Aims. The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic
Ankle arthrodesis is the gold standard for treatment of end stage ankle arthritis. We analysed the data of 124 Ankle Arthrodesis (Open Ankle Arthrodesis (OAA) −27; Arthroscopic Ankle Arthrodesis (AAA)- 97) performed between January 2005 and December 2015 by fellowship trained foot and ankle surgeons in a single institution. Based on preoperative deformity (AAA- 28 degree valgus to 26 degrees varus; OAA- 41 degree valgus to 28 degree varus), they were subdivided into 2 groups based upon deformity more than 15 degrees.
Aims. There is ambiguity surrounding the degree of scaphoid
Aims. It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when
Securing the osteotomized greater trochanter (GT) during total hip arthroplasty (THA) for dislocated dysplastic hips (DDH) poses a significant challenge. This study evaluates the
Abstract. Background. Extracorporeal radiation therapy (ECRT) has been reported as an oncologically safe and effective reconstruction technique for limb salvage in diaphyseal sarcomas with promising functional results. Factors affecting the ECRT graft-host bone incorporation have not been fully investigated. Methods. In our series of 51 patients of primary bone tumors treated with ECRT, we improvised this technique by using a modified V-shaped osteotomy, additional plates and intra-medullary fibula across the diaphyseal osteotomy in an attempt to increase the stability of fixation, augment graft strength and enhance
Abstract. Objectives. Clavicle fractures are common, yet debate exists regarding which patients would benefit from conservative versus operative management. Traditionally shortening greater than 2cm has been accepted as an indicator for surgery. However, clavicle length varies between individuals. In a cadaveric study clavicle shortening greater than 15% was suggested to affect outcomes. There is no clinical correlation of this in the literature. In this study we investigate outcomes following middle third clavicle fractures and the effect of percentage shortening on
Introduction. Non-union is agonising for patients, complex for surgeons and a costly burden to our healthcare service; as such, its management must be well defined. There is debate as to the requirements for the successful treatment of such patients, in particular, the need for additional biological therapies to ensure
To develop a reliable and effective radiological score to assess the healing of isolated ulnar shaft fractures (IUSF), the Radiographic
Aims. Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. Patients and Methods. MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included
Fractures of the ankle are common, and they mostly affect young adults. Wound complications are not uncommon following the fixation of these fractures. This study evaluated the impact of HIV on wound healing after plate osteosynthesis in patients with closed ankle fractures. This is an observational retrospective study of patients operated on at a tertiary level hospital. We reviewed hospital records for patients above 18 years of age who presented with wound breakdown following ankle open reduction and internal fixation. The patients’ hospital records were retrieved to identify all the patients treated for closed ankle fractures and those who developed wound breakdown. Patients with Pilon fractures were excluded. The National Health Laboratory System (NHLS) database was accessed to retrieve the CD4 count, viral load, haematology study results, and biochemistry results of these patients at the time of surgery and subsequent follow-up. The x-rays were retrieved from the electronic picture archiving system (PACS) and were assessed for fracture
Aims. We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to
Background. Fractures of the metatarsal bones are the most frequent fracture of the foot. Up to 70% involve the fifth metatarsal bone, of which approximately eighty percent are located proximally. Low-intensity pulsed ultrasound (LIPUS) has been shown to be a useful adjunct in the treatment of delayed fractures and non
Introduction and Objective. Nonunion is incomplete healing of fracture and fracture that lacks potential to heal without further intervention. Nonunion commonly presents with persistent pain, swelling, or instability. Those symptoms affect patient quality of life. It is known that using low intensity pulsed ultrasound (LIPUS) for fresh fractures promotes healing. However, effectiveness of LIPUS for nonunion is still controversial. If LIPUS is prove to be effective for healing nonunion, it can potentially provide an alternative to surgery. In addition, we can reduce costs by treating nonunion with LIPUS than performing revision surgery. Materials and Methods. The two authors carried out a systematic search of PubMed, Ovid MEDLINE, and the Cochrane Library. Meta-analysis of healing rate in nonunion and delayed
