Advertisement for orthosearch.org.uk
Results 1 - 20 of 40
Results per page:
Bone & Joint Open
Vol. 5, Issue 8 | Pages 708 - 714
22 Aug 2024
Mikhail M Riley N Rodrigues J Carr E Horton R Beale N Beard DJ Dean BJF

Aims. Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. Methods. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. Results. A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm ‘endpoint’ to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. Conclusion. The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject. Cite this article: Bone Jt Open 2024;5(8):708–714


Bone & Joint 360
Vol. 12, Issue 5 | Pages 30 - 34
1 Oct 2023

The October 2023 Shoulder & Elbow Roundup360 looks at: Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomized, placebo-controlled trial; Superior capsular reconstruction partially restores native glenohumeral loads in a dynamic model; Gene expression in glenoid articular cartilage varies in acute instability, chronic instability, and osteoarthritis; Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery; Level of pain catastrophizing rehab in subacromial impingement: secondary analyses from a pragmatic randomized controlled trial (the SExSI Trial); Anterosuperior versus deltopectoral approach for primary reverse total shoulder arthroplasty: a study of 3,902 cases from the Dutch National Arthroplasty Registry with a minimum follow-up of five years; Assessment of progression and clinical relevance of stress-shielding around press-fit radial head arthroplasty: a comparative study of two implants; A number of modifiable and non-modifiable factors increase the risk for elbow medial ulnar collateral ligament injury in baseball players: a systematic review.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_4 | Pages 10 - 10
3 Mar 2023
Brock J Jayaraju U Trickett R
Full Access

There is no consensus for the appropriate surgical management of chronic ulnar collateral ligament (UCL) injuries of the thumb. A systematic review of Pubmed, MEDLINE, EMBASE and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-analysis (PRISMA) guidelines and formal protocol registered with PROSPERO. Two authors collated data from 10 studies that met strict inclusion criteria, using various surgical techniques in 131 thumbs. Results were heterogenous and metanalysis of results not possible. These data were, therefore, qualitatively assessed and synthesised. Bias was assessed using the ROBINS-I tool. Direct repair, reconstruction with free tendon or bone-tissue-bone grafts and arthrodesis all demonstrated favourable outcomes with Patient Reported Outcome Measures. Direct repair can be safely performed more than two months following injury, with a positive mean Disabilities of the Arm, Shoulder and Hand (DASH) score of 13.5 despite evidence of radiographic osteoarthritis. Arthrodesis should be considered in heavy manual laborers or those at risk of osteoarthritis as it provides significant reduction in pain (Mean Visual Analogue Score of 1.2) when compared to other methods. Free tendon grafting has been criticised for failure rates and poor functional grip strength, however collated analysis of 97 patients found a single graft rupture and mean grip strength of 97% (of the contralateral thumb). Bone-tissue-bone grafting was the least effective method across all outcome measures. Studies included were at high risk of bias, however, it can be concluded that delayed direct repair can be performed safely, while arthrodesis may benefit certain patient subgroups. New findings suggest poor efficacy of bone-tissue-bone grafts, but that free tendon grafting with palmaris longus are in fact safe with good restoration of grip strength. The optimal graft and configuration are yet to be determined for reconstructive methods


The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1329 - 1333
1 Dec 2022
Renfree KJ

This annotation reviews current concepts on the three most common surgical approaches used for proximal interphalangeal joint arthroplasty: dorsal, volar, and lateral. Advantages and disadvantages of each are highlighted, and the outcomes are discussed.

Cite this article: Bone Joint J 2022;104-B(12):1329–1333.


Bone & Joint Research
Vol. 11, Issue 11 | Pages 814 - 825
14 Nov 2022
Ponkilainen V Kuitunen I Liukkonen R Vaajala M Reito A Uimonen M

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Methods

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.


