal nerve palsy, 1 re-operation for a retained guide pin, 1 post operative fracture, 1 DVT, 1 PE and 8 patients received oral antibiotics for wound erythema or discharge but there were no deep infections. 89% would recommend the operation to a friend, with males rating the operation more highly. Mean visual analogue score of 91% for overall satisfaction, again males rating higher. Conclusions: Birmingham Hip Resurfacing gave signiþcant improvements in patient function, comparable or better than other similar results looking at conventional hip replacement. Patient satisfaction is high despite the younger patient group with active life styles. The group includes one Jiu Jitsu instructor and a triple marathon runner. One patient had previously had a contralateral conventional uncemented total hip replacement which he was pleased with... until he had experienced Òthe ÒfeelÒ of my Birmingham HipÒ

Purpose: Poor bone quality is a common challenge to orthopaedic surgeons and frequently leads to complications such as non union and implant failure, particularly the elderly whose capacity for tissue repair is significantly reduced. The current study was designed to determine if bone marrow derived mesenchymal stem cells (MSC) seeded in dense collagen scaffolds and delivered to a surgically-induced femoral defect will expedite bone healing. Method: Ex Vivo: MSC isolated from four month old donor mice were expanded ex vivo, seeded into hydrated type I collagen, which was subjected to unconfined compression to generate dense collagen scaffolds. The cell-seeded scaffolds were then cultured for up to 21 days. MSC viability was monitored using the AlamarBlue. ®. metabolic assay and differentiation into osteoblasts using alkaline phosphatase (ALP) and von Kossa stain. In Vivo: A 3mm x 1mm window defect was drilled in the femur of elderly recipient C57Bl6 and C3H mice. The C3H mice were assigned to one of two study groups:. LEFT femur drill hole alone; RIGHT femur acellular scaffold. LEFT femur acellular scaffold; RIGHT femur cell-seeded scaffold. The quantity and quality of bone regeneration was assessed after 2 and 4 weeks using micro computed tomography (mCT) and histology. Results: Ex Vivo: The dense collagen scaffold had superior mechanical properties and supported the survival and differentiation of MSC into osteoblasts up to 21 days in culture. Cells in uncompressed gels and those in compressed gels in non-osteogenic medium, had fewer ALP-positive cells at early time point and less mineral deposited at later times compared with those in compressed gels in osteogenic medium. In Vivo: A high incidence of postoperative fracture was seen in C57Bl6 mice compared with age matched C3H mice in the first study group. Furthermore, the empty surgical defect healed more rapidly than that containing the dense collagen scaffold, in which bone volume compared with tissue volume (BV/TV), trabecular number (Tb.N.) and connectivity were lower. In study group two, bone regeneration was evident at 2 weeks post operative and transplantation of MSC-seeded dense collagen scaffolds resulted in higher BV/TV, Tb.N. and trabecular connectivity compared with the acellular dense collagen scaffold. Conclusion: Bone fragility in elderly C57Bl6 mice led to post operative fracture after generation of a non-critical sized drill hole defect in the proximal femur whereas age-matched C3H mice with higher bone mass sustained no fractures. Dense collagen scaffolds supported the survival and osteoblast differentiation of bone marrow derived MSC in 3D culture. Their superior mechanical properties allowed for transplantation into non-critical sized femoral defects, suggesting the approach shows promise as adjunct therapy for use with bone grafts and implants in patients with poor quality bone

Aims and Objectives Lateral condyle fractures can be difficult diagnose and the treatment still remains controversial. It is well known that these fractures are prone to a number of complications, both early and late. The aim of this paper was to review the treatment practice of lateral condyle fractures presenting to a children’s hospital fracture unit over the past 5 years to identify any consistency in the management of these fractures. We also aimed to try and determine if a particular treatment method was more favourable than others in terms of complications and the need for further surgery with a view to developing a treatment protocol. Methods: We conducted a chart and x-ray review of all lateral condyle fractures treated operatively from December 1998 to August 2004. We recorded patients’ age, sex, side of injury and month of injury. The fractures were classified according to the Milch classification. We also measured the preoperative and postoperative fracture displacement. We recorded the nature of surgery (Examination Under Anaesthetic (EUA) and casting, Manipulation Under Anaesthetic (MUA) and wiring and Open Reduction and wiring). We documented whether the wires were percutaneous or buried. Length of time in cast and length of time to wire removal were also noted. Finally any complications and the need for further surgery were documented. Results: 90 patients were identified. 72% were male and 28% female, with an average age of 5.6. 28% of injuries were right sided, 72% were left sided. 21 (23%) patients were Milch Type 1 fractures and 66 (73%) were Type II fractures. Preoperative fracture classification was unavailable for 3 patients. In 78 patients we were able to determine the initial fracture displacement. 8 (9%) patients were displaced < 2 mm, 18 (20%) were displaced 2–4 mm and 52 (58%) were displaced > 4 mm. 7 patients (10%) had associated elbow dislocations – all of these were Milch type II fractures. 5 patients had EUA and casting, 19 had MUA and K wiring and 63 had open reduction and wiring. In the 19 patients who had MUA and K wiring, 13 were percutaneous and 6 were buried. In the open reduction and wiring group 59 patients had their wires buried and 6 were percutaneous. 1 patient did not have that information recorded. The average time in cast was 41 days. In those with buried wires average length of time to wire removal was 63 days. Average percutaneous wire removal was at 42 days. For the 5 patients undergoing EUA and casting residual displacement was < 2 mm in all. 2 of these patients (40%) had complications of lateral spur formation and delayed union. For the 19 having MUA and k wiring, 14 had a post op displacement of< 2 mm and 5 had 2–4 mm displacement. 3 of the 14(21%) had the complications of spur formation, pin site infection and wire prominence. 2/5 (40%) of those with residual displacement of 2–4 mm developed complications, 1 patient had ulceration of wires through the skin and another had loss of position requiring further surgery. In the patients treated with open reduction and wiring 51 had a residual displacement of < 2 mm, 14 had 2–4 mm residual displacement and 1 remained displaced > 4 mm. 11/51 (22%) in the first category developed complications. 6 were problems with the wires, 1 lost position requiring re-operation, 1 lateral spur development. 2 malunions and 1 delay in ossification of the lateral condyle. In the 2–4 mm group 8/14 (57%) developed complications. – 2 wire ulcerations, 2 wound infections, 1 non-union and 3 malunions. Finally the 1 patient with residual displacement > 4 mm developed a malunion requiring further operative intervention. In total 5 patients had further surgery - 1 patient for wire prominence 2 for loss of position and 2 patients required corrective surgery for malunion. Conclusion: This study highlights the variety in treatment methods for these fractures. Complications occurred in all treatment groups. The short term complications such as wire problems and initial loss of position had no long term sequelae. All malunions occurred in the open reduction and wiring group, despite 2 patients having post operative fracture displacement of < 2 mm. The patient with a non union was a late referral but underwent open reduction and wiring at our unit and subsequently healed. We recommend that displaced fractures should be reduced either closed or open and all fractures should be secured with k wires to prevent loss of position. These should be bent and buried allowing them to remain insitu for 3 months. Postoperative casting should be for 6 weeks. These fractures need to be followed closely at fracture clinic for the short and long term problems they can develop