Objectives. The radiographic
We assessed the rates of fracture healing in a number of patients in Southern Africa where the Human Immunodeficiency Virus (HIV) is highly prevalent. Our aim was to deduce whether rates of
Aims An estimated 5–10% of fractures fail to heal adequately. Novel therapies in the treatment of problem fractures include the use of culture expanded cells. An animal model of delayed fracture
Abstract. Introduction. Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following acute dislocation of the patella. This study looked at the radiological and functional outcomes of fixation of osteochondral fractures. Methods. Twenty-nine patients (18 male, 11 female) sustained osteochondral fractures of the knee following patellar dislocation. All patients had detailed radiographic imaging and MRI scan of the knee preoperatively. An arthroscopic assessment was done, followed by fixation using bio-absorbable pins or headless screws either arthroscopically or mini-open arthrotomy. VMO plication or MPFL repair were done if necessary. MRI scan was done at follow-up to assess for healing of the fixed fragment prior to patient discharge. Results. The mean age of the patients was 21 yrs (9–74), 11 had osteochondral fracture of the patella (38%), while 18 were from the lateral femoral condyle (62%). 13 patients needed additional VMO plication. Mean follow up period was 7.7 years (1 to 12 years). As per Tegner activity scale, all patients returned to their pre-injury activity level (Mean score 7) and sports. None of the patients had a further episode of patellar dislocation. Mean postoperative IKDC score was 86.5 (SD 17.3), Kujala was 91.1(SD 15.5) and Tegner- lysholm was 88.7 (SD 14.4). All patients had statistically significant (p < 0.05) improvement. Post-operative MRI scan showed satisfactory
1. Fibrous
Aims. To evaluate the effect of a single early high-dose vitamin D
supplement on fracture
The aim of the study was to assess the rate of greater tuberosity non
Background. Shockwave therapy has been shown to induce osteoneogenesis in animal models. The mechanism of action is unclear, but experimental evidence suggests micro-fracture formation and increased blood flow as the most likely explanation. Several reports from Europe have suggested good results from the treatment of delayed fracture
Introduction. Stem cells have the capacity for self renewal and capability of differentiation into various cell lineages. Non
Introduction: Scaphoid non
Tobacco, in addition to being one of the greatest public health threats facing our world, is believed to have deleterious effects on bone metabolism and especially on bone healing. It has been described in the literature that patients who smoke are approximately twice as likely to develop a nonunion following a non-specific bone fracture. For clavicle fractures, this risk is unclear, as is the impact that such a complication might have on the initial management of these fractures. A systematic review and meta-analysis were performed for conservatively treated displaced midshaft clavicle fractures. Embase, PubMed, and Cochrane Central Register of Controlled Trials (via Cochrane Library) were searched from inception to 12 May 2022, with supplementary searches in Open Grey, ClinicalTrials.gov, ProQuest Dissertations & Theses, and Google Scholar. The searches were performed without limits for publication date or languages.Aims
Methods
The treatment of nonunion is challenging providing the surgeon with a variety of different surgical options in order to encourage and achieve bone consolidation. Despite excellent results presented in 2008 of 99%
Delayed
We have examined the outcome in 19 professional rugby
The aim of this audit was to assess the
Introduction: We performed a clinical and radiological study to determine the functional outcome in terms of
Background: Foot injuries represent a small but important proportion of injuries to professional rugby
The aim of limb-salvage surgery in malignant bone tumours in children is to restore function and eradicate local disease with as little morbidity as possible. Allografts are associated with a high rate of complications, particularly malunion at the allograft-host junction. We describe a simple technique which enhances
A total of 45 tibial shaft fractures, all conservatively treated and with
Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of
Background:. There is limited evidence regarding HIV infection as a risk factor for delayed
The hypothesis provides a theoretical justification for, and re-emphasises the practical importance of, close reduction and strict immobilisation in the treatment of fractures of the neck of the femur. It does not support the view that failure of
Introduction: Humerus non
