Aims. In our unit, we adopt a two-stage surgical reconstruction approach using
Aims. In contrast to operations performed for other fractures, there is a high incidence rate of surgical site infection (SSI) post-open reduction and
We report a prospective single-blind controlled
study of the incidence of early wound infection after
Objectives. The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited
A consecutive series of 320 patients with an
intracapsular fracture of the hip treated with a dynamic locking
plate (Targon Femoral Neck (TFN)) were reviewed. All surviving patients
were followed for a minimum of two years. During the follow-up period
109 patients died. There were 112 undisplaced fractures, of which three (2.7%) developed
nonunion or re-displacement and five (4.5%) developed avascular
necrosis of the femoral head. Revision to an arthroplasty was required
for five patients (4.5%). A further six patients (5.4%) had elective
removal of the plate and screws. There were 208 displaced fractures, of which 32 (15.4%) developed
nonunion or re-displacement and 23 (11.1%) developed avascular necrosis.
A further four patients (1.9%) developed a secondary fracture around
the TFN. Revision to a hip replacement was required for 43 patients
(20.7%) patients and a further seven (3.3%) had elective removal
of the plate and screws. It is suggested that the stronger distal fixation combined with
rotational stability may lead to a reduced incidence of complications
related to the healing of the fracture when compared with other
contemporary fixation devices but this needs to be confirmed in
further studies. Cite this article:
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
We compared a new fixation system, the Targon
Femoral Neck (TFN) hip screw, with the current standard treatment of
cannulated screw fixation. This was a single-centre, participant-blinded,
randomised controlled trial. Patients aged 65 years and over with
either a displaced or undisplaced intracapsular fracture of the
hip were eligible. The primary outcome was the risk of revision
surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute
reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5)
in favour of the TFN hip screw (chi-squared test, p = 0.741), which
was less than the pre-specified level of minimum clinically important
difference. There were no significant differences in any of the
secondary outcome measures. We found no evidence of a clinical difference in the risk of
revision surgery between the TFN hip screw and cannulated screw
fixation for patients with an intracapsular fracture of the hip. Cite this article:
Introduction. Circular external fixators are fundamental to lower limb reconstruction, primarily in situations with a high risk of infection such as open fractures. During the Covid-19 pandemic, use of circular frames in our unit decreased, following departmental approval, due to resource management and in keeping with BOA guidelines as we opted to “consider alternative techniques for patients who require soft tissue reconstruction to avoid multiple operations”. These alternatives included the use of
Introduction and Objective. Postoperative management regimes vary following open reduction and
Aims. Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint infection (PJI), but their diagnostic values are unclear for screening fixation-related infection (FRI) in patients for whom conversion total hip arthroplasty (THA) is planned after failed
The results of meta-analysis show a revision rate of 33% for
The incidence of hip fractures in the elderly is increasing. Minimally displaced and un-displaced hip fractures can be treated with either
Abstract. Background. The incidence of periprosthetic fractures of the femur around a total knee arthroplasty (TKA) is rising and this is owed to the increased longevity that today's TKA implants allow for, as well as an aging population. These injuries are significant as they are related to increased morbidity and mortality. Methods. We retrospectively reviewed all periprosthetic fractures around a TKA that presented to our NHS Trust between 2011 to 2020. Medical records were reviewed. Treatment, complications and mortality were noted. Results. 37 patients (34 females) with an average age of 84 (range 65–99) met the inclusion criteria for this study. 17 patients (45.9%) underwent open reduction and
Introduction. Ankle fractures in the elderly have been increasing with an ageing but active population and bring with them specific challenges. Medical co-morbidities, a poor soft tissue envelope and a requirement for early mobilisation to prevent morbidity and mortality, all create potential pitfalls to successful treatment. As a result, different techniques have been employed to try and improve outcomes. Total contact casting, both standard and enhanced open reduction
