Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years’ follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein’s line were recorded. Subanalysis was performed according to sex and age.Aims
Methods
The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)).Aims
Methods
Femoral neck fractures account for half of all hip fractures and are recognized as a major public health problem associated with a high socioeconomic burden. Whilst internal fixation is preferred over arthroplasty for physiologically younger patients, no consensus exists about the optimal fixation device yet. The recently introduced implant Femoral Neck System (FNS) (DePuy Synthes, Zuchwil, Switzerland) was developed for
Nearly one quarter of ankle fractures have a recognized syndesmosis injury. An intact syndesmosis ligament complex stabilizes the distal tibio-fibular joint while allowing small, physiologic amounts of relative motion. When injured, malreduction of the syndesmosis has been found to be the most important independent factor that contributes to inferior functional outcomes. Despite this, significant variability in surgical treatment remains. This may be due to a poor understanding of normal dynamic syndesmosis motion and the resultant impact of static and
In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years.Aims
Methods
INTRODUCTION. The elimination of motion and disc stress produced by spinal fusion may have potential consequences beyond the index level overloading the spinal motion segments and leading to the appearance of degenerative changes. So the “topping-off” technique is a new concept instructing
Plating displaced proximal humeral fractures is associated with a high rate of screw perforation. Dynamization of the proximal screws might prevent these complications. The aim of this study was to develop and evaluate a new gliding screw concept for plating proximal humeral fractures biomechanically. Eight pairs of three-part humeral fractures were randomly assigned for pairwise instrumentation using either a prototype gliding plate or a standard PHILOS plate, and four pairs were fixed using the gliding plate with bone cement augmentation of its proximal screws. The specimens were cyclically tested under progressively increasing loading until perforation of a screw. Telescoping of a screw, varus tilting and screw migration were recorded using optical motion tracking.Aims
Methods
Three Cannulated Screws (3CS), Dynamic Hip Screw (DHS) with antirotation screw (DHS–Screw) or with a Blade (DHS–Blade) are the gold standards for fixation of unstable femoral neck fractures. Compared to 3CS, both DHS systems require larger skin incision with more extensive soft tissue dissection while providing the benefit of superior stability. The newly designed Femoral Neck System (FNS) for
Bicondylar tibial plateau fractures result from
high-energy injuries. Fractures of the tibial plateau can involve
the tibial tubercle, which represents a disruption to the extensor
mechanism and logically must be stabilised. The purpose of this
study was to identify the incidence of an independent tibial tubercle
fracture in bicondylar tibial plateau fractures, and to report management
strategies and potential complications. We retrospectively reviewed
a prospectively collected orthopaedic trauma database for the period
January 2003 to December 2008, and identified 392 bicondylar fractures
of the tibial plateau, in which 85 tibial tubercle fractures (21.6%)
were identified in 84 patients. There were 60 men and 24 women in
our study group, with a mean age of 45.4 years (18 to 71). In 84 fractures
open reduction and internal fixation was undertaken, either with
screws alone (23 patients) or with a plate and screws (61 patients).
The remaining patient was treated non-operatively. In all, 52 fractures
were available for clinical and radiological assessment at a mean
follow-up of 58.5 weeks (24 to 94). All fractures of the tibial
tubercle united, but 24 of 54 fractures (46%) required a secondary
procedure for their tibial plateau fracture. Four patients reported
pain arising from prominent tubercle plates and screws, which in
one patient required removal. Tibial tubercle fractures occurred
in over one-fifth of the bicondylar tibial plateau fractures in
our series. Fixation is necessary and can be reliably performed
with screws alone or with a screw and plate, which restores the
extensor mechanism and facilitates early knee flexion. Cite this article:
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. Controversy exists regarding
the optimal treatment for patients with unstable trochanteric proximal
femoral fractures. The recognised treatment alternatives are extramedullary
fixation usually with a sliding hip screw and intramedullary fixation
with a cephalomedullary nail. Current evidence suggests that best
results and lowest complication rates occur using a sliding hip screw.
Complications in these difficult fractures are relatively common
regardless of type of treatment. We believe that a novel device,
the X-Bolt dynamic plating system, may offer superior fixation over
a sliding hip screw with lower reoperation risk and better function.
We therefore propose to investigate the clinical effectiveness of
the X-bolt dynamic plating system compared with standard sliding
hip screw fixation within the framework of a the larger WHiTE (Warwick
Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article:
Introduction. Ankle fusion presents a difficult problem in the presence of infection, inadequate soft tissue, poor bone stock and deformity. Nonunion and infection remains a problem even with internal fixation. Ilizarov frame provides an elegant solution to the problem with stable remote fixation while allowing lengthening, deformity correction and weight bearing. Patients and methods. Twenty-one consecutive patients were studied. The mean age at onset of disease was 52 years (range 4-70). Mean duration of the problem was 59.9 months (6-372). Aetiology included traumatic arthritis in 5, traumatic arthritis with osteomyelitis in 1, failed ankle fusion in 8, septic arthritis in 1, infected ankle fracture nonunion in 1, avascular necrosis of talus in 1, congenital deformity in 3 and failed ankle arthroplasty in 1. 15 patients had deformity of the ankle at the time of presentation. 15 of the 21 patients had either clinical or radiological evidence of infection. Treatment principles involved local excision, deformity correction with good alignment and soft tissue management. Static Compression was achieved with an Ilizarov frame while
We report the outcome of 32 patients (37 knees) who underwent hemicallostasis with a dynamic external fixator for osteoarthritis of the medial compartment of the knee. There were 16 men (19 knees) and 16 women (18 knees) with a mean age at operation of 54.6 years (27 to 72). The aim was to achieve a valgus overcorrection of 2° to 8° or mechanical axis at 62.5% (± 12.5%). At a mean follow-up of 62.8 months (51 to 81) there was no change in the mean range of movement, and no statistically significant difference in the Insall-Salvati index or tibial slope (p = 0.11 and p = 0.15, respectively). The mean hip-knee-ankle angle changed from 190.6 (183° to 197°) to 176.0° (171° to 181°), with a mean final position of the mechanical axis of 58.5% (35.1% to 71.2%). The desired alignment was attained in 31 of 37 (84%) knees. There were 21 excellent, 13 good, two fair and one poor result according to the Oxford knee score with no correlation between age and final score. This score was at its best at one year with a statistically significant deterioration at two years (p = 0.001) followed by a small but not statistically significant deterioration until the final follow-up (p = 0.17). All the knees with Ahlback grade 1 osteoarthritis had excellent or good results. Complications included pin tract infections involving 16.4% of all pins used, delayed union in two, knee stiffness in four, fracture of the lateral cortex in one and ring sequestrum in one. In conclusion, hemicallostasis provides precision in attaining the desired alignment without interfering with tibial slope or patellar height, and is relatively free of serious complications.
