Background

The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy.

The purpose of this study was to investigate the use of early post-operative bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip. Bone scans from one hundred and four hips (Steinberg stage I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Bone scan scores were significantly lower in the failed group (n=31) compared to the successful group (n=73), p=0.03. Logistic regression demonstrated that a higher bone scan score was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40).

The purpose of this study was to investigate the use of bone scintigraphy to predict surgical outcome following vascularized fibular grafting (VFG) for osteonecrosis of the hip.

Subjects with a higher bone scan score post-operatively had a three-fold higher chance of success than subjects with the lowest score.

These results suggest that having a well perfused and viable graft in the early post-operative period improves the chances of a successful result.

Single Photon Emission Computed Tomography images from one hundred and four hips (Steinberg I–IV) treated with VFG between 1994 and 2000 were retrospectively reviewed. Each scan was divided into three regions, the greater trochanter, neck, and head. The intensity at the graft in each region (axially and coronally) was compared to the intensity at the ipsilateral proximal femoral diaph-ysis and assigned a score: less than diaphysis (one), equal to (two), and greater than (three). Cumulative scores were obtained for each subject. Intraobserver variability was 0.93. Surgical failure was defined as conversion to or on the waiting list for total hip arthroplasty.

Thirty percent of hips failed treatment (n=31, mean survival 34.9 months, range 5–98), while 70% were successful (n=73, mean follow-up 56.6 months, range 22–100). Bone scan scores were significantly lower in the failed group (mean 7.1, range 6–12) compared to the successful group (mean 8.5, range 6–18), p=0.03. Positive skewness (+1.7) was demonstrated as 64% of hips had a score of six while 36% had a score > 6 (range 8–18). Logistic regression demonstrated that a bone scan score > 6 was associated with success, p=0.028, with an odds ratio of 3.08 (1.13–8.40).

The purpose of this study was to investigate patient-based functional outcome and objectively measure strength following plate fixation of fractures of both bones of the forearm. Twenty-five subjects were clinically and radiographically reviewed. Strength of elbow flexion, extension, supination, pronation, wrist flex-ion, extension and grip were significantly reduced in the injured arm. (p< 0.01, range 62%–84% of normal). Mean (+/− SE) DASH score was 19.5 +/− 4.0 and eighty-eight percent (22/25) scored good to excellent on the Gartland-Werley scale (mean 4.04 +/− 0.91). No statistical difference in mean maximal radial bow (MRB) or location of MRB between injured and non-injured arm was found.

The purpose of this study was to investigate functional outcome and objectively measure strength following plate fixation of fractures of both bones of the forearm (BBOF).

Anatomic reduction was associated with good to excellent functional outcome. However strength of the elbow, forearm, wrist and grip were significantly reduced in the injured arm.

Despite good to excellent functional outcome following this injury, significant reduction in strength of the upper extremity should be expected, and thus is an area for potential improvement in post-operative care.

Twenty-five subjects (M/F 19/6, mean age 47.6 (range 20–71)) treated with plate fixation for fractures of BBOF were clinically and radiographically reviewed. Mean duration of follow-up was 5.7 years (range 2–13.4 y). Post-operative protocol included short-term immobilization followed by active-assisted ROM and strengthening starting between four and six weeks. Isometric muscle strength was objectively measured with the Baltimore Therapeutic Equipment work simulator (model WS-20). Strength of elbow flexion (72% of non-injured arm, p< 0.0001), elbow extension (84%, p=0.0004), forearm supination (75%, p=0.005), forearm pronation (69%, p< 0.0001), wrist flexion (81%, p=0.009), wrist extension (62%, p< 0.0001) and grip (70%, p< 0.0001) were all significantly reduced in the injured arm. Mean (+/− SE) DASH and Gartland-Werley scores were 19.5 +/− 4.0 (range 0–61) and 4.04 +/− 0.91 (range 0–15) respectively. Eighty-eight percent (22/25) scored good to excellent on the Gartland-Werley scale. No statistical difference in mean maximal radial bow (MRB) between injured and non-injured arm was found (mean +/− SE, 1.42 +/− 0.07 vs 1.58 +/− 0.05 respectively) or in location of MRB (61% vs 59%).

Purpose: Fractures of the femoral head are relatively uncommon injuries and usually occur following a traumatic dislocation of the hip joint. The purpose of this study was to evaluate self-reported functional outcome of patients who have sustained a femoral head fracture.

Methods: A search of the trauma database at a Level I trauma center between the years 1987–2003 was conducted. Sixty two patients, sustaining 63 femoral head fractures were identified. Two patient-based outcome measures, the Short Form-36 (SF-36) and Short Musculoskeletal Functional Assessment (SMFA) were used to evaluate functional outcome. Forty patients were lost to follow-up including three deaths.

Results: To date twenty-three subjects (13 male, mean age 37.3 +/− 15.6), with 24 femoral head fractures have complete functional outcome data. Ten hips (42%) were classified as Pipkin type I, 12 (50%) type II, 1 (4%) type III, and 1 (4%) type IV. The mean follow-up was 10.3 +/− 5.4 yrs. Mechanism of injury included motor vehicle collisions (18/24), and falls from height (6/24). The mean ISS was 11.3 +/− 5.3. Fifteen subjects were treated operatively (13 internal fixation, 1 excision, 1 open reduction only). Four hips failed initial treatment and required delayed total hip arthroplasty (THA). Subjects (n=20) not having a THA functioned below the Canadian normal population for SF-36 physical component score (mean 44.5 +/− 11.0, p < 0.03).

Conclusions: This is the first report of patient-based functional outcome following treatment of femoral head fractures. Physical function was significantly lower when compared to Canadian population norms.

Introduction and Aims: Patient-based functional outcome and strength following plate fixation of diaphyseal fractures of the radius and ulna is unknown. Therefore, the purpose of this study was to investigate patient-based functional outcome and objectively measured strength following plate fixation of fractures of both bones of the forearm (BBOF).

Method: Twenty-five subjects (M/F 19/6, mean age 47.6 (range 20–71) treated with plate fixation for fractures of BBOF were clinically and radiographically reviewed. Mean duration of follow-up was 5.7 years (range 2–13.4 years). Post-operative protocol included short-term immobilisation followed by active-assisted ROM and strengthening starting between four and six weeks. All subjects were assessed in person at follow-up with a detailed examination of strength of their injured and non-injured arms. Isometric muscle strength was objectively measured with the Baltimore Therapeutic Equipment work simulator (model WS-20). Standardised anteroposterior and lateral radiographs were made of both forearms.

Results: Strength of elbow flexion (72% of non-injured arm, p< 0.0001), elbow extension (84%, p=0.0004), forearm supination (75%, p=0.005), forearm pronation (69%, p< 0.0001), wrist flexion (81%, p=0.009), wrist extension (62%, p< 0.0001) and grip (70%, p< 0.0001) were all significantly reduced in the injured arm. Mean (+/− SE) DASH and Gartland-Werley scores were 19.5 +/− 4.0 (range 0–61) and 4.04 +/− 0.91 (range 0–15) respectively. Eighty-eight percent (22/25) scored good to excellent on the Gartland-Werley scale. No statistical difference in mean maximal radial bow (MRB) between injured and non-injured arm was found (mean +/− SE, 1.42 +/− 0.07 vs 1.58 +/− 0.05 respectively) or in location of MRB (61% vs 59%).

Conclusion: Restoration of anatomic alignment with stable internal fixation following BBOF fracture results in good to excellent functional outcome. Despite this, significant reduction in strength of the elbow, forearm, wrist and grip should be expected following this injury, and is an area for potential improvement in post-operative care.