Introduction. Femoral shaft fractures in children is a serious injury that needs hospitalization, with a high prevalence in the age group 6–8 years old. Various treatment options are available and with a comparable weight of evidence. Submuscular plating provides a dependable solution, especially in length-unstable fractures and heavier kids. We present a novel technique to facilitate and control the reduction intraoperatively, which would allow for easier submuscular plate application. Materials and Methods. We have retrospectively reviewed four boys and three girls; all were operated in one centre. Polyaxial clamps and rods were applied to the sagittally-oriented bone screws, the reduction was done manually, and the clamps were tightened after achieving the proper alignment in the anteroposterior and lateral fluoroscopy views. The submuscular plate was applied as described, then clamps and bone screws were removed. Results. The mean age at surgery was 13 years (range, 9–14). The mean body weight was 43.3 kg (range, 30–66). There were five mid-shaft fractures, one proximal third and one distal third. There were Four type A fractures, two type B and one type C. Four patients had road traffic accidents while three had direct trauma. The mean preoperative haemoglobin concentration 12.5 g/dl (range 11.3–13 g/dl). No blood transfusion was needed intraoperatively or postoperatively. The operative time averaged 122 minutes, and the mean hospital stay was one (range 1–4 days). The patients reported no pain at a mean of 1.5 weeks (range, one-three weeks). All fractures united at a mean of 8.7 weeks (range 6–12 weeks). No wound healing problems nor deep infections happened. The knee joint range of motion was full in all patients at six weeks postoperatively. There was no mechanical irritation from the inserted plate. At the final follow-up, all fractures united without malalignment nor length discrepancy. Conclusions. External fixator-assisted
Distal radius fractures are the most common adult fractures, yet there remains some uncertainty surrounding optimal treatment modalities. Recently, the rate of operative treatment of these injuries has been increasing, however, predictors of outcomes in patients treated surgically remain poorly understood. The purpose of this study was to evaluate independent predictors of 30-day readmission and complications following
Aims. The aim of this study was to describe the technique of distraction
osteogenesis followed by arthrodesis using
Failed
Aim. Previous studies of primary
Aims. Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and
1. Eighty consecutive open fractures of the tibial shaft were treated by primary
Purpose of the study:. To determine the outcomes of cases converted from an external fixator to an internal fixation device in the management of limb reconstructions and deformity corrections. Method:. A retrospective review of 18 patients, that underwent a conversion procedure to
We compared the reoperation rate after
1. The results of
Triple arthrodesis is the most effective treatment resource for restoring shape and stability to the hind-foot. It is used in order to achieve a plantigrade foot, aligned, stable and painless, in the treatment of various pathologies. However, it has the effect of changing the dynamic mobility of the foot and diminishes the adapting ability to uneven ground, influencing the outcome. Opinions differ on the necessity of
Background: The importance of HIV in trauma has been poorly investigated. There’re few reports in the literature on the effects of HIV on fracture healing, those that there are involve small numbers. Many surgeons have concerns about both internal and external fixation in these patients. Some of the most recent published studies have suggested a 4 fold increase in infection rates in
Background. Studies have compared open reduction
Objective. Failures of
We studied 60 patients with an acute displaced fracture of the femoral neck and with a mean age of 84 years. They were randomly allocated to treatment by either
A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or
Open reduction and
Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002. Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic. Method: All patients underwent an open reduction,
Purpose. To compare the clinical and radiological results between
Management of acetabular fractures in the elderly population remains somewhat controversial in regards to when to consider is open reduction
Aim. Unexpected positive infections are distinct entity in prosthetic revision surgery. The prevalence and characteristics of unexpected positive cultures in
In a series of 450 patients over 70 years of age with displaced fractures of the femoral neck sustained between 1995 and 1997 treatment was randomised either to
Two hundred and thirty-two ankle fractures were treated in the orthopaedic department of the Royal Portsmouth Hospital between 1959 and 1960. Seventy-one fractures treated by
The Orthofix acute correction template has been developed for multiplanar deformity corrections, with or without lengthening, using a monolateral external fixation system such as the limb reconstruction system (LRS). Pin placement is achieved by marrying the template onto the particular deformity in the frontal, sagittal and rotational planes, so that after the osteotomy the pins can be rearranged by manipulating the fragments to permit application of the standard Orthofix fixation system. The options of compression, dynamisation or lengthening through the osteotomy sites remain available should they be required in the reconstructive procedure. We have found the template useful in correcting multiplanar deformities intra-operatively. This is followed by
Lisfranc injuries are uncommon and can be challenging to manage. There is considerable variation in opinion regarding the mode of operative treatment of these injuries, with some studies preferring primary arthrodesis over traditional open reduction and
The operative treatment of displaced fractures of the tibial plateau is challenging. Recent developments in the techniques of