Bone & Joint 360
Vol. 11, Issue 4 | Pages 25 - 29
1 Aug 2022


Bone & Joint 360
Vol. 10, Issue 4 | Pages 27 - 30
1 Aug 2021


The Bone & Joint Journal
Vol. 103-B, Issue 7 | Pages 1187 - 1188
1 Jul 2021
Murray IR Makaram NS Rodeo SA Safran MR Sherman SL McAdams TR Murray AD Haddad FS Abrams GD


The Bone & Joint Journal
Vol. 103-B, Issue 7 | Pages 1189 - 1196
1 Jul 2021
Murray IR Makaram NS Rodeo SA Safran MR Sherman SL McAdams TR Murray AD Haddad FS Abrams GD

Aims. The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary. Results. A total of 202 studies were initially identified, and 35 met criteria for the scoping review; 33 (94.3%) were published within the last eight years, and 18 (51.4%) originated from the USA. Platelet rich plasma was the most studied biologic therapy, being evaluated in 33 (94.3%) studies. Ulnar collateral ligament and hamstring injuries were the conditions most studied (nine (25.7%) studies and seven (20.0%) studies, respectively). Athletes most frequently participated in baseball, soccer, and American football. Only two (5.7%) studies were level 1 evidence, with interpretation and comparison between studies limited by the variations in the injury profile, biologic preparations, and rehabilitation protocols. Conclusion. There is diverse use of biologic therapies in the management of musculoskeletal injuries in professional and Olympic athletes. There is currently insufficient high-level evidence to support the widespread use of biologic therapies in athletes. Further research priorities include the development of condition/pathology-specific preparations of biologic therapies, and of outcome measures and imaging modalities sufficiently sensitive to detect differences in outcomes, should they exist. Cite this article: Bone Joint J 2021;103-B(7):1189–1196


Bone & Joint 360
Vol. 10, Issue 1 | Pages 18 - 19
1 Feb 2021


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1618 - 1619
1 Dec 2020
Klug A Nagy A Gramlich Y Hoffmann R


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1620 - 1628
1 Dec 2020
Klug A Nagy A Gramlich Y Hoffmann R

Aims

To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes.

Methods

Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2.0 to 9.4). The Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score were evaluated. Radiographs of all patients were analyzed. Fracture types included 13 Mason type I, 16 type II, and 59 type III. Surgical treatment consisted of open reduction and internal fixation (ORIF) in all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) was performed if reconstruction was not possible.


Bone & Joint 360
Vol. 9, Issue 1 | Pages 47 - 50
1 Feb 2020


The Bone & Joint Journal
Vol. 102-B, Issue 2 | Pages 227 - 231
1 Feb 2020
Lee SH Nam DJ Yu HK Kim JW

Aims

The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI.

Methods

We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear.


Bone & Joint 360
Vol. 8, Issue 4 | Pages 29 - 32
1 Aug 2019


Bone & Joint 360
Vol. 8, Issue 3 | Pages 23 - 26
1 Jun 2019


The Bone & Joint Journal
Vol. 99-B, Issue 9 | Pages 1197 - 1203
1 Sep 2017
Laumonerie P Reina N Ancelin D Delclaux S Tibbo ME Bonnevialle N Mansat P

Aims

Radial head arthroplasty (RHA) may be used in the treatment of non-reconstructable radial head fractures. The aim of this study was to evaluate the mid-term clinical and radiographic results of RHA.

Patients and Methods

Between 2002 and 2014, 77 RHAs were implanted in 54 men and 23 women with either acute injuries (54) or with traumatic sequelae (23) of a fracture of the radial head. Four designs of RHA were used, including the Guepar (Small Bone Innovations (SBi)/Stryker; 36), Evolutive (Aston Medical; 24), rHead RECON (SBi/Stryker; ten) or rHead STANDARD (SBi/Stryker; 7) prostheses. The mean follow-up was 74.0 months (standard deviation (sd) 38.6; 24 to 141). The indication for further surgery, range of movement, mean Mayo Elbow Performance (MEP) score, quick Disabilities of the Arm, Shoulder and Hand (quickDASH) score, osteolysis and positioning of the implant were also assessed according to the design, and acute or delayed use.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_2 | Pages 30 - 30
1 Jan 2017
Kuenzler M Akeda M Ihn H McGarry M Zumstein M Lee T
Full Access