Non-union is a potential complication following hindfoot arthrodesis and occurs at a rate of 5–10% as reported in the literature. Following the procedure, patients are usually kept non-weight bearing (NWB) for 6–8 weeks followed by protected full weight bearing (FWB) for further 6 weeks. Based on radiological and clinical evidence of bony union at 12 weeks patients are allowed to mobilise FWB without protection. The aim of this study is to evaluate the effect of early post operative weight bearing on the
Aims. Fractures of the distal femur can be challenging to manage and
are on the increase in the elderly osteoporotic population. Management
with casting or bracing can unacceptably limit a patient’s ability
to bear weight, but historically, operative fixation has been associated
with a high rate of re-operation. In this study, we describe the outcomes
of fixation using modern implants within a strategy of early return
to function. Patients and Methods. All patients treated at our centre with lateral distal femoral
locking plates (LDFLP) between 2009 and 2014 were identified. Fracture
classification and operative information including weight-bearing
status, rates of
Introduction: Non-union is a potential complication following hindfoot arthrodesis and occurs at a rate of 5–10% as reported in the literature. Following the procedure, patients are usually kept non-weight bearing (NWB) for 6–8 weeks followed by protected full weight bearing (FWB) for further 6 weeks. Based on radiological and clinical evidence of bony union at 12 weeks patients are allowed to mobilise FWB without protection. Aim: The aim of this study is to evaluate the effect of early post operative weight bearing on the
Introduction: Septic non
Open tibial shaft fractures are the most frequent in whole skeletal trauma and the way of their treatment cause determined hesitations. Open tibial fractures present complex surgical problem on account of their cure which needs reachable approach, because of the complications which aren’t rare, and because of their influence of the final outcome. Lately, as an alternative method of the standard intramedulary nailing, limited reamed technique was established as a concept which has to minimize the negative effect of reaming and also to provide a biomechanical stability to prevent the problems of
Introduction: The concept of osteoperiosteal decortication for the treatment of fracture non-union and mal-union was introduced by Judet in the early 1960’s. Over 1000 cases have been treated with a
The stability of
Despite continuous advances in the treatment of long bone fractures, disturbances of healing processes remain a difficult challenge. Currently, autologous cancellous bone and bone marrow grafting has become the standard treatment of delayed
1. Practical experience has shown that subcapital fractures of the femur unite freely if reduction is stable and fixation is secure. 2. Stable reduction is obtained when the muscular and gravitational forces tending to redisplace the fracture are opposed by equal and opposite counterforces, and inherent stability is believed to depend upon the integrity of the flared cortical buttress at the postero-inferior junction of the femoral neck and head. 3. In the stable subcapital fracture a state of equilibrium is reached when the forward and upward thrust of the fixation appliance in the femoral head is opposed by the counterthrust of the closely applied and cleanly broken fragments at the postero-inferior aspect of the fracture. When the postero-inferior cortical buttress is comminuted, inherent stability is lost, lateral rotation deformity recurs and the fixation device is avulsed from the cancellous bone of the head. 4. Stability may be restored by reduction in the "valgus" position, by various forms of osteotomy, by refashioning the fracture fragments or by a postero-inferiorly positioned bone graft. Theoretically, stability may also be obtained by a double lever system of fixation in which an obliquely placed fixation device or bone graft is combined with a horizontally disposed wire, pin, nail or screw crossing it anteriorly. Multilever fixation by three or more threaded wires or pins inserted at different angles and lying in contact at their point of crossing may likewise provide stability. 5. Fixation by two crossed screws has been chosen for clinical trial in 100 displaced subcapital fractures. Imperfect positioning of the screws in seven patients has been followed by early breakdown of reduction and non-union, but satisfactory positioning has been associated with radiological
Introduction. Objective was to assess clinical results of treatment of Infected Non
Introduction: In patients with gonarthrosis secondary to a femoral or a tibial mal
Rugby
Between January 2003 and December 2004, 14 patients underwent bilateral resurfacing arthroplasty via a Ganz trochanteric osteotomy. This bilateral group was mobilised fully weight-bearing with crutches. During the same period 139 Ganz trochanteric osteotomies were performed for unilateral hip resurfacing. These patients were mobilised with crutches, weight-bearing up to 10 kg on the operated leg. Nine osteotomies (32%) in the bilateral group subsequently developed a symptomatic non