Over a seven-year period we treated a consecutive series of 58 patients, 20 men and 38 women with a mean age of 66 years (21 to 87) who had an acute complex anterior fracture-dislocation of the proximal humerus. Two patterns of injury are proposed for study based upon a prospective assessment of the pattern of soft-tissue and bony injury and the degree of devascularisation of the humeral head. In 23 patients, the head had retained capsular attachments and arterial back-bleeding (type-I injury), whereas in 35 patients the head was devoid of significant soft-tissue attachments with no active arterial bleeding (type-II injury). Following treatment by open reduction and
In a meta-analysis of fourteen trials (N=1901 patients) in patients with displaced hip fractures, we identified significant reductions in the risk of revision surgery with
The treatment of infected exposed implants which have been used for
Introduction. Intracapsular hip fractures in young adults are treated with
We present the management and outcome of patients who presented following
The place of
1. The results in 211 fractures of the shaft of the femur in adults treated by
Failed
Background: Complex anterior fracture-dislocations of shoulder are rare injuries and little is known about the functional outcomes following operative treatment. The aim of our study was to evaluate the functional outcomes following open reduction and
We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and
Purpose. The aim of this study was to report the outcomes of a series of patients with clavicle fracture non-union who had undergone open reduction and
Introduction:. We report our 10-year experience of post-operative complications of calcaneal fractures treated by
Background. Intracapsular neck of femur fractures are one of the most common injuries seen in Orthopaedics. When the fracture is amenable to
Many two-part fractures of the proximal humerus are treated conservatively due to the frequent failure of
Aims. We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. Methods. HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and
Failed
8 patients with cervical myelopathy treated by French-door laminoplasty and
The aim of this study was to review the number of patients operated on for traumatic disruption of the pubic symphysis who developed radiological signs of movement of the anterior pelvic metalwork during the first post-operative year, and to determine whether this had clinical implications. A consecutive series of 49 patients undergoing
1. A method of
Introduction and aims: Infected non-unions of long bones with failure of
We report three cases of avulsion of the ischial tuberosity with marked chronic disability after delay in diagnosis and non-union of the fracture. All were treated by open reduction and
Introduction Infected non-unions of long bones with failure of
To determine the optimum choice of treatment for the displaced intracapsular fracture in the elderly, 455 patients aged over 70 years with a displaced intracapsular fracture were entered into a prospective randomised trial. Treatment was either an uncemented Austin Moore hemiarthroplasty or reduction and
Background. Outcome of Type II and III (Sander's CT classification) fracture of the calcaneum who underwent open reduction and
Introduction. Intraarticular calcaneal fractures often need open reduction and
The displaced intracapsular fracture in the elderly has frequently been termed the ‘unsolved’ fracture because of the debate as whether the femoral head should be preserved or replaced. To answer this question 413 patients aged over 70 years with a displaced intracapsular fracture were entered into a prospective randomised trial, to treatment with either an uncemented Austin Moore hemiarthroplasty or reduction and fixation with three cancellous screws. Pathological fractures, Paget’s disease and rheumatoid arthritis patients were excluded. Analysis of pre-operative characteristics of patients showed there was no significant difference between the two groups. Mean follow-up of surviving patients was 827 days.
We describe a series of 20 patients with ununited fractures of the femoral neck following neglected trauma or failed primary
Abstract. Objective. To compare the clinical and radiological outcome between less invasive stabilization system (LISS, Synthes, Paoli, PA.) and open reduction with
Introduction. Lateral humeral condyle fractures account for 17% of the distal humeral condyle fractures. They affect children between 5 and 10 years of age. Recent reports advocate closed reduction and
Purpose: Comparison of functional, anatomical and roenthgenological outcomes of subtalar arthrodesis technique: Ilizarov apparatus- EF and
Patellar fractures account for approximately 1% of all fractures. Open reduction and
We describe a method of
It remains a matter of debate whether displaced fractures of the neck of the femur should be treated by
Introduction: Failure of
Introduction: Conservative treatment of humeral diaphyseal fractures yields reliable union rates with satisfactory clinical outcome. The high incidence of shoulder complications following intramedullary fixation of humeral fractures has led clinicians to consider other less invasive treatment modalities. There is a growing body of evidence supporting the role of functional bracing in the conservative management of these fractures. Aims: To compare the outcome of patients with humeral fractures treated non-operatively using functional bracing and those treated by
