We report our retrospective multicentre experience of managing periprosthetic knee fractures using locking plates, cemented nails and distal femoral prosthesis. The Aim of this study is to analyze the practicality of management of these injuries using modern methods of fixation or salvation. 62 patients presented to 3 centres between 2003 and 2010. After implementation of inclusion criteria, clinical, radiological and functional outcomes were evaluated in 54 patients, with a minimum follow-up of 6 months. 34 patients were treated with locking plates (10 males, 24 female; mean age 76), 16 with cemented/locking nails (4 males, 12 females; mean age 84.5), and 4 with distal femoral replacement prosthesis (2 males, 2 females; mean age 79).

Locking plates which were used with a minimally invasive pattern produced the best outcomes in our study. A statistical significance of p value of less than 0.01 was found in union time between patients operated on with an open technique (6.69±2.69 months) and those operated on with a minimally invasive technique (3.6±0.91 months). Nailing with augmented cement is a useful technique in patients who are not suitable for challenging surgery & rehabilitation programmes. There was a significant difference in mean time to functional weight bearing (p< 0.01) between the plate group (4.79±2.6 months) and the nail group (2.63±0.5 months). Post-operative range of motion was also better for nails (106.36±14.33^O flexion) compared to plates (93.24±26.8^O), a result that approached significance (p=0.065). We recommend minimal invasive plating in uncompromised physiological conditions, as an ideal method of fracture fixation in view of statistically significant union rates. Cemented nailing is recommended in patients where early rehabilitation is essential. Distal Femoral prosthesis replacement is a useful salvage method.

Purpose of the study

To report the difference in the rates of avascular necrosis (AVN) of the femoral head following change in the hip abduction angle in the hip spica.

Purpose of the study

We describe a new technique of talar dome osteotomy in the treatment of fixed equinovalgus deformity of the foot in patients with Fibular Hemimelia and successfully applied it in two patients.

A recent meta-analysis for total knee replacement (TKR) undertaken with navigation demonstrated improved accuracy of implant positioning but did not have sufficient evidence on functional outcomes. This meta-analysis evaluates the functional outcomes for TKR with and without navigation.

We present a randomized prospective and comparative studies on functional outcomes of TKR with and without navigation were identified. The selected articles were tested for publication bias and heterogeneity. Studies presenting the functional outcomes in terms of knee society score, oxford knee score and HSS scores were included in the study. The data was then aggregated by random-effects modelling after which estimated weighted mean differences for individual functional scores were calculated.

Sixty two studies were identified and reviewed independently by two researchers; ten studies fulfilled the inclusion criteria, resulting in 976 cases for the meta-analysis (490 with navigation and 486 without). The mean age of both groups was similar (68 and 69). Results of a meta-analysis are best demonstrated by funnel graphs, forest plot, P values, and confidence intervals. In summary, the weighted mean of difference of KSS score is −0.288, with a p value of 0.867. Moreover, the standard means of difference of Oxford knee score was 0.133, with a P value of 0.257. The HSS scores resulted in a SMD of −0.099 and a ‘p’ value of 0.686. Finally, the range of motion weighted means of difference was 1.428, and a ‘p’ value of 0.228.

This meta-analysis demonstrated that there is no statistical advantage to the use of navigation for TKR in terms of functional outcome; the increased positional accuracy does not impart an improved outcome as has been proposed. This is probably due to the tolerances available in the implant positioning. This meta-analysis is providing the early outcomes & highlighting the necessity of long term studies.

Currently, the optimal treatment of pipkin fractures remains controversial. To rovide guidance on the management of these challenging injuries, we systematically viewed the available literature on outcomes following presentation with pipkin fracture dislocations and meta analysis was applied where applicable.

Material and Methods: Electronic databases were searched for studies on “Pipkin fractures”. Thompson & Epstein scale used as primary outcome measure and Merle’d Aubgine score, AVN, Nerve injuries, Heterotrophic ossification used as secondary outcome measures.