A simple technique for screw fixation of the carpal scaphoid in cases of delayed
Introduction: Non-union occurs at a rate of 5–10 % following ankle and hindfoot arthrodesis, but the effect of early weight bearing on
Study Design: Retrospective review. Objectives: Rugby
Introduction: Recent studies proved that Colchicine inhibits in-vitro proliferation of osteoblasts and osteosarcoma cells, and that Colchicine is non-selective mitosis inhibitor and selective inhibitor of mineralization. Aim: The aim of this study was to evaluate the effects of Colchicine (CO), given on a daily basis on healing process of bones. Materials and Methods: In a double blind prospective study, 3 groups of adult rats were checked. In each rat the left posterior tibia was broken. The study groups were treated with CO, one week before the fracture in one group, and on the fracture day in other group. The control group was not treated with CO at all. After six weeks the broken tibias were x-rayed and the radiographic
Gold standard for the management of non-union is open surgical debridement, stabilisation, and autologous bone grafting. LIPUS is becoming more popular, yet the evidence is still inconclusive. LIPUS involves the use of ultrasound at the fracture site with little risk to the patient. The purpose of this study was to assess effectiveness and cost benefit of LIPUS in the management of non-unions post sustaining an open fracture. We retrospectively reviewed 29 patients with open fractures with established non-union undergoing LIPUS since 2010 (4 females, mean age 48) range 3–27 months, mean 9 months, either post injury or last intervention. All were tertiary referrals, sustaining injuries to the following areas; Tibial 21, Femur 6, Humerus 2, Radius 1. Definitive fixation being; 9 TSF's, 11 IMN's, 9 plates. (undergoing a mean 2.4 procedures). Aside from sustaining an open fracture, 7 had risk factors for non-unions 5 smokers, 2 NSAID's. Failure of treatment was based on undertaking bone grafting. In 28 patients (1 lost to follow up)
Lumbar spondylolysis can heal with conservative treatment, but few attempts have been made to identify factors which may affect
1. A series of 102 cancellous strip grafts for delayed
Inter-observer agreement and reproducibility of opinion were assessed for the radiographic diagnosis of
This study aims to ascertain the value of CT in assessing
The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671).Aims
Methods
Congenital pseudarthrosis of the tibia (CPT)
is a rare but well recognised condition. Obtaining
Any intervention for limb with compromised bone and soft tissue in paediatric age group is often studded with complications of flare of infection, wound breakdown, delayed healing or failure of grafting. We report our experience with managing 8 such cases with periosteal sleeve taken from tibia along with fibular grafting. The lesion was gap non-union following bone sequestration in 7 cases (2 proximal humerus; 4 femur and one metacarpal) and one case tibia vara in post osteomyelitic tibia. The infective lesions were silent for minimum of 1 year before this procedure. The periosteal sleeve was taken from proximal tibia and fibular graft was also procured from same leg. Following freshening of bone ends, the fibular graft was applied at non-union/osteotomy site and enclosed in the freshly harvested periosteal sleeve. The limb was protected in plaster cast for 6 weeks and assessed clinicoradiologically at 3 and 6 weeks intervals. Uneventful
This is a clinically based study to assess the reliability of fracture stiffness as a measurement of clinical
Traditionally autologous bone graft is the standard treatment for non-union of fractures. More recently osteo-inductive agents with or without allograft have been utilised. A trial of Autologous Mesenchymal Precursor Cells has been completed at the Royal Melbourne Hospital to investigate their potential for the treatment of nonunion of long bone fractures. With the approval of the ethics committee at the Royal Melbourne Hospital a human safety trial was commenced for the treatment of fracture non-union. Bone marrow cells were harvested from patients approximately six weeks before surgery and cultured in a laboratory. The cells were expanded in a culture medium. At the time of definitive surgery the stem cells were implanted on a hydroxy apatite/tricalcium phosphate matrix to the non-union site. Any further fixation that was required at the time of the
