To identify factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

There is a paucity of information on factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

Patients were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). VOTOR includes all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria, Australia. Patient-reported outcomes and data on possible predictive factors, including demographic details, injury-related and treatment-based factors, were obtained from the VOTOR database.

Patient-reported outcomes were measured at 12 months post-injury using the 12-Item Short-Form Health Survey (SF-12), a Numerical Rating Scale (NRS) for pain, global outcome questions and data was collected on return to work or study. For the identification of predictive factors, univariate analyses of outcome vs. each predictor were carried out first, followed by logistic multiple regression.

344 patients were eligible for the study and data were obtained for 264 (76.7%) patients at 12 months follow-up. Patients reported ongoing pain at 12 months post-injury (moderate–severe: 33.5%), disability (70.1%) and inability to return to work or study (23.3%). A number of demographic, injury-related and treatment-based factors were identified as being predictive of poor patient-reported outcomes. Patients who had associated radius fracture(s) were more likely to have moderate to severe disability (odds ratio (OR) = 3.85, 95% confidence interval = 1.30–11.39), a poorer physical health status (OR = 3.73, 1.37–10.12) and moderate to severe pain (OR = 3.23, 1.22–8.56) at 12 months post-injury than patients without radius fracture. Patients who did not receive compensation for work-related or road traffic-related injuries were less likely to report moderate to severe pain (OR = 0.45, 0.23–0.90) or have a poorer mental health status (OR = 0.17, 0.04–0.70) at 12 months post-injury than those who received compensation.

The prognostic factors identified in this study may assist clinicians in the identification of patients requiring more intensive follow-up or additional rehabilitation to ultimately improve patient care.

A key determinant of long-term implant survival following primary TKA is post- operative alignment of the limb and components. The aim of this study was to compare the accuracy of the Vector-Vision CT-free navigation system versus conventional hand-guided TKA by comparing post-operative alignment.

In a retrospective study 51 sets of post-operative radiographs were analysed, 33 computer-guided and 18 hand-guided. A specific protocol for the measurement of post-operative TKA radiographs was outlined and a novel Trigonometric Method (TM) of angle measurement was compared with the traditional Goniometer Method (GM) of measurement.

The standardised protocol was applied to all 51 sets of radiographs. In total, six angles were measured on each radiograph by two independent observers and compared between the computer-guided and hand-guided groups.

A protocol for the measurement of post-operative TKA radiographs was delineated with step-by-step instructions. The TM of angle measurement had a precision of 1.06° compared with 1.5° using the GM. The standard deviation of the TM was significantly smaller than the GM (p=0.033) and the intra-class correlation coefficient (ICC) of the TM was 0.94 versus 0.90 for the GM.

For the Mechanical Axis (MA), 91% of patients in the computer-guided group attained a MA within 180±3o compared with only 78% in the hand-guided group. T he absolute median raw deviation from 180° was 0.8 in the navigated group and 1.9° in the hand-guided group (p=0.029). Thus, the navigated group was associated with significantly less variability about the neutral 180°. For the other five angle measurements, a higher percentage of patients attained a more neutral alignment with computer-guided TKA; however, these did not reach statistical significance

The computer-assisted group demonstrated significantly more neutral alignment following TKA, and this may in turn lead to reduced TKA failure rates and improved implant longevity. In addition, a new TM of angle measurement was found to be more superior in terms of precision in comparison to the traditional method.

Frozen Shoulder (FS) is a debilitating musculoskeletal condition with an uncertain aetiology and poorly understood pathogenic mechanism. This study aimed to investigate the pathology of FS. We hypothesised that an altered expression of cytokines may disrupt the normal tissue remodeling process, leading to FS, which would be apparent histologically.

Patients undergoing arthroscopic treatment of FS were prospectively recruited, along with control patients being treated for subacromial impingement. Synovial biopsies were taken from all subjects. Synovial RNA levels were analysed using quantitative Polymerase Chain Reaction (qPCR). Inflammatory cytokines and growth factors thought to play a role in the pathogenesis of FS were assessed. These included metalloproteases (MMP, ADAMTS) involved in tissue remodeling and fibrosis, inflammatory cytokines such as interleukins (IL), and growth factors such as colony stimulating factors (MCSF, GMCSF, CSF1R). Samples underwent histological analysis, to assess inflammation and fibrosis.

Thirteen patients with FS and ten control patients with subacromial impingement were recruited. Arthroscopic inspection revealed greater levels of synovitis (2.63+ vs 0.40+, p< 0.01) and papillary proliferation (50% vs 10%, p=0.02) in FS patients compared with the control group, confirming the initial clinical diagnosis of FS. Histological analysis of the synovium revealed samples from the FS group were more likely to demonstrate a fibrotic, focally nodular collagen morphology (53.8% vs 10%, p=0.03). There were similar levels of chronic inflammatory cells present in those with FS and control patients (53.8% vs 30%, p=0.25). There was no evidence of acute inflammation in any of the samples. Immunohistochemical staining revealed a high level of AGEs present in the synovium and smooth muscle tissue in all samples. There was no observed difference between diabetic and non-diabetic samples. Cytogenetic analysis using qPCR revealed fibrogenic factors MMP3 (p=0.068), and ADAMTS4 (p=0.083) to be elevated in FS cases, as were inflammatory cytokines IL6 (p=0.062) and IL8 (p=0.075)

We have quantified the level of inflammatory cytokines and growth factors in FS, demonstrating that these factors are elevated in FS. This indicates that altered levels of inflammatory cytokines may be associated with the pathogenesis of inflammation evolving into fibrosis, the characteristic feature of FS. We have also shown the histology of this fibrosis to be different to that observed in normal synovium.