It remains a matter of debate whether to fix or to replace subcapital fractures of femur, particularly the displaced one’s. Orthopaedic surgeons face the challenge of providing the best treatment for intracapsular fracture of the femur. Most authors agree that in young demanding patients with no displacement fracture, the
Introduction: Unstable Lisfranc (tarsometatarsal) joint injuries are increasingly being treated by open reduction and
Purpose. To perform comparative analysis between the results of
A series of 49 pilon fractures in a tertiary referral centre treated definitively with open reduction and
We reviewed the functional outcome of cominnuted intraarticular fractures of the distal humerus managed with
Purpose: To review the results of periprosthetic femoral fractures treated using cortical strut allograft and plate
This paper reports our experience of revision open reduction,
We investigated the clinical outcome of internal
fixation for pathological fracture of the femur after primary excision of
a soft-tissue sarcoma that had been treated with adjuvant radiotherapy. A review of our database identified 22 radiation-induced fractures
of the femur in 22 patients (seven men, 15 women). We noted the
mechanism of injury, fracture pattern and any complications after
internal fixation, including nonunion, hardware failure, secondary
fracture or deep infection. The mean age of the patients at primary excision of the tumour
was 58.3 years (39 to 86). The mean time from primary excision to
fracture was 73.2 months (2 to 195). The mean follow-up after fracture
fixation was 65.9 months (12 to 205). Complications occurred in
19 patients (86%). Nonunion developed in 18 patients (82%), of whom
11 had a radiological nonunion at 12 months, five a nonunion and
hardware failure and two an infected nonunion. One patient developed
a second radiation-associated fracture of the femur after internal
fixation and union of the initial fracture. A total of 13 patients
(59%) underwent 24 revision operations.
34 adult patients were assessed at an average of 15 years (13–20) after stable
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
Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable
Introduction. Many patients with displaced intracapsular femoral neck fractures (IFNF) are treated with hemiarthroplasty (HA) which has been shown superior to internal fixation(IF) the first year after injury. Long term results, however, are sparse. Methods. A total of 222 consecutive patients above 60 years, including mentally disabled, with IFNF were randomized to either
There is continuing debate regarding the merits of
Purpose: The optimal treatment for displaced femoral neck fractures in patients aged 60–80 years is controversial. Orthopaedists that advocate for arthroplasty cite strong evidence that there is an increased revision rate with
Objective. The aim of this study was to determine the correlation between body weight and fracture union for displaced intracapsular fracture neck of femur treated by closed reduction and
The clinical results following open reduction and
Objectives: Surgical treatment of comminuted subtrochanteric fractures may be associated with high incidences of nonunion and implant failure. Taking the advantages of biologic fixation may solve this problem by yielding rapid callus formation and thus butressing the medial cortex. Patients and method: 21 patients with comminuted subtrochanteric femur fractures were operated. Mean age was 35.4 (13–60) years. There were 5 type IA, 9 type IB, 3 type IIA and 4 type IIB fractures according to Russel-Taylor classification. All patients were treated with indirect reduction and biologic
Purpose of the study: Arthrodesis is the treatment of choice for advanced-stage infection involving the tibiotarsal joint. In aseptic conditions, clinical and biomechanical experiments have shown that
To discover the long-term outcome of
Twenty fresh-frozen clavicles were fractured and randomized to one of four fixation techniques. Three plates were used: the LCP (locking compression plate), LCDCP (low contact dynamic compression plate) and Recon (pelvic reconstruction plate). One intramedullary device was used (the Rockwood Clavicle Pin). The constructs were tested for stiffness in bending and torque modes and ultimate strength in bending. The three plates were significantly stiffer then the Pin. Of the three plates, the Recon was significantly less stiff and weaker in ultimate strength then the LCP and LCDCP plates. This study was conducted to compare and evaluate different fixation techniques for clavicle fractures. Plate fixation with LCP (locking compression plate), LCDCP (low contact dynamic compression plate) and Recon (reconstruction plate) is stiffer then Pin fixation. The Recon plate was weaker and less stiff then the other two plates. Fractures of the clavicle are common and account for approximately 5–10% of all fractures and represent 35–45% of shoulder girdle fractures. Open reduction,
Our study describes a posterolateral approach to the distal humerus for open reduction and
1. This paper presents a series of 135 patients with displaced ankle fractures treated by rigid
Purpose of the Study: We evaluated the results of surgical treatment for rotator cuff tears accompanied by proximal humerus fractures. Materials and Methods: Between September 2005 and April 2009, among a total of 103 patients undergoing surgical treatment with