Aim. To evaluate the efficacy of bone marrow derived stromal cells (BMSC) for the treatment of non-unions in fractures. Methods. An ethically approved single centre randomised control trial recruited 35 patients for treatment of non-unions with BMSC during 2006–2010. Autologous BMSC were culture expanded at the Good Manufacturing Practice (GMP) standard Oscell® laboratory in the hospital. Following in vitro expansion- cells in autologous serum and serum alone were randomised for insertion at one of the two fracture sides by StratOs® computer software. Patients and the operating surgeon were blinded to the side of cell insertion. Such method of randomisation created internal controls at the fracture sites- one side receiving the cell (‘test side’) and other, not (‘control’). Serial radiographs extending up to an average of twelve months were evaluated by six independent assessors blinded to side of cell insertion. Callus formation and bridging of fracture was compared for ‘test’ and ‘control’ side. Radiological and clinical outcome at final follow-up was also noted. Results. The study had 21 males and 14 females with a mean age of 51.2±13.2 years (range 18–76). The average duration of non-union was 3±2 years (range 1–10 years) with mean 3.5 (range 1–12) surgical interventions prior to BMSC insertion. Independent assessment of ‘test’ and ‘control’ side revealed that the callus formation and fracture bridging was slow although a trend to improvement on the side of the BMSC insertion was observed at 9–12 months. At final follow-up 22 patients progressed to bony union; 13 patients had persisting non
Our aim is to study the epidemiology of delayed
The development of the iron-cored electromagnet as a stimulator of bony union is described. In a clinical trial extending over eight years, 80 patients were treated for various forms of failed
Cigarette smoking has a negative impact on the skeletal system, causes a decrease in bone mass in both young and old patients, and is considered a risk factor for the development of osteoporosis. In addition, it disturbs the bone healing process and prolongs the healing time after fractures. The mechanisms by which cigarette smoking impairs fracture healing are not fully understood. There are few studies reporting the effects of cigarette smoking on new blood vessel formation during the early stage of fracture healing. We tested the hypothesis that cigarette smoke inhalation may suppress angiogenesis and delay fracture healing. We established a custom-made chamber with airflow for rats to inhale cigarette smoke continuously, and tested our hypothesis using a femoral osteotomy model, radiograph and microCT imaging, and various biomechanical and biological tests.Aims
Methods
Introduction. Grade IIIa/b open tibial fractures (OTF) result mostly following high energy trauma and may be accompanied by significant associated injuries. Aim of this study was to compare the characteristics and the outcome of OTF between patients of different injury severities. Materials and methods. Retrospective analysis of the records of patients admitted to a level I centre in a 4 year period with an OTF. Epidemiologic data, AO-ASIF classification, method of treatment, complication rates and time to fracture-union have been statistically analysed. An AIS98-ISS threshold (ISS 16) was used to separate OTF in 2 groups (A<16, B>16). Results. Forty-one cases of OTF have been retrieved. Group A included 28 and Group B 13 patients. Gender ratio and mechanisms of injuries did not show significant differences. Median age was 35.5 vs 41 years and median ISS 9.7 vs 26 for A and B groups respectively. AO types 42.A and 42.B were identified in 25% vs 23%, and type 42.C in 50% and 53% respectively. External fixation was used in 33% of the less severely injured and in 61% of the severely injured OTF; nailing techniques in 54% and 31% and covering flaps in 57% and 77% in that order. Secondary interventions were recorded in 38% of the B group but only in 17% of the A group. Median time to
Objective: 6 cases of postraumatic arthritis of the distal radius treated by chondro costal graft are reported with a minimum follow up of 2 years. Material and methods: 6 patients (One 22 years old patient with a dislocated radiocarpal joint 6 months after an injury, 3 patients (48, 52 and 53 years old) respectively 1, 1,5 and 2 years after a intraarticular fracture of distal radius and a patient (74 years old) with radio lunate arthritis reported two mains complaints : pain and stiffness. The last patient was a female with a destruction of radio scaphoid joint after septic complication of scaphoid surgery. Location of the cartilage defect was central in two cases and palmar in the others. A dorsal approach in one case, a palmar approach in the five others allowed reduction and reconstruction of the destroyed radial part of joint. An osteochondro costal graft harvested on the eight’s rib was inserted and fixed by plate in place of the articular impaction. Plaster cast of 3 months in the first case and 1 month in the others cases followed the articular reconstruction. Results : No complication have been pointed.