Results: This metaanalysis included 242 cases from 13 studies. Mean age of patients is 41.2 (sex ratio 7:3 male to female). Motor vehicle accidents contributes to 93% of cases, followed by fall from height in 6% cases. Patients were divided in to two groups, one with hip reduction with in 6 hours and second group more than 6 hours. ‘P’ value calculated using CMA software has shown no statistical advantage of reducing hip in less than six hours (p – 0.87). Majority of Type I cases treated by excision, type II cases were treated by ORIF. Type III cases predominantly treated by arthroplasty, where as type IV cases mainly treated by open reduction and internal fixation. Thompson & Epstein results were excellent in 13% of cases, 47% good, 16% fair to satisfactory and 24 % cases reported poor results. Incidence of good results descended from Type I to Type IV, where as incidence of poor results increased. Meta analysis of TE results and surgical approach has not shown any advantage of anterior or posterior approach in producing better TE outcomes. Similarly early time to reduction or surgery also failed to show any statistical advantage over delayed reduction or surgery. Analysis of the outcomes treated by non operative and operative methods in type I cases has shown operative methods producing less favourable outcomes in type I fractures with a p value of poor outcomes 0.018, showing advantage of non operative methods in type I fractures.

In type II, III & IV cases, no statistically significant advantage is noticed in this respect. Overall incidence of AVN is 11%, highest incidence is reported in type III fractures.Highest incidence of Heterotopic ossification is reported in anterior or anterolateral approaches. Incidence of nerve injury in Pipkin fractures reported as 13%.

Conclusions: Pipkin fracture is a high energy complex trauma resulting in significant morbidity.

Incidence of poor results increases from type I to type IV cases. Statistically no significant difference is added on to anterior or posterior approaches or timing of reduction within or after six hours in the management of these fractures based on TE results. This meta analysis proving type of fracture is the most important prognostic factor influencing the outcome.

Introduction: Distal radius locking plates are increasingly being used to treat distal radius fractures.

The purpose of our study was to determine the medium term clinical and radiological outcome of comminuted, displaced fractures of the distal radius. We present our experience in using the Aculoc (Acumed) volar fixed angle plate to treat 100 consecutive fractures of the distal radius.

Methods: All one hundred patients were prospectively (clinically and radiologically) assessed between 2003 –2007, with a minimum follow up of one year. Fractures were radiologically classified using the Frykman classification Clinical outcome was measured using the Mayo score, DASH questionnaire, SF36 and Range of Wrist Movement and pinch and grasp power. The post operative x rays were assessed for fracture union, alignment and displacement.

Conclusion: Our study demonstrates that volar fixation of distal radius fractures, using a fixed angle, locking accumed plate provides satisfactory treatment for fractures of the distal radius. Angular stability of the implant provides mechanical stability and aids early rehabilitation which results in good functional outcomes.

The aim of the paper is to provide an independent single surgeon experience with BHR after a seven-year follow-up.

A cohort of 117 hips in 101 consecutive patients operated by the senior author between Jan 1998 and Dec 2002 were assessed to note their clinical, radiological and functional outcome after a mean follow-up of 7 years (5–9.4 years). Primary osteoarthritis was seen in 73 hips and secondary in 44 hips. Their mean age at surgery was 54 years (range 20–74years). At latest follow-up their mean flexion was 100°and their mean functional outcome scores were respectively: Oxford hip score of 21.5 (12–52, mode 12); Harris hip score of 84.8 (25–100, mode 97), Charnley modification of Merle d’ Aubigné and Postel scores were 4.8 for pain, 4.3 for walking and 5.4 for movement; and SF-36 (physical component 43.9 and mental component 51.45). Failure in the study was defined as revision for any reason. Revision was undertaken in 8 hips (6.8%), five within the first year for periprosthetic fracture neck of femur and 3 hips after the end of 5-year follow-up (2 for advance collapse of the femoral component in patients’ with avascular necrosis of the femoral head and 1 hip for sepsis).

