Aims

Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.

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The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures.

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In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA).

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National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD.

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Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.

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Successful cell therapy in hip osteonecrosis (ON) may help to avoid ON progression or total hip arthroplasty (THA), but the achieved bone regeneration is unclear. The aim of this study was to evaluate amount and location of bone regeneration obtained after surgical injection of expanded autologous mesenchymal stromal cells from the bone marrow (BM-hMSCs).

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Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits.

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The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis.

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We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae.

Aims. In orthopaedic and trauma surgery, implant-associated infections are increasingly treated with local application of antibiotics, which allows a high local drug concentration to be reached without eliciting systematic adverse effects. While ceftriaxone is a widely used antibiotic agent that has been shown to be effective against musculoskeletal infections, high local concentrations may harm the surrounding tissue. This study investigates the acute and subacute cytotoxicity of increasing ceftriaxone concentrations as well as their influence on the osteogenic differentiation of human bone progenitor cells. Methods. Human preosteoblasts were cultured in presence of different concentrations of ceftriaxone for up to 28 days and potential cytotoxic effects, cell death, metabolic activity, cell proliferation, and osteogenic differentiation were studied. Results. Ceftriaxone showed a cytotoxic effect on human bone progenitor cells at 24 h and 48 h at concentrations above 15,000 mg/l. With a longer incubation time of ten days, subtoxic effects could be observed at concentrations above 500 mg/l. Gene and protein expression of collagen, as well as mineralization levels of human bone progenitor cells, showed a continuous decrease with increasing ceftriaxone concentrations by days 14 and 28, respectively. Notably, mineralization was negatively affected already at concentrations above 250 mg/l. Conclusion. This study demonstrates a concentration-dependent influence of ceftriaxone on the viability and mineralization potential of primary human bone progenitor cells. While local application of ceftriaxone is highly established in orthopaedic and trauma surgery, a therapeutic threshold of 250 mg/l or lower should diminish the risk of reduced osseointegration of prosthetic implants. Cite this article: Bone Joint Res 2021;10(3):218–225

Bone is a dynamic tissue with a quarter of the trabecular and a fifth of the cortical bone being replaced continuously each year in a complex process that continues throughout an individual’s lifetime. Bone has an important role in homeostasis of minerals with non-stoichiometric hydroxyapatite bone mineral forming the inorganic phase of bone. Due to its crystal structure and chemistry, hydroxyapatite (HA) and related apatites have a remarkable ability to bind molecules. This review article describes the accretion of trace elements in bone mineral giving a historical perspective. Implanted HA particles of synthetic origin have proved to be an efficient recruiting moiety for systemically circulating drugs which can locally biomodulate the material and lead to a therapeutic effect. Bone mineral and apatite however also act as a waste dump for trace elements and drugs, which significantly affects the environment and human health.

Cite this article: Bone Joint Res 2020;9(10):709–718.

Aims

COVID-19 necessitated abrupt changes in trauma service delivery. We compare the demographics and outcomes of patients treated during lockdown to a matched period from 2019. Findings have important implications for service development.

Aims. We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations. Methods. We constructed 3D models from 17 scaphoid waist fracture CTs performed between four to 18 weeks after fracture that did not unite (nonunion group), 17 age-matched scaphoid waist fracture CTs that healed (union group), and 17 age-matched control CTs without injury (control group). We measured the 3D bone density for the distal and proximal fragments relative to the triquetrum bone density and compared findings among the three groups. We then performed bone density measurements using 2D CT and evaluated the correlation with 3D bone densities. We identified the optimal cutoff with diagnostic values of the 2D method to predict nonunion with receiver operating characteristic (ROC) curves. Results. In the nonunion group, both the distal (100.2%) and proximal (126.6%) fragments had a significantly higher bone density compared to the union (distal: 85.7%; proximal: 108.3%) or control groups (distal: 91.6%; proximal: 109.1%) using the 3D bone density measurement, which were statistically significant for all comparisons. 2D measurements were highly correlated to 3D bone density measurements (Spearman’s correlation coefficient (R) = 0.85 to 0.95). Using 2D measurements, ROC curve analysis revealed the optimal cutoffs of 90.8% and 116.3% for distal and proximal fragments. This led to a sensitivity of 1.00 if either cutoff is met and a specificity of 0.82 when both cutoffs are met. Conclusion. Using 3D modelling software, nonunions were found to exhibit bone density increases in both the distal and proximal fragments in CTs performed between four to 18 weeks after fracture during the course of treatment. 2D bone density measurements using standard CT scans correlate well with 3D models. In patients with scaphoid fractures, CT bone density measurements may be useful in predicting the likelihood of nonunion. Cite this article: Bone Joint J 2020;102-B(9):1200–1209

Aims

Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under anaesthesia (MUA) may be performed. Historically, a limited ROM preoperatively was used as the key harbinger of the postoperative ROM. However, comorbidities may also be useful in predicting postoperative stiffness. The goal was to assess preoperative comorbidities in patients undergoing TKA relative to incidence of postoperative MUA. The hope is to forecast those who may be at increased risk and determine if MUA is an effective form of treatment.