Introduction: For a period of 7 years were treated in Emergency Hospital Pirogov 205 patients with humeral shaft fracture (HSF)–125 with interlocking nailing (ILN), 80 with AO plates, these include 55 delayed
Introduction: Intramedullary nailing of the humerus for the treatment of diaphyseal fractures can be done through both extremities of the bone. The aim of the authors is to evaluate the positive and negative aspects of both techniques, evaluating postoperative shoulder and elbow function,
Ten patients with humeral shaft fractures and no clinical or radiographic signs of healing after at least six weeks' immobilisation were treated by flexible intramedullary nailing using a closed retrograde technique. Bone grafting was not performed, and active movement was encouraged after operation. Nine fractures healed; the mean time to
Aim: Pure torsional deformities of the tibia can be treated with either a proximal or distal tibial osteotomy. It is noted that the relative advantages of these osteotomies are controversial and maybe influenced by other factors. A retrospective study was undertaken to assess the two methods. Materials and Methods: Between 1997 and 2003, a retrospective study of 48 osteotomies was undertaken. Clinical records and X-rays were reviewed. There were 27 proximal osteotomies and 21 distal osteotomies. 24 were stabilised with plate fixation and 23 with percutaneous wires. The osteotomies were not matched with variables in age, site and fixation type. The sex distribution was similar. The majority of proximal osteotomies were fixed with a plate and distal osteotomies with pins. Results: There were 2 cases of proximal osteotomy which developed a non-union. In general however, the time to radiological
Aims: The treatment of long bone non-union now days finds its gold standard in autologous bone grafting. Since this technique is affected by a high morbidity rate of the donor site, many studies tried to find valid alternatives to this procedure, but during the last few years the advances made in tissue engineering techniques opened new frontiers. In this study BMPs/AGFs were used in posttraumatic long bone non-union and osseous defects to test their clinical and radiological effectiveness in order to find a valid alternative to autologous bone grafting. Methods: The cases selected can be divided in two groups. Group A: Patients affected by long bones Non
Tibiotalocalcaneal fusion is generally reserved for complex cases such as severe deformity or bone loss, infection, Charcot and revision procedures. Subsequently published series have been small and there are no studies comparing plate fixation and intramedullary nailing. We present the outcomes in the largest series to date and have also compared the
The Fixion expandable nailing system provides an intramedullary fracture fixation solution without the need for locking screws. Proponents of this system have demonstrated shorter surgery times with rapid fracture healing, but several centres have reported suboptimal results with loss of fixation. This is the largest comparative series to be reported to date. We compared outcomes between 50 consecutive diaphyseal tibial fractures treated with a Fixion device at our institution to an age, sex and fracture configuration matched series of 57 fractures at a neighbouring hospital treated with a conventional interlocked intramedullary nail. Minimum follow up time was 2 years. Operating time was significantly reduced in the Fixion group (mean 61 minutes, range 20–99) compared to the interlocked group (88 minutes, 52–93), p< 0.00001. The
Following a laboratory rat study where iliac crest was removed, the femoral vessels were placed as a pedicle through the centre of the graft which was wrapped in silastic sheeting and transplanted to the subcutaneous abdominal wall, which showed in all cases bone revascularisation and viability within three weeks. A human study followed in two patients with chronic complex scaphoid non
The Radiographic
The aim of the study was to prospectively review the incidence of shoulder injuries in a group of professional rugby
Introduction: Goal of study to demonstrate that treatment with low-intensity pulsed ultrasound [LIPUS] results in greater increases in bone density and greater reductions in bone gap area as compared to sham control in tibia fractures with delayed
To evaluate if clinical recovery following midshaft clavicle fracture is associated with nonunion and determine if this has superior predictive value compared to estimation at time of injury. A prospective study of all patients (≥16 years) who sustained a displaced midshaft clavicle fracture was performed. We assessed patient demographics, injury factors, functional scores and radiographic predictors with a standardized protocol at six-weeks. Conditional-stepwise regression was used to assess which factors independently predicted nonunion at six-months post-injury determined by CT. The nonunion predictor six-week model (NUP6) was compared against a previously validated model based on factors available at time of injury (NUP0-smoking, comminution and fracture displacement). 200 patients completed follow-up at six months. The nonunion rate was 14% (27/200). Of the functional scores, the QuickDASH had the highest accuracy on receiver-operator-characteristic (ROC) curve analysis with a 39.8 threshold, above which was associated with nonunion (Area Under Curve (AUC) 76.8%, p<0.001). On regression modelling QuickDASH ≥40 (p=0.001), no callus on radiograph (p=0.004) and fracture movement on examination (p=0.001) were significant predictors of nonunion. If none were present the predicted nonunion risk was 3%, found in 40% of the cohort (n=80/200). Conversely if two or more were present, found in 23.5% of the cohort, the predicted nonunion risk was 60%. The NUP6 model appeared to have superior accuracy when compared to the NUP0 model on ROC curve analysis (AUC 87.3% vs 64.8% respectively). Delayed assessment at six-weeks following displaced clavicle fracture enables a more accurate prediction of fracture healing.