Posterolateral rotatory instability (PLRI) is the most common type of elbow instability. It is caused by an insufficiency of the lateral ligamentous complex, which consists mainly of the radial collateral ligament (RCL) and the lateral ulnar collateral ligament (LUCL). Investigate the influence of serial sectioning of the lateral ligamentous complex on elbow stability in a cadaveric model of PLRI. Kinematics of six fresh frozen cadaveric elbow specimens were measured by digitizing anatomical marks with a Microscribe 3DLX digitizing system (Revware Inc, Raleigh, NC). Each specimen was tested under four conditions: Intact, LUCL tear, LUCL and RCL tear, and complete Tear (LUCL, RCL and capsule tear). Each specimen was tested in 30°, 60° and 90° elbow flexion angles. Varus- laxity was measured in supination, pronation, and neutral forearm rotation positions and total forearm rotation was measured with 0.3 Nm of torque. Statistical significant differences between the conditions were detected using a two-way ANOVA with Tukey's post-hoc test. The radial head dislocated in all specimens in LUCL and RCL tear and Comp but not in LUCL tear. Total forearm ROM did not increase form intact to LUCL tear (p>0.05) but significantly increased in LUCL and RCL tear (p=0.0002) and complete tear (p<0.0001) in all flexion angles. Additionally, ROM in LUCL tear significantly differed from LUCL and RCL tear and complete tear (p=0.0027 and p=0.0002). A similar trend was seen with the varus angle. While there was a significant difference when the intact condition was compared to both the LUCLand RCL tear and complete tear conditions (p<0.0001 and p<0.0001), there was no difference between the intact and LUCL tear conditions. LUCL tear alone is not sufficient to cause instability and increase ROM and varus angle, meanwhile the increase of ROM and varus angle with additional capsular tear was not significant compared to LUCL and RCL tear. The increase of ROM after LUCL and RCL tear is an unknown symptom of PLRI


The Bone & Joint Journal
Vol. 95-B, Issue 10 | Pages 1383 - 1387
1 Oct 2013
Lanting BA Ferreira LM Johnson JA Athwal GS King GJW

We measured the tension in the interosseous membrane in six cadaveric forearms using an in vitro forearm testing system with the native radial head, after excision of the radial head and after metallic radial head replacement. The tension almost doubled after excision of the radial head during simulated rotation of the forearm (p = 0.007). There was no significant difference in tension in the interosseous membrane between the native and radial head replacement states (p = 0.09). Maximal tension occurred in neutral rotation with both the native and the replaced radial head, but in pronation if the radial head was excised. Under an increasing axial load and with the forearm in a fixed position, the rate of increase in tension in the interosseous membrane was greater when the radial head was excised than for the native radial head or replacement states (p = 0.02). As there was no difference in tension between the native and radial head replacement states, a radial head replacement should provide a normal healing environment for the interosseous membrane after injury or following its reconstruction. Load sharing between the radius and ulna becomes normal after radial head Replacement. As excision of the radial head significantly increased the tension in the interosseous membrane it may potentially lead to its attritional failure over time.

Cite this article: Bone Joint J 2013;95-B:1383–7.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_13 | Pages 17 - 17
1 Mar 2013
Kulshreshtha R Gibson C Jariwala A Wigderowitz C
Full Access

Various authors have linked hypermobility at the trapeziometacarpal joint to future development of arthritis. When examining hypermobility, the anterior oblique ligament (AOL) and ulnar collateral ligament (UCL) are the two most important supporting structures. Literature suggests that reconstructive techniques to correct the hypermobility can prevent subsequent development of osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the ligamentous support of this joint in 1973. This cadaveric biomechanical study aimed to evaluate the resultant effect on the mobility of the thumb metacarpal following this reconstructive technique. Seventeen cadaveric hands were prepared and strategically placed on a jig. Movements at the trapeziometacarpal joint were created artificially. Static digital photographs were taken with intact AOL and UCL at trapeziometacarpal joint (controls), for later comparison with those after sectioning of these ligaments and following Eaton-Littler reconstructive technique. The photographic records were analyzed using Scion.Image. Statistical analysis was performed using Minitab. A paired T-test was used to establish statistical relevance. Results confirmed that the AOL and UCL had a major role in limiting excessive motion at the trapeziometacarpal joint, principally in extension. Division of these ligaments produced a significant degree of subluxation of the metacarpal at this joint with thumb in neutral position (p-value = 0.013). Reconstruction of the ligamentous support using the Eaton-Littler technique reduced the degree of extension available (p-value = 0.005). This study confirmed the important role of the AOL and UCL in maintaining trapeziometacarpal joint stability, and that the Eaton-Littler reconstructive technique reduces the degree of hyperextension at this joint