Aims

Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures.

Abstract

Background

Periprosthetic femoral fractures following total hip arthroplasty are relatively uncommon but are associated with significant morbidity. With an increasing number of total hip arthroplasties being carried out in an aging population we need to ensure correct implants are chosen for our patients. A recent review of NJR data suggested a significantly higher revision risk for the Zimmer CPT stems due to periprosthetic fractures when compared to the Stryker Exeter stems.

Our aim was to compare the biomechanical strength modified side-to-side repair with modified pulvertaft technique keeping overlap length, anchor points, type of suture, suture throw and amount of suture similar.

In our study, we have used turkey tendons. Two investigators performed 34 repairs during one summer month. All mechanical testing was carried out using the tensile load testing machine. Variables measured were maximum load, load to first failure, modulus, load at break, mode of failure, site of failure, tensile strain, and tensile stress. The statistical comparison was carried by Levene's test and T test for means.

The mean maximum load tolerated by modified side-to-side repair was 50.3N(S.D13.7) and that by modified pulvertaft 46.96N(S.D: 16.4), overall it was 48.29 N (S.D: 14.57). The tensile stress at maximum load for modified pulvertaft and modified side-to-side repair was 4.2MPa(S.D: 3.1) and 4.7 MPa (S.D: 3.8) respectively {Overall 4.3MPa(S.D: 3.5)}. The tensile stress at yield was 4.01 MPa (S.D: 3.1) and 5.5 MPa (S.D: 3.7) respectively for modified pulvertaft and modified side-to-side repair {overall 4.44 MPa (S.D: 3.45)}. The tensile strain at maximum load respectively for side-to-side and modified pulvertaft repair was 7.87%(S.D: 33.3) and 7.84%(S.D: 34.02) respectively.

We found no statistical difference between 2 repairs in terms of strength, load to first failure, and maximum load to failure. The suture cut through was the commonest mode of failure.

Our study uniquely compares two techniques under standard conditions, and contrary to existing evidence found no difference.

Stress shielding of the proximal femur occurs in stemmed implants. Resurfacing implant does not invade the intramedullary region. We studied the stress patterns in conventional and nonstemmed designs.

The aim of this study was to

describe the measurements of range of circumduction in normal volunteers and develop summaries of the data,

Forty healthy subjects with a mean age of 42.6 years were assessed with flexible biaxial electrogoniometry in standard 90° pronated position of wrist for kinematic assessment of movement in orthogonal planes. Functional range of flexion-extension, ulnar-radial deviation and circumduction was measured and analysis of the digital output produced a visual display of the results as Lissajous's figures. This also allowed measurement of the total range of circumduction as two-dimensional area under the curve measurement. The rate and rhythm of movements were mathematically calculated and displayed over the two dimensional circumduction curves. The average arc of uniplanar flexion and extension is greater than the flexion and extension component of the circumduction curve but mean uniplanar radial ulnar deviation arc is similar to the radial-ulnar deviation component of the circumduction curve. The area of circumduction and circumference of the circumduction curve was used to measure the total range of circumduction. The four quadrants for the velocity of circumduction showed that the rate was faster in the deviation components as compared to flexion and extension. Quadrant analysis showed the changes in the rhythm was less in the deviation components compared to flexion and extension. The accuracy for measuring uniplanar movements showed a standard deviation of 6°. The accuracy for measuring circumduction showed a standard deviation of 347 °° (7%). Accuracy for measuring velocity of circumduction showed a standard deviation of 17°/s. This technique was found to be accurate and reliable in measuring the rate, range and rhythm of wrist circumduction.

Both intrinsic and extrinsic hand muscles contribute to finger flexion; however there are different ways in which individuals can flex their fingers. Due to different muscle insertions, it is possible to distinguish the mechanical effect of intrinsic muscles from extrinsic muscles. The aim of this observational study was to investigate the degree to which individuals in the population rely on either their intrinsic or extrinsic hand muscles. A high frequency camera was used to record the hands of 31 healthy participants, aged between 18 to 40, while they made a fist repeatedly. The hands were placed on a horizontal plane and the video was taken from the ulnar side, aligned horizontally with the hand. The maximum vertical distance between the fingertip and the distal palmer creases (XY) was recorded using WIN analyze 3D software. Three examiners independently analysed the videos and classified them into intrinsic dominant, extrinsic dominant or a mixed pattern. A t-test was performed on the XY values for the three different categories. The XY height difference between the intrinsic and extrinsic groups were statistically significant (P=0.001). The XY of mixed and intrinsic was also statistically significant (p=0.012) but not for mixed and extrinsic (p=0.46). Assessment of time when movement starts at each individual joint showed significant difference with intrinsic predominant moving the MCPJ before IPJ and extrinsic dominant individual moving their IPJ before MCPJ. This study shows that there is a difference in hand muscle dominance between individuals. More importantly it shows that there are individuals who rely on their intrinsic hand muscles more than their extrinsic muscles.

Background

Scaphoid fractures with displacement have a higher incidence of nonunion and unite in a humpback position that can cause pain and reduced movement, strength and function. The aim of this study is to review the evidence available and establish the risk of nonunion associated with management of displaced scaphoid fractures in a plaster cast.

Background

Scaphoid fracture malunion with flexion and shortening results in the ‘humpback deformity’. This is thought to be associated with poor clinical results when assessed with the lateral intra-scaphoid angle and the Green and O'Brien wrist evaluation scale. This method of deformity measurement is now considered unreliable and the functional score has not been validated in the setting of scaphoid fractures.