Introduction: The management atlanto-axial fractures, particularly those of the odontoid peg, remains controversial. We managed patients with C1/C2 fractures non-operatively in rigid immobilization until CT-scanning confirmed bony union, rather than for the standard 3-month period. We examined whether this improved outcomes and reduced the need for surgery. Method: All patients admitted to our unit with atlanto-axial fractures between 2001–2007 were retrospectively analyzed. All fractures had the ‘intention-to-treat’ conservatively in either halothoracic vest (85%) or Aspen collar (15%). Rigid immobilization was maintained until CT-scanning demonstrated bony fusion. Functional stability was subsequently assessed with flexion-extension radiographs after removal of rigid immobilization. Results: Twenty-seven patients were studied. Nineteen had odontoid peg fractures (10 type II; 9 type III). The remainder consisted of 3 Hangman’s, 3 lateral mass and 2 atlas ring fractures. 83% of patients progressed to
Purpose: We aimed to preliminarily validate a newly developed system, the radiographic
Eighty-two of 85 patients who had sustained a fracture of the waist of the scaphoid in 1985 were reviewed more than one year after injury. The incidence of nonunion, defined as a clear gap at the fracture site one year after injury, was 12.3%. This was much higher than expected. Most of the patients with nonunion had symptoms and had appreciable restriction of wrist movement. In a further 25% of the patients at review, the site of the fracture could be easily identified although it appeared to have healed. These patients were older and more of them were women. Three-quarters of these patients had symptoms but their wrist movement was essentially normal.
The case reports of four patients with breakage of the intramedullary nail of the femur are presented. In all four patients the nail broke after consolidation of the fracture of the femoral shaft. All the nails broke at the same place: the junction between the round cross-section and the cloverleaf cross-section.
This study was performed to determine whether
pure cancellous bone graft and Kirschner (K-) wire fixation were sufficient
to achieve bony union and restore alignment in scaphoid nonunion.
A total of 65 patients who underwent cancellous bone graft and K-wire
fixation were included in this study. The series included 61 men
and four women with a mean age of 34 years (15 to 72) and mean delay
to surgery of 28.7 months (3 to 240). The patients were divided
into an unstable group (A) and stable group (B) depending on the
pre-operative radiographs. Unstable nonunion was defined as a lateral
intrascaphoid angle >
45°, or a radiolunate angle >
10°. There were
34 cases in group A and 31 cases in group B. Bony union was achieved
in 30 patients (88.2%) in group A, and in 26 (83.9%) in group B
(p = 0.439). Comparison of the post-operative radiographs between
the two groups showed no significant differences in lateral intrascaphoid
angle (p = 0.657) and scaphoid length
(p = 0.670) and height (p = 0.193). The radiolunate angle was significantly
different
(p = 0.020) but the mean value in both groups was <
10°. Comparison
of the dorsiflexion and palmar flexion of movement of the wrist
and the mean Mayo wrist score at the final clinical visit in each
group showed no significant difference (p = 0.190, p = 0.587 and
p = 0.265, respectively). Cancellous bone graft and K-wire fixation
were effective in the treatment of stable and unstable scaphoid
nonunion. Cite this article:
The aim of an anterior cruciate ligament (ACL) reconstruction is to regain functional stability of the knee following ACL injury, ideally allowing patients to return to their pre-injury level of activity. The purpose of this study was to assess clinical, functional and patient-centered outcomes a minimum of 1-year following ACL reconstruction. This study assessed for relationships between post-operative ACL graft laxity, functional testing performance, and scores on the ACL Quality of Life (ACL-QOL) questionnaire. A prospective cohort study design (n = 1938) was used to gather data on clinical laxity, functional performance and quality of life outcomes. Post-operative ACL laxity assessment using the Lachman and Pivot-shift tests was completed independently on each patient by a physiotherapist and an orthopaedic surgeon at a minimum of 12-months post-operatively. A battery of functional tests was performed including single leg balance, single leg landing, 4 single-leg hop tests, and tuck jumps. The hop tests provided a comparative assessment of limb-to-limb function including a single hop for distance, a 6m timed hop, a triple hop for distance, and a triple crossover hop. Patients com¬pleted the ACL-QOL at the 12-month and 24-month post-operative appointments. Descriptive and demographic data were collected for all patients. The degree and frequency of post-operative laxity was calculated. A Pearson r correlation coefficient was employed to determine the relationship between the presence of post-operative laxity and the ACL-QOL scores, between the battery of functional tests and the ACL-QOL scores, as well as between the functional tests and the laxity assessments. Data was gathered for 1512/1938 patients (78%). At clinical assessment a minimum of 1-year post-operatively, 13.2% of patients demonstrated a positive Lachman and/or Pivot-shift test. The mean ACL-QOL score for patients with no ACL laxity was 80.8/100, for patients with a positive Lachman or Pivot-shift test the mean score was 72.3/100, and for patients with both positive Lachman and Pivot-shift tests the score was 66.9/100. Pearson r correlation coefficient demonstrated a significant relationship between the presence of ACL graft laxity and ACL-QOL score (p < 0.05). Statistically significant correlations were evident between all of the operative limb single-leg hop tests and the post-operative ACL-QOL scores (p < 0.05). Statistically significant correlations were evident between the operative limb triple-hop tests and presence of ACL graft laxity (p < 0.05). Patients with clinically measurable ACL graft laxity demonstrate lower ACL-QOL scores as well as lower performance on a battery of functional tests. The disease-specific outcome measure was strongly correlated to the patient's ability to perform single-limb functional tests, indicating that the ACL-QOL score accurately predicted level of function.
