The purpose of this study was to evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome. One hundred and fifteen patients were identified. 63% were male; mean age was thirty-seven years; mean ISS was thirty. Three patients died from their injuries. At a mean follow-up of 3.5 years, patients exhibited profound functional deficits compared to the normal population. Those with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

To evaluate functional outcome in patients with combined pelvic and acetabular fractures and to identify factors associated with outcome.

Combined pelvic and acetabular injuries are associated with high mortality and functional morbidity irrespective of treatment.

These results will allow us to further investigate which injury is dictating prognosis in the combined injury – the pelvic or the acetabular fracture.

One-hundred and fifteen patients with combined pelvic and acetabular injuries were identified at a level One trauma centre. 63% were male; mean age was thirty-seven years (13–88); mean ISS was thirty (16–75). Three patients died from their injuries. 16% involved bilateral pelvic fractures; 7% bilateral acetabular fractures; and for 2%, both were bilateral. 64% were Tile B and 34% were Tile C. Most acetabular fractures involved the anterior column or both column. Only 18% were treated with ORIF for both injuries. 25% had ORIF of their acetabulum and 14% had ORIF on their pelvis. Sixty-five patients completed validated functional outcome questionnaires at a mean follow-up of 3.5 (one to eleven) years. Patient function was significantly compromised with a mean MFA score of 33.8 (SD 21.8). Function was worse for all 8 SF-36 domains and the two component scores compared to the health status of the Canadian normal population (p< 0.001). Those individuals with an acetabular fracture involving the posterior wall or an associated lower extremity injury have a particularly poor prognosis. There was no relationship found between treatment or the pre-defined stability groups and functional outcome.

Funding: Grant funded from AO/ASIF

In the past, the treatment of acute elbow fracture-dislocations has emphasized repair to the medial collateral ligament (MCL), with favorable results. We report improved results using a strategy based on lateral-sided repair (lateral collateral ligament, radial head, coronoid) without MCL repair. In forty-seven patients, this strategy resulted in a high degree of success with no residual instability (valgus or otherwise). The dynamic stabilizers of the elbow activated through early postoperative motion, are important adjunct to stability. We have devised a reproducible radiographic method to demonstrate this.

To review the surgical treatment of elbow dislocations without surgical MCL repair, and to determine if early active motion aids in restoring stability and concentric joint reduction.

In the setting of acute fracture-dislocation of the elbow, concentric elbow stability with excellent functional results can be achieved using laterally-based surgical strategy without MCL repair. The dynamic stabilizers of the elbow, activated through the early motion, assist in providing joint congruity and stability.

Forty-seven patients with acute elbow fracture-dislocations requiring operative treatment were treated at two university-affiliated teaching hospitals and evaluated an average of twenty-one months after injury. The protocol consisted of repair of the ulna and coronoid, repair or replacement of the radial head, and repair of the LCL, and early motion. The MCL was not routinely repaired. The LCL origin had been avulsed and reattached in all patients. One patient had a second procedure related to malpositioned radial head prosthesis. A stable mobile (average one hundred and one degree arc) articulation was restored in all patients. There was no evidence of valgus instability in any patient. Early motion was initiated at a mean of two weeks postoperatively. Postoperative ulnohumeral joint space opening improved from 4.9 ± 1.2 mm in the early postoperative period to 2.0 ± 0.5 mm (p < 0.00003) at final follow-up. We believe this is due to the effect of the dynamic stabilizers, which were allowed to function through early motion.

Thirty-eight patients with nonunion of the humeral shaft underwent a comprehensive assessment including completion of three patient-based functional outcome surveys as well as the determination of the Constant shoulder and Mayo elbow scores. Treatment consisted of compression plating with or without bone grafting. Smokers were found to have significantly longer time to union as compared to nonsmokers (25.1 weeks vs. 16.2 weeks, p< 0.001). Our results also demonstrated that increased time to union had a significant negative effect on the patient-reported functional outcome scores.

To evaluate the functional outcome and identify prognostic factors that influence the healing time of surgically treated humeral shaft nonunions.

Time to consolidation of operatively treated humeral shaft nonunions was significantly longer in smokers versus non-smokers. Time to union was negatively associated with the patient-reported functional outcome scores.

The long-term functional outcome following surgical treatment of humeral shaft nonunions is dependent upon the time to consolidation. Smoking is a significant remediable risk factor for delayed union following surgical repair of humeral shaft nonunion.

We identified thirty-eight patients (mean age fifty-five years) treated surgically for nonunion of the humeral shaft at a mean follow-up of sixty months. All patients underwent a comprehensive assessment including the completion of the SF-36, the DASH, the SMFA and the determination of the Constant shoulder and Mayo elbow scores. Seventeen (44.7%) patients were classified as ‘smokers’ and twenty-one (55.3%) were ‘non-smokers’. All nonunions united with a mean time of 16.2 weeks for non-smokers and 25.1 weeks for smokers (p< 0.001). Time to union was negatively associated with the Physical Function portion of the SF-36 (p=0.01), the DASH (p=0.01), and the Arm and Hand Function part of the SMFA (p=0.005). The only other factor that had a significant negative effect on the functional outcome scores was the presence of one or more comorbid factors (SF-36, p< 0.001; DASH, p< 0.001; SMFA, p< 0.001). Patient-oriented and surgeon based scores were found to correlate well (range r=0.545 to r=0.916, p< 0.001 for all combinations).