A particular pattern of complex instability of the elbow is “the terrible triad”, in which elbow dislocation is associated with fractures of the coronoid and radial head. Other frequent patterns are the variant of Monteggia lesions (Bado II) described by Jupiter which is characterized by ulnar fracture associated with fracture-dislocation of proximal radius, and the articular fracture of the distal humerus associated with elbow dislocation. The goal of treatment is to restore the primary stabilizers of the elbow such as the coronoid process, olecranon and both collateral ligaments by internal fixation and reconstruction of the ligaments. If elbow stability obtained at operation is unsatisfactory or internal fixation not enough stable, there an indication for applying a dynamic external fixator (DEF). The latter allows:. the articular congruence to be maintained and the ligaments to heal in adequate tension and position,. internal fixation and ligaments reconstruction to be protected, and. immediate joint motion to be carried out. From 2005 to 2008, we treated surgically 31 patients with complex instability of the elbow. DEF was applied in 38% of cases, namely 3 terrible triads, 5 fracture-dislocations of Monteggia and 4 articular fractures of the humerus associated with elbow dislocation. The mean age of patients was 44 years (range 30–74). All patients underwent ORIF, reconstruction of ligaments and
Introduction: We prospectively followed all hip fracture patients admitted between 2004–2006, identified cases where the intention was to treat conservatively and compared their functional outcome and mortality with a similar cohort treated surgically over the same period. Methods: We recorded length of hospital stay, place of discharge, pre and post-fracture mobility and residence, 30 day and 1 yr mortality, re-admission and delayed surgery. The group treated surgically was recruited and matched for age, gender, pre and post fracture mobility, mental confusion and independence with the conservatively treated group. Results: 25 patients were treated conservatively. 22 patients treated surgically over the same period were recruited. The mean hospital stay was 13 days in both groups. There were 4 extracapsular (3 displaced) and 21 intracapsular fractures (5 displaced) in the conservative arm and 11 extracapsular and 9 intracapsular fractures in the surgically treated arm. 4 patients from the conservative treatment group underwent late surgery 20 days – 2 months after the index event. Surgically treated group had 11
The surgical treatment of three- and four-part fractures of the proximal humerus in osteoporotic bone is difficult and there is no consensus as to which technique leads to the best outcome in elderly patients. Between 1998 and 2004 we treated 76 patients aged over 70 years with three- or four-part fractures by percutaneous reduction and internal fixation using the Humerusblock. A displacement of the tuberosity of >
5 mm and an angulation of >
30° of the head fragment were the indications for surgery. Of the patients 50 (51 fractures) were available for follow-up after a mean of 33.8 months (5.8 to 81). The absolute, age-related and side-related Constant scores were recorded. Of the 51 fractures, 46 (90.2%) healed primarily. Re-displacement of fragments or migration of Kirschner wires was seen in five cases. Necrosis of the humeral head developed in four patients. In three patients a secondary arthroplasty had to be performed, in two because of re-displacement and in one for necrosis of the head. There was one case of deep infection which required a further operation and one of delayed healing. The mean Constant score of the patients with a three-part fracture was 61.2 points (35 to 87) which was 84.9% of the score for the non-injured arm. In four-part fractures it was 49.5 points (18 to 87) or 68.5% of the score for the non-injured arm. The Humerusblock technique can provide a comfortable and mobile shoulder in elderly patients and is a satisfactory alternative to replacement and traditional techniques of internal fixation.
As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was ≥ 3 mm.
Introduction and Aims: Eight thousand Duraloc 300 cups were implanted worldwide in 2002. To our knowledge, no 10-year results have been published to date. We undertook this study to ascertain whether this optimism was justified. Method: One hundred consecutive total hip replacements using a Duraloc 300 cup were reviewed at a minimum of 10 years. Post-operative x-rays were analysed for cup placement and interface gaps. Follow-up films were analysed for lucent lines, osteolysis, wear and migration. Kaplan-Meier survivorship analysis was performed. Results: All components were found to be stable with no evidence of loosening or migration. The mean rate of wear was 0.12mm per year. Three hips developed pelvic osteolysis in zone 2 at the level of the apex hole, of which two have successfully undergone a bone grafting procedure and one patient is awaiting surgery. Conclusion: The Duraloc 300 cup has excellent 10-year results with no cases of loosening. There was a low incidence of pelvic osteolysis. Cementless