To assess the effect of deformity on Grip strength characteristics in the Rheumatoid Hands using force time curves. Forty seven (6 males and 41 females) patients with mean age 62 years (29–79 yrs) with Rheumatoid arthritis had their handgrip strength measured with closed fluid dynamometer generating force-time curves.

These were analysed further in blinded fashion for:

peak force;

Data was also collected on joint mobility, pain and disability using Patient Evaluation Measure (PEM) and Functional Disability Scores (FDS).

The patients were divided into five groups according to the degree of deformity: No deformity, ulnar deviation, Boutonniere, Swan neck or combined deformities (two or more deformities). These patient groups showed significant differences in grip strength (p value < 0.01). Patients with combination of deformities showed low peak and average forces as measured on force-time curves. The hands with Swan neck deformities had the highest variability in the plateau region of the curve and had the greatest disability scores both with PEM and FDS scores (P Value < 0.005). This group was particularly disabled (P Value < 0.007) being less able to sustain the grip over time.

Swan Neck Deformity causes the most significant dysfunction and this should be carefully considered when making decisions regarding surgery.

There is no general consensus amongst Orthopaedic Surgeons on how best to manage the urinary tract and its complications after lower limb arthroplasty. This prospective audit investigates whether post-operative urinary retention can be predicted pre-operatively using the validated International Prostate Symptom severity score (IPSS).

182 patients undergoing lower limb arthroplasty under spinal anaesthetic were given the IPSS questionnaire to complete pre-operatively and an audit into numbers catheterised post-operatively carried out.

69% of males and 39% of females required catheterisation. Following logistic regression analysis there was 0.85 predicted probability that males over seventy years would require catheterisation. The IPSS score was not useful in predicting retention in either sex at any age.

We propose that all males over seventy years undergoing this type of surgery should be catheterised pre-operatively and all other patients should be catheterised post-operatively with close monitoring of bladder volumes to prevent established urinary retention.

Objective: To study the role of anterior spinal surgery in scoliosis in Indian settings and to discuss the complications.

Study Design: Prospective study

Subjects: The present study comprises of forty patients of scoliosis in growing age group (10–25 years) with Cobbs angles ranging from 52”–98”. They were treated with Leeds procedure which is by anterior loosening followed by Posterior Harrington fixation + Luque derotation + Fusion and Costoplasty.

Results: Average correction of the deformity after surgery was 45%. Satisfaction level of patients and parents was good in 60% of the cases. Majority of the curves were thoracic (60%), and right sided (72%). The modality of treatment was decided on the basis of personality of each case, its demand and requirement, time of presentation and the potential for increasing severity. Anterior spinal surgery for scoliosis is an effective procedure in hands of experienced surgeons and it reduces stiffness of the curve, shortens the anterior column, and decreases thoracic lordosis that leads to some improvement of pulmonary function. But there is greater risk of damage to vital structures with higher risks of cardio-respiratory failure. The potential risks have to be balanced with the expected rewards. The optimum method of correction has to be decided by careful preoperative evaluation.

Conclusions: This study reaffirms the role of anterior spinal surgery in India as the patients due to lower levels of health awareness present late and with severe deformities. Combined procedure of anterior and posterior surgery causes lesser decrease in pulmonary functions than costoplasty alone, and achieves better cosmetic correction.

Introduction: Understanding the factors in progression of curves in spinal deformities are crucial to the planning of treatment. While clinical and genetic parameters appear to be involved in the progression of adolescent idiopathic scoliosis, it remains very difficult to objectively study this as it is difficult to find pedigree cohorts. We wish to report the difference in progression of adolescent idiopathic scoliosis curves in two essentially homogenous racial groups that utilise our Scoliosis service.

Methods and Results: Three hundred and twenty-four patients were treated at the Scoliosis service of our Institute from 1985 to 1998. The aetiology of the curves were as follows: 218 AIS, 37 Neuromuscular, 48 Congenital, 21 other diagnostic type, and 11 aetiology not known. The racial distribution of utilisation of service: 44% Malay, 44.7% Chinese, 2.0% Indian and 9.3% not known or mixed race. The Malay and Chines groups were matched and studied. There was no difference in the menarchal age, curve size at presentation and age at presentation to the service (P=0.3). Patients were analysed in two groups: below 10 years, and above 10 years at presentation.

The rate of progress of the AIS curves > 50° were fastest in the Chinese patients with a rate of 14.7°/year; with Malay patients progressing at 8.4°/year. Rates of progression of curves 30–50° were the same for both groups with Chinese at 7.7°/year, and Malays at 6.7°/year. Curves < 30° progressed at the same rate also with Chinese at 5.0°/year and Malays at 7.0°/year.

Conclusion: From our data, it appears that race (genetics) does influence the rate of progression of AIS curves.

Lower limb injuries are the main cause of temporary and permanent disability among motorcyclists in the developing world of the Asia –Pacific region. They cause non-fatal but serious injuries requiring hospitalisation. This study presents computer simulation of the crash behaviour of the carry basket of a small-engined motorcycle with the lower limb using finite element (FE) methods. The results suggest that the extensive deformation of the motorcycle basket may reduce the risk of injury to the lower limb. The behaviour of the basket during collision is analogous to the crumple zone of automobiles. The use of these deformable baskets is recommended for all small engined motorcycles.