Introduction and Aims: Open femoral fracture is a serious injury. We have asked the question: do open femur fractures in polytrauma patients correlate with higher injury severity scores, increased length of stay and higher mortality rates than in closed femur fracture polytrauma patients.

Method: We undertook a retrospective review of a prospectively gathered trauma database at a Level 1 trauma centre. We identified multiple-injured patients with femur fractures who presented in a 36 month period. The cases were divided into 2 groups; open femur fractures (n=33) and closed femur fractures (n=80). Data was collected on demographics, precipitating event, length of stay spent in the ICU, number of associated injuries, ISS, AIS for affected systems, number of femoral surgeries and disposition. Data was analyzed using parametric statistical tests with a significance level of 0.05.

Results: Our analysis revealed that an average, patients in the open femur fracture group spent 8 + 9 days in ICU, sustained 4 + 1 associated injuries, underwent 2 + 1 femoral surgeries, had an ISS of 29 + 13, and died of their injuries in 30.3% of cases. Patients in the closed femur fracture groups spent 8 + 9 days in ICU, sustained 4 + 1 associated injuries, underwent 1 + 1 femoral surgeries, had an ISS of 29 + 14, and died of their injuries in 12.5% of cases. One-way ANOVA showed no statistically significant difference between groups in terms of time spent in ICU, ISS and number of associated injuries. The average number of surgeries was significantly greater in the open femur fracture group (p-value 0.000). A Chi-squared analysis of disposition indicated that patients with femur fractures were more likely to die of their injuries (p-value 0.020).

Conclusions: Findings of the current study demonstrate that while the presence of an open femur fracture does not correlate with an increase in ISS or increase ICU length of stay it may act as a marker for more serious prognosis in polytrauma patients.

Introduction and Aims: The combination of ipsilateral intertrochanteric and femoral shaft fractures is an uncommon pattern associated with high-energy trauma. This retrospective study used self-report measures to evaluate functional outcome of patients sustaining this fracture pattern and compared two common treatment methods.

Method: Three patient-based outcome measures, the Short Form-36 (SF-36), Short Musculoskeletal Functional Assessment (SMFA), and Lower Extremity Functional Scale (LEFS) were used to evaluate the functional outcome of twenty-one patients (13 male, mean 46.7 +/− 16.5 years) treated with a reconstruction nail (n=11) or with a sliding hip screw and retrograde nail (n=10).

Results: Mechanisms of injury included motor vehicle accidents (66.7%) and falls from height (14.3%). SF-36 physical and mental component scores were less than Canadian norms, with mean values of 35.9 (p=0.0001) and 43.7 (p=0.02), respectively. There was a trend towards better functional outcome in the group treated with the sliding hip screw with retrograde nail despite this group sustaining more severe injuries as measured by ISS (p=0.004), number of days in hospital (p=0.027), and number of days in ICU (p=0.009).

Conclusion: Functional outcome following treatment of ipsilateral intertrochanteric and femoral shaft fractures was reduced compared to Canadian norms. Despite having sustained more severe injuries, the sliding hip screw with retrograde nail group showed a trend towards better outcome as compared to the group treated with the reconstruction nail.

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.

Introduction and Aims: Open femoral fracture is a serious injury. We have asked the question: do open femur fractures in polytrauma patients correlate with higher injury severity scores, increased length of stay and higher mortality rates than in closed femur fracture polytrauma patients.

Method: We undertook a retrospective review of a prospectively gathered trauma database at a Level 1 trauma centre. We identified multiple-injured patients with femur fractures who presented in a 36-month period. The cases were divided into two groups: open femur fractures (n=33) and closed femur fractures (n=80). Data was collected on demographics, precipitating event, length of stay spent in the ICU, number of associated injuries, ISS, AIS for affected systems, number of femoral surgeries and disposition. Data was analysed using parametric statistical tests with a significance level of 0.05.

Results: Our analysis revealed that on average, patients in the open femur fracture group spent eight + nine days in ICU, sustained four + one associated injuries, underwent two + one femoral surgeries, had an ISS of 29 + 13, and died of their injuries in 30.3% of cases. Patients in the closed femur fracture groups spent eight + nine days in ICU, sustained four + one associated injuries, underwent one + one femoral surgeries, had an ISS of 29 + 14, and died of their injuries in 12.5% of cases. One-way ANOVA showed no statistically significant difference between groups in terms of time spent in ICU, ISS and number of associated injuries. The average number of surgeries was significantly greater in the open femur fracture group (p-value 0.000). A Chi-squared analysis of disposition indicated that patients with femur fractures were more likely to die of their injuries (p-value 0.020).

Conclusions: Findings of the current study demonstrate that while the presence of an open femur fracture does not correlate with an increase in ISS or increase ICU length of stay, it may act as a marker for more serious prognosis in polytrauma patients.

A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score, pinch strength and grip strength improved significantly in all patients. There was no statistically significant difference in the radiological restoration of anatomical features or the range of movement between the groups.

During the period of two years, patients who underwent indirect reduction and percutaneous fixation had a more rapid return of function and a better functional outcome than those who underwent open reduction and internal fixation, provided that the intra-articular step and gap deformity were minimised.

We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience.

Our findings suggest that AO ‘type’ and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO ‘group’ and especially AO ‘subgroup’. To categorise distal radial fractures according to joint displacement and AO type is simple and reproducible.

Our study examined only whether distal radial fractures could be consistently classified according to the AO system. Validation of the classification as a predictor of outcome will require a prospective clinical study.

We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.