To examine the performance of a novel blood plasma-based bone putty for augmenting the treatment of open tibia fractures. The putty was manufactured from pooled blood plasma and contains a concentration of both plasma and platelet-derived regenerative factors. Based on clinical reports of the use of autologous platelet-rich plasma to treat injuries, we hypothesized that the putty would accelerate healing of fractures and surrounding soft tissues. Two-arm, randomized controlled study including 20 treatment patients and 10 controls. Follow-up examinations occurred at 14, 30, 60, 90, 180, and 365 days. The product was provided in a syringe containing 3 cc of putty in a double-pouched, sterile box. The putty was placed at the fracture site during open fracture reduction and mechanical stabilization.Purpose:
Methods:
The addition of interlocking screws to intramedullary nails adds greatly to the stability of these constructs, yet the placement of distal screws accounts for a significant proportion of the total fluoroscopy and operative times. The Sureshot® (Smith and Nephew™) is a computerised system that allows placement of distal screws without fluoroscopy by using electromagnetic guided imagery. The purpose of this study is to compare traditional free-hand technique to the Sureshot® technique in terms of operating time, radiation dose and accuracy. Between September 2011 and March 2012 we prospectively randomised 66 consecutive patients presenting to us with femur shaft fractures requiring intramedullary nails to either free-hand (n=33) or Sureshot® assisted (n=28) distal locking. Fractures warranting only one distal locking screw, or those requiring retrograde or cephalo-medullary nailing, were excluded. Five patients' data was not suitable for analysis. The two groups were assessed for distal locking time, distal locking radiation and accuracy of distal locking.Purpose of study
Methods
Kaplan-Meier survivorship analysis was performed.
The good results of the Charnley stem are well documented. Modifications to the stem design need to be evaluated clinically in order to assess possible risks and benefits. We assessed the results of the first 100 consecutive Elite Plus arthroplasties performed at one centre. At a minimum of five years postoperatively, patients were recalled for clinical and radiological assessment. Postoperative radiographs were graded A to D and compared to final radiographs. Overall results were good, with 97% of the stems still functioning well clinically and radiologically. The three failures, all of which occurred at the bone cement interface in young patients, showed early signs of radiological debonding. In the rest of the patients there was good fixation, with no evidence of subsistence or loosening. The Elite Plus stem modifications to the Charnley stem appear to yield good results at five years. It is postulated that the canal should not be power-reamed because, by eliminating good cancellous bone and polishing the cortex, this may contribute to failure at the bone-cement interface. We will undertake further follow-up to evaluate longer term results.
We evaluate the results of total hip arthroplasty using either a porous-coated or a hydroxyapatite (HA) coated femoral component. For a prospective trial we selected a cohort of young patients with a mean age of 39 (19 to 56). They were randomly selected to have either a one-third porous-coated or one-third HA-coated uncemented femoral component. One of two experienced hip surgeons performed the operations. Within the constraints of pathology, the approach and surgical technique was the same in all the cases. Patients were followed-up clinically and radiologically for a mean period of 102 months (87 to 113). To date there have been no revisions. All components have remained well fixed and there is no evidence of progressive subsidence. We found no significant difference between porous-coated or HA-coated stems.
