Ankle fractures represent an increasing workload, particularly in the elderly female population. The posterior tibial tendon is exposed to injury during displaced medial malleolar fractures. Posterior tibial tendon dysfunction delays rehabilitation and results in significant morbidity and is most prevalent in women over 40. To ascertain whether posterior tibial tendon should be routinely explored in displaced medial malleolar fractures and consequently should post-operative rehabilitation of ankle fractures be modified. Intra-operative assessment of the tendon may help with this diagnosis and consequently alter post-operative rehabilitation.Background
Objective
Excessive soft tissue swelling will delay surgery for a proportion of patients admitted with ankle fractures. Surgical and anesthetic teams may waste time assessing patients destined to be cancelled due to swelling. The aim of this investigation was to determine factors associated with cancellation. Case notes of 87 patients (46 male, 41 female), mean age 43 years (range, 13 to 80) who underwent ankle fracture fixation were retrospectively analysed. 31 of 87 ankles (36%) were unsuitable for day after admission surgery due to swelling. Factors investigated included age, gender, mechanism of injury, fracture configuration and necessity for reduction on arrival in the emergency department due to dislocation; each factor was independently analysed for significance using Fisher's exact test.Introduction
Methods
To identify the incidence and reasons for revision of the Oxford prosthesis (OXF) in New Zealand. Review and compare UKA and TKA data including patient-generated Oxford scores after operation.Purpose
Methods
Reducing infection in total joint replacement by using ultra clean air and protective enclosed suits (space suits) has become the standard in many operating theatres without good supporting evidence. This study examined the impact of laminar flow and space suits on the rate of revision for early infection following total hip (THR) and knee (TKR) replacement. We used the 10-year results of the New Zealand Joint Registry to compare the rates of revision for early infection between laminar flow and conventional theatres both with and without the use of space suits. We separated hospitals and surgeons who had worked with and without space suits in both environments to exclude other confounding variables.Introduction
Method
Compression and absolute stability are important in intra-articular fractures such as transverse olecranon fractures. This biomechanical study aims to compare tension band wiring (TBW) with plate fixation by measuring compression within the fracture. A cross-over design and synthetic ulna models were used to reduce variation between samples. Identical transverse fractures were created using a 0.5mm saw blade and cutting jig. A Tekscan(tm) force transducer was calibrated and placed within the fracture gap. Twenty TBW or Acumed(tm) plate fixations were performed according to the recommended technique. Compression was measured while the constructs were static and during simulated elbow range of movement exercises. Dynamic testing was performed using a custom jig reproducing cyclical triceps contraction of 20N and reciprocal brachialis contraction of 10N. Both fixation methods were tested on each sample. Half were randomly allocated to TBW first and half to plating first. Data was recorded using F-scan (v 5.72) and analysed using SPSS(tm) (v 16). Paired T-tests compared overall compression and compression at the articular side of the fracture.Aims
Methods
Anterior cruciate ligament (ACL) reconstruction has traditionally been performed using a single bundle (SB) technique, providing good to excellent results in most cases . There is some evidence from biomechanical studies that double bundle (DB) techniques may improve anteroposterior and rotational stability. A number of prospective randomised trials have been performed producing conflicting results. The aim of this study was to find out any differences in outcome between single bundle and double bundle ACL reconstruction. A systematic review was performed to compare the evidence pertaining to the outcomes of double bundle versus single bundle ACL reconstruction methods. Medline (1966 onwards), EMBASE (1980 onwards) and the Cochrane database were searched, retrieving 9,568 possible articles. Only 6 studies fulfilled all the inclusion criteria. To be included, the study had to be prospective and randomised, comparing double bundle and single bundle grafts inserted using an arthroscopically assisted technique and have a minimum 12 month follow-up period for all patients. Analysis was performed using Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008. Five hundred and sixty patients (341 single bundle and 219 double bundle reconstructions) were considered for statistical analysis from these six papers. There was a significant difference between the groups with the double bundle reconstruction showing less of pivot shift positivity (P< 0.03). The DB group had significantly greater antero-posterior stability on KT arthrometer testing (P=0.002). Double bundle ACL reconstruction improved both antero-posterior and rotational stability. There was also significant improvement in IKDC scores in patients with double bundle ACL reconstruction compared to single bundle reconstruction.