The Kaplan-Meier survival with revision as end point at minimum 5-years of follow-up was 95.7% (95% CI 92–99%) and overall survival at an average 7-years was 91.7% (95% CI 86–97.6%). All the failures were due to the femoral component. However, the reported survival with the use of traditional uncemented and cemented femoral stems is beyond 99% at similar period of follow-up. Patient selection particularly in patients with secondary osteoarthritis is therefore a critical factor when choosing BHR components.

Aim: We present the outcome of Birmingham Hip Resurfacing Arthroplasty performed by a single surgeon after at least five years follow up.

Patients and Methods: One hundred hips in 84 patients were studied with a mean follow-up of 6.4 years (5–8.3 years), performed by a single surgeon. Three patients died of unrelated causes and 2 patients were lost to follow-up, hence the study group comprised of 79 patients with 95 hips. Birmingham resurfacing femoral and acetabular components were used in all patients.

The clinical outcome was measured using Harris, Charnley, Oxford hip scores and quality of life using SF-36. Radiographs were systematically analysed for implant position, fixation, and loosening.

Results: The mean age was 54 years (20–74years) and BMI of 28 (19–35). Primary osteoarthritis was seen in 69 hips. Six patients (6.1%) underwent revision of the femoral component (3 for peri-prosthetic fractures of the neck of femur, 2 for deep infection and 1 for collapse due to AVN). None of the patients had evidence of loosening around the acetabular component and femoral components in 28 patients. Type 1 pedestal sign was seen in 61 hips and Type 2 in 2 hips.

The clinical scores were respectively, Harris 85 (25–100), Oxford 21.5 (12–52), mean Charnley score 4.8 for pain, 5.3 for movement and 4.3 for mobility; the mean SF-36 score were 44 (12–58) for the physical and 51.4 (19–71) for the mental component. With an end point of definite or probable aseptic loosening, the probability of survival at 5 years was 100% and 97.3% (95% CI = 2.9) for acetabular and femoral components respectively. Overall survival at 5years with removal or repeat revision of either component for any reason as the end point was 91% (95% CI: 82 to 97%).

Conclusion: The results of this study support the continued use of Birmingham Hip Resurfacing Arthroplasty in young active individuals. As loosening can occur as a late phenomenon, a longer follow up is needed to determine longevity, durability of this prosthesis.

Background: This meta-analysis aims to evaluate the quality of life in post traumatic amputees in comparison with a limb salvage group, using peer-reviewed studies in these areas.

Methods: Electronic databases were searched for studies on lower limb amputation and limb reconstruction following trauma. A manual review of the literature and abstracts was also conducted. Only studies having more than 24 months of follow up, and those using generic scales using physical and psychological parameters (SIP or SF36), were included. Two reviewers performed the search, inclusion, and data extraction independently.

Results: 214 studies were identified after extensive searching, Eleven studies fulfilled all the inclusion criteria, reviewing the outcomes of 1874 patients including 899 cases of amputation and 975 cases of reconstruction. Outcome assessments were based on two generic scales of measurement for quality of life, namely SIP or SF 36.

In the studies using SF36, the mean Physical Component Summary (PCS) for the amputation group was 39.76 +/−7.06 and mean Mental Component Summary (MCS) was 52.05+/−3.39. The mean PCS for the reconstruction group was 38.5+/−0.78 and the mean MCS was 50.76 +/− 3.09. The mean physical SIP score for amputation was 13.033 with SEM of 3.048, and the psychological SIP score was 15.953 with SEM of 1.153. The mean Physical SIP for reconstruction was 10.686 with SEM of 1.034 and the psychological SIP was 10.754 with SEM of 0.647. The Unpaired t test was used to compare the outcomes of amputation and reconstruction, studies using SF36 and SIP scores were compared independently. Our results show that physical morbidity in both groups is not significantly influenced by the modality of surgical intervention, but there is a statistically significant difference noted in psychological morbidity, the group with reconstruction being better. These results were consistent in studies using either of the two generic scales namely, SF36 or SIP scores.

Conclusion: This meta-analysis provides evidence that limb reconstruction in lower limb trauma yields better psychological outcomes without significant difference in physical morbidity compared to amputation.