In addition, using the characteristics of the inserted screw as a scaleable marker, it was calculated what would have been the optimum length of screw thread in order to maximise screw thread length in the target bone whilst preventing the screw threads being across the fusion site.
Currently available screws have thread lengths that are either too long (breaching the fusion site) or too short for ideal fixation and we propose a different thread length to those currently available. However, even with current screws, we found no correlation between thread length, thread positioning across the fusion site and non-union.
The aim of this randomised, controlled
To investigate the use of the Ilizarov circular fixator in treating diaphyseal non-union following previous intra-medullary nailing. The stability of each non-union was augmented using an Ilizarov fixator with nail retention. We retrospectively reviewed nine consecutive patients (mean age 31 years, range 24–53 years) who were treated in our institution between 1993 and 1997 (mean follow up 19.2 months, range 6–33 months). Two femoral, three tibial and four humeral non-unions were included in the study. All patients were referred from other centers after failure to achieve bone union with intramedullary nailing. Patients who had non-union with other fixation devices in situ, those with active infection and those who had their non-unions explored at the time of fixator application were excluded from the study. The patients had undergone an average of 2.4 operations (range 1–5 operations) prior to fixator augmentation. The circular fixator was applied over the nail as a closed procedure (non-union not surgically explored) in all nine patients. The non-union was manipulated either by compression or oscillation during fixator treatment. The mean duration of fixator treatment was 6.2 months (range 3–11 months). Outcome measures assessed were bone union, deformity, shortening and functional outcome. Bone union was achieved in all nine patients. The bone results were graded as six excellent, one good and two fair. All patients reported a reduction in pain and satisfaction with their final outcome. We recommend the use of the Ilizarov fixator with nail retention in resistant long bone union in carefully selected patients. This technique is particularly useful in the humerus where it avoids the morbidity associated with nail removal and plating. The augmentation method can shorten the fixator time and has the advantage of a simpler frame construct.
One hundred consecutive closed fractures of the adult tibial shaft treated by closed methods were surveyed prospectively in order to observe their natural history. The fractures were analysed with regards to speed of healing and the influence of age, sex, causal force, radiological morphology and concurrent fibular fracture. At 20 weeks 19 fractures had not yet united, but 15 of these had united by 30 weeks with conservative treatment alone. The remaining four cases were operated upon because no further progress in healing was anticipated. These findings suggest that, with regard to healing, open reduction and internal fixation is rarely justified in closed adult tibial shaft fractures.
The delay looks radiographically as a fracture callus not very evident or absent 6 months after osteosynthesis. Patients undergo a long period of immobilization and this fact causes the increase the social cost of the disease. The technique we suggest aims to the reduce the period of immobilization and as a consequence the management costs of the disease. Our technique includes the infiltration of the delay focus with platelet rich fibrin, bone marrow concentrated and demineralized bone matrix. Outpatients and radiographic checks were carried out 3, 6 and 12 months after surgery. The treatment was considered fail in case of absence of bone callus at 3 out of 4 corticals at the rx after 6 months from surgery.Introduction
Materials and methods
Aims. The purpose of this systematic review was to determine the rates of
Aims. Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions. Methods. We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded. Results. There were 70 patients with mean follow-up of 54 months (SD 26). Overall, 51 patients (72%) and 52 patients (74%) were fully weightbearing at one year postoperatively and at final follow-up, respectively. The overall hindfoot