A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group 3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted. 26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=<0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=<0.0001). Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears.
Multiple joint registries have reported better implant survival for patients aged >75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or uncemented implant combinations. However, there is considerable variation within these broad implant categories, and it has therefore been suggested that specific implant combinations should be compared. We analysed the most common contemporary uncemented (Corail/Pinnacle), hybrid (Exeter V40/Trident) and cemented (Exeter V40/Exeter X3) implant combinations in the New Zealand Joint Registry (NZJR) for patients aged >75 years. All THAs performed using the selected implants in the NZJR for patients aged >75 years between 1999 and 2018 were included. Demographic data, implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the NZJR, and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were recorded. 5427 THAs were included. There were 1105 implantations in the uncemented implant combination group, 3040 in the hybrid implant combination group and 1282 in the cemented implant combination group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the cemented implant combination (0.31 revisions/100 component years) and the hybrid implant combination (0.40 revisions/100 component years) but were statistically significantly higher in the uncemented implant combination (0.80/100 component years). Femoral-sided revisions were significantly greater in the uncemented implant combination group. The cemented implant and hybrid implant combinations provide equivalent survival and functional outcomes in patients aged over 75 years. Caution is advised if considering use of the uncemented implant combination in this age group, predominantly due to a higher risk of femoral sided revisions. The authors recommend comparison of individual implants rather than broad categories of implants.
This study was conducted to find out whether blood transfusion was an independent risk factor for mortality and wound infections after hip fracture surgery. A retrospective cohort study analysed prospectively collected data for 3571 hip fracture patients undergoing surgery over the last 15 years in one institution. Out of these 1068 patients underwent blood transfusion. There were no significant differences in the mortality values at 30, 120 and 365 days and in the rates of infection (superficial and deep) in the two groups (transfused and non-transfused).
Conventional treatment for nondisplaced intracapsular hip fractures is with cannulated screws. Some authors have argued that in the older patient a hemiarthroplasty offers a better outcome even in the case of a nondisplaced fracture. We have compared the outcomes of an age, sex &
co-morbidity matched cohort of 346 patients who have had their nondisplaced hip fracture treated using cannulated screws with a group of 346 patients who have had a displaced fracture treated with a hemi-arthroplasty. The average age of the patients studied was 80.8 years. All operations were carried out at Peter-borough District Hospital and the follow up data was collected as part of the hip fracture project. Operation time, hospital stay and peroperative complication rate are less for the fixation group. They also have better outcomes in terms of pain, use of walking aids and mobility scores at one year. Mortality is 4% less at one year in the patients treated with screws and this, again, is statistically significant. There is no difference in terms of residential status at one year. In patients where the fracture is initially treated with cannulated screws the reoperation rate is considerably higher (17 % versus 6%) but length of stay is less for secondary procedures. We feel that there is little evidence to justify the use of hemi-arthroplasty in nondisplaced femoral neck fractures in patients of any age.
