Aim

To use Patient Reported Outcome Measures (PROMs) to determine the effectiveness of lumbar spinal surgery at a single UK institution.

Summary Statement

Discovery system produced effective functional improvement in both primary and revision total elbow replacement. The incidence of major complications was in an acceptable range.

Background:

A large percentage of the patients who present for unilateral TKA have bilateral disease. Performing simultaneous, bilateral TKA has been debated and currently there is no consensus on the risks and benefit of this approach. In addition, specific selection criteria have not been defined to more accurately identify which patients are potentially appropriate candidates for this approach.

Background

The quest for the perfectly designed elbow prosthesis continues as instability and loosening remain the foremost reasons for the failure of total elbow replacement (TER). The Discovery® Elbow System (Biomet, UK) (Figure 1), which has been used in UK since 2003, is one of the latest generations of linked prosthesis. This system was designed to decrease polyethylene-bushing wear, improve anatomic stem design, restore elbow joint biomechanics, and produce a hinge that could be easily revised. This report describes the short term outcome of TER using the Discovery® Elbow System.

Background

Wallis implant was developed in 1986 to stiffen unstable operated degenerate lumbar segments while preserving some intervertebral mobility. The long-term results of first-generation Wallis implant from developers were promising. However, documentation pertaining to safety and efficacy of second generation Wallis implant is sparse in literature.

Purpose of study: Aim was to evaluate the functional outcome of External fixation supplemented by K-wire fixation in communited fractures of lower end radius and compare the outcome in closed and open fractures treated by this method.

Methods: External fixation along with K-wire fixation was done in 25 consecutive patients (mean age-41.9 years; range-20 to 72 years). According to Frykman’s classification, there were 3 Type VII fractures and 22 Type VIII fractures. 15 fractures were closed type, 4 were Open grade I, 4 were Open grade II and 2 were Open grade III according to Gustilo and Anderson classification. The mean follow-up period was 14.1 months (range- 6 to 25 months).

Results: The mean union time was 7 weeks (range-5 to 8 weeks). Mean dorsiflexion was 37.6 degrees, mean palmar flexion was 44.4 degrees, mean ulnar deviation was 16.2 degrees, mean radial deviation was 14.2 degrees, mean supination was 73 degrees and mean pronation was 79 degrees. Comparison of union time, dorsiflexion, palmarflexion, ulnar deviation, radial deviation, supination and pronation between closed, Open grade I, Open grade II and Open grade III fractures revealed no significant difference. Significant radial shortening was observed in patients with open fractures (P=0.004). 1 patient developed schanz pin tract infection and late distal radioulnar joint subluxation was seen in 4 patients.

Conclusion: Supplementation of External fixator with K-wires is an effective method for treating both closed and open fractures of distal end radius however; radial shortening is seen in some cases with open fractures.

Purpose of study: We aimed to compare the efficacy and effect of Ender nail and unreamed interlock nail in the management of Type I, II and IIIA fractures.

Methods: 33 cases of open tibial shaft fractures in 32 patients were included in this prospective study. 17 tibial fractures were fixed with Ender nails introduced by antegrade approach and 16 tibial fractures were fixed with statically locked Interlocking nails. The mean follow-up period was 17.8 (6 to 32) months. The mean injury-surgery interval was 5.6 (1 to 16) days.

Results: In the Ender nail group, the average union time for open fracture was 19.5 weeks and 18.3 weeks for Type-I fracture. In the Interlock nail group, the average union time for open fracture was 24.8 weeks and 23.8 weeks for Type-I fracture. Mann-Whitney test revealed significant difference between the two groups for the data described above. Treatment with either nails showed no significant difference in union time for Type-II and type-IIIA fractures. Ankle movement restriction was noted more in interlock nail group (p = 0.04). Anterior knee pain, chronic osteomyelitis and breakage of distal screw were observed in interlock nail group. No complication was seen in Ender nail group.

Conclusion: Ender nailing is a safe and effective choice for treatment of open tibial shaft fractures due to faster fracture union rate and fewer complications. Ender nail is a good implant in treatment of open tibial shaft fractures especially in regions with limited access to specialized, sophisticated and expensive facilities.

PURPOSE OF STUDY: We report our experience with multiple flexible intramedullary nailing (Ender nailing) of fractures of shaft of the femur in paediatric age group.

METHODS: We did a prospective review of 20 children (mean age- 8.8 years; range- 6.5 to 15 years) treated with Ender nailing. Fall from height was the predominant mechanism of injury (18 children). The mean follow-up period was 16.3 months (range- 4 to 28 months).

RESULTS: 18 fractures united by 6-8 weeks and 2 fractures united by 8-10 weeks. Minor limb length discrepancies were seen in this series (range, -5mm to +10mm). 2 children had shortening of 5mm while 4 children with upper third fractures had 10mm lengthening. All patients were able to squat on floor and sit cross-legged. All but one patient had full hip and knee range of motion. Varus angulation of 15 degree was seen in 2 patients who were non-compliant and had started early weight bearing. Backing out of 1 nail was seen in 1 patient and the nail was extracted. TEN outcome scoring system was used to critically analyse the results. 16 children had excellent outcome, 2 children had satisfactory outcome and 2 children (with varus malunion) had poor outcome.

CONCLUSION: Ender nailing is a safe and effective method for treatment of femoral shaft fractures in children between the age of 6 and 15 years. Patient compliance is crucial for a satisfactory outcome since early full weight bearing can predispose to varus malunion.

Purpose: It is known from the literature that gripping, which is commonly used in various work-related, sport-related, and daily activities, activates both wrist extensors and flexors. Pain aggravation occurs during grip due to over-exertion of the extensor muscle group in lateral epicondylitis and grip strength is reduced. Of grip strength studies, few studies have simultaneously investigated muscular response using electromyography as a method of monitoring muscular fatigue or muscular activity of forearm muscles. The fatigability and activity of wrist antagonistic muscles in patients with lateral epicondylitis has not been previously investigated.

Methods: 16 tennis elbow patients (Tennis Elbow Group) and 16 healthy volunteers (Control Group) were participated in this study. In both groups, local muscular fatigue and muscular activity were measured for 3 forearm muscles contributing to the wrist extension and 2 muscles contributing to the wrist flexion using EMG and during gripping at 50% maximum voluntary contraction (MVC). Fatigability and activity of muscles then were compared between control and tennis elbow groups.

Results: Grip strength was significantly lower in tennis elbow group than that in control group (p < 0.05). Median frequency (MDF) and root mean square (RMS) of electromyographic signals were used as parameters to measure muscular fatigue and muscular activity, respectively. Further analysis showed no significant difference in the fatigability of forearm muscles between two groups. The activity of Extensor Carpi Radialis (ECR) showed statistically significant reduction in tennis elbow group compared to the control group (p < 0.05).

Conclusion: This is the first study to simultaneously investigate the fatigability and activity of the forearm antagonistic muscle groups in patients with lateral epi-condylitis. The fact that ECR showed similar level of muscular fatigue to other muscles despite decreased muscular activity may indicate of higher fatigability of this muscle in tennis elbow. Furethermore, decreased muscular activity of ECR may be a part of mechanism to protect the muscle from further injury in tennis elbow patients.