Purposes And Background. Having found a significant limitation of neural movement (66.6%) during SLR performed on the symptomatic side in patients with sub-acute lumbar intervertebral disc herniation (LIDH), we followed up on the same patients over 1.5 years to ascertain if changes in cord excursion accompany changes in clinical symptoms. Methods. 14 patients, who originally had sciatic symptoms due to subacute LIDH, were re-assessed both clinically and radiologically with a 1.5T magnetic resonance (MR) scanner. Displacement of the conus medullaris during the unilateral and bilateral SLR was quantified reliably with a randomized procedure and compared between maneuvers and with data from baseline. Multivariate regression models and backward variable selection method were employed to identify variables more strongly associated with decrease in low back pain and radicular symptoms. Results. Compared to previously presented baseline values, the data showed an extensive increase in neural sliding of 323.4% (2.52mm, p≤0.001) with the symptomatic SLR, 37.1% (0.82mm, p=0.0058) with asymptomatic SLR, and 48.2% (1.64mm, p≤0.001) with the bilateral SLR. Increase in neural sliding correlated significantly with decrease of both radicular symptoms (Pearson=−0.719, p≤0.001) and low back pain (Pearson=−0.693, p≤0.001). Multivariate regression models and backward variable selection method confirmed that improvement of neural sliding effects (p≤0.004) as the main variable being associated with improvement of self-reported clinical symptoms. Conclusion. To our knowledge, these are the first non-invasive data to objectively support the association between increase in magnitude of neural adaptive movement and decrease in clinical symptoms in in-vivo and structurally intact human subjects. No conflicts of interest. Sources of funding: This research was partly funded by Finnish National VTR Grant for Medical Research, grant number 128/2012

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Failure of healing is a well-known problem after repair of the rotator cuff. This study aimed to investigate if early repair of trauma-related full-thickness rotator cuff tears (FTRCTs) could prevent this failure.

Background. There is a recent interest and focus on reducing the length of stay and early discharge after total joint replacement (TJR). However, safety criteria for same-day (SD) or next-day (ND) home discharge are not well defined. We implemented a screening questionnaire to identify patients that qualify for early home discharge. The aim of this study was to assess the efficiency of this questionnaire and short-term outcomes including re-admission and peri-operative complications after TJR. Methods. Between January 2016 and July 2017, 423 consecutive primary hip and knee arthroplasties were performed by the two senior surgeons at our institution. All cases were followed for a minimum of 3-month prospectively after institutional review board approval. Patients were divided based on using a pre-operative questionnaire to determine their disposition after surgery. Group 1 includes 121 cases as control and group 2 includes 302 cases with pre-operative questionnaire. Spinal anesthesia and multimodal pain management including peri-articular injection was used in all cases. The pre-operative questionnaire (PQ, Swiftpath, Inc) included an overall score based on age, comorbidities, body mass index, physical assessment, motivation, comprehension, family support, home setup (i.e. easy access/stairs), proximity to the hospital and lack of serious barriers to early home discharge. Patients were divided into 3 categories based on the score: SD/ND home, regular home discharge and rehabilitation/subacute nursing facility (SNF) discharge. Length of stay (LOS), post-operative complications, readmissions, and discharge destination were assessed. Correlation the questionnaire score and outcomes were assessed. Results. In group 1, 29% of the patients were discharged home after minimum 2 days after surgery with home services and 71% were discharged to short- or long-term rehabilitation center. The mean length of stay was 4.6 ± 2.5 days (range 2 to 7 days). 3% had symptomatic DVT and one patient pulmonary embolism during hospital stay, all after total knee arthroplasty. There was one re-operation for acute periprosthetic infection (0.8%), two cardiopulmonary events (1.6%), and 4 other ER visits for inadequate pain control (3%). In group 2, 51% of the patients were discharged home, 6% of which (10 patients) were same-day discharge. The mean length of stay was 2.2 ± 0.8 days (range 0 to 5 days). One patient (1%) had symptomatic DVT. There were 5 (1.6%) ER visits for wound concerns and pain. There were no acute re-admissions, infections or re-operations. Conclusions. Implementation of a screening questionnaire for SD/ND early discharge is safe and results in significant reduction of length of stay, higher discharge to home, lower rate of DVT/PE/cardiopulmonary complications and less ER visits