Aims. The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and
The aim of this study was to investigate
Abstract. Background. Reconstruction following resection of sarcomas of the
Aims. The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an
Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after
Mirels’ score predicts the likelihood of sustaining pathological fractures using pain, lesion site, size and morphology. The aim is to investigate its reproducibility, reliability and accuracy in
Nerve transfer is an emerging treatment to restore
Introduction. Purpose: Injuries to the long bones of the
Abstract. Objectives. Falling studies have been conducted in controlled environments but not in field studies for ethical reasons; this limits the validity and applicability of previous studies. We performed field studies on existing YouTube © videos of skateboarders falling. The aims were to measure the wrist angle at impact on videos of real unprotected falls and to study the dynamics of the
Aims. Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an
Necrotising soft-tissue infections (NSTIs) of
the
Aims. The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures. Methods. A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders. Results. The systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and
Aims. This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced
Abstract. Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the
Injuries to the limb are the most frequent cause
of permanent disability following combat wounds. We reviewed the medical
records of 450 soldiers to determine the type of
The charts and X-rays of one hundred and fifty-nine consecutive children with Osteogenesis imperfecta (OI) were reviewed to evaluate the functional outcome of OI patients with
Purpose: Vascular injuries occur in approximately 3% of all patients with major civilian trauma and peripheral vascular injuries account for 80% of all cases of vascular trauma.
Purpose: It is known from previous studies that reduced grip strength is associated with tennis elbow; however; assessment of muscular strength over other parts of
Introduction. There has been little research into the effect of suffering a simultaneous hip and
Aims. To assess the proportion of patients with distal radius fractures (DRFs) who were managed nonoperatively during the COVID-19 pandemic in accordance with the British Orthopaedic Association BOAST COVID-19 guidelines, who would have otherwise been considered for an operative intervention. Methods. We retrospectively reviewed the radiographs and clinical notes of all patients with DRFs managed nonoperatively, following the publication of the BOAST COVID-19 guidelines on the management of urgent trauma between 26 March and 18 May 2020. Radiological parameters including radial height, radial inclination, intra-articular step-off, and volar tilt from post-reduction or post-application of cast radiographs were measured. The assumption was that if one radiological parameter exceeds the acceptable criteria, the patient would have been considered for an operative intervention in pre-COVID times. Results. Overall, 92 patients formed the cohort of this study with a mean age of 66 years (21 to 96); 84% (n = 77) were female and 16% (n = 15) were male. In total, 54% (n = 50) of patients met at least one radiological indication for operative intervention with a mean age of 68 years (21 to 96). Of these, 42% (n = 21) were aged < 65 years and 58% (29) were aged ≥ 65 years. Conclusion. More than half of all DRFs managed nonoperatively during the COVID-19 pandemic had at least one radiological indication to be considered for operative management pre-COVID. We anticipate a proportion of these cases will require corrective surgery in the future, which increases the load on corrective
Introduction: Intra-uterine vascular deficiency of the
Aim. To review the natural history of
We have developed an illustrated questionnaire, the Hand20, comprising 20 short and easy-to-understand questions to assess disorders of the
Purpose of the study: The incidence and type of complications observed with arthroscopic procedures remains a timely subject, particularly as the use of new techniques becomes increasingly widespread. Material and methods: In cooperation with the members of ISAKOS, The International Society of Arthroscopy, Knee surgery and Orthopaedic Surgery, we instituted two studies: a retrospective study of
We evaluated 56 patients for neurological deficit after enucleation of a histopathologically confirmed schwannoma of the
Background: The reconstructive surgery of the
Introduction: It was hypothesized that ipsilateral
This paper describes the presence of tenodesis effects in normal physiology and explores the uses of operative tenodesis in surgery of the
In cerebral palsy patients, while
The universal availability of CT scanners has led to lower thresholds for imaging despite significant financial costs and radiation exposure. We hypothesized that this recent trend increased the use of CT for
Introduction: Upper limb injuries in road traffic accidents (RTAs) have been sparsely investigated and poorly understood. The purpose of this study was to obtain more specific information on upper limb injuries sustained by front seat occupants in car accidents with a view to identifying injuries that are a priority for prevention and further research. Methods: With ethical approval and after obtaining identification of cases from the Transport and Research Laboratory the appropriate hospital records and radiographs were reviewed. Data were analysed to identify the frequency and severity of upper limb injuries, the mechanism of injury and the impairment sustained in accordance with the American Medical Association guide. The costs of management of the upper limb injury and that for the patient in total were calculated. Results: Sixty cases were reviewed (29 male), aged 18–83 years (mean 45 years). There were 19 clavicle fractures of which 17 were right sided, two requiring operative intervention. These injuries were attributed to a “seat-belt” effect. The mean
Although the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was designed, and has been validated, as a measure of disability in patients with disorders of the
We evaluated the construct validity of the Musculoskeletal Tumour Society rating scale (Enneking score) as a functional measure for patients with sarcoma involving the
Major
Current knowledge regarding
Background: The purpose of this study was to investigate the relationship between neck pain and
Between 1972 and 2002 74 patients were treated under the combined care of the orthopaedic oncology service and lymphoma clinic with primary bone lymphoma. We reviewed the seventeen cases affecting the
In bone and joint infections, several materials can be used for local antibiotic elution at site of infection. Polymethylmethacrylate (PMMA) cement is often used. Recently the use of antibiotic impregnated dissolvable synthetic pure calcium sulphate beads [Stimulan R]1 has been used as an alternative, due to several perceived advantages. We present our experience of using Calcium sulphate beads in infections involving the
Introduction and Aim: The metacarpal fractures constitute 10% of skeletal fractures in general affecting mainly children and young adults. There is a lot of discrepancy and lack of evidence with regards to correctly managing the little finger metacarpal fractures. Our study was aimed at investigating the current practice of management little finger metacarpal fractures among
Neurological examination in children presenting with
The management of spasticity of children with cerebral palsy is often complex and challenging. Effective treatment requires a multidisciplinary approach involving paediatricians, orthotists, occupational therapists, physiotherapists and orthopaedic surgeons. Botulinum toxin A therapy in the lower limb has been shown to relieve spasticity and to improve the function in the short term. However, the use of Botulinum toxin A in the
We prospectively studied 26 consecutive patients with clinically documented sensory or motor deficiency of a peripheral nerve due to trauma or entrapment using ultrasound, and in 19 cases surgical exploration of the nerves was undertaken. The ultrasonographic diagnoses were correlated with neurological examination and the surgical findings. Reliable visualisation of injured nerves on ultrasonography was achieved in all patients. Axonal swelling and hypoechogenity of the nerve was diagnosed in 15 cases, loss of continuity of a nerve bundle in 17, the formation of a neuroma of a stump in six, and partial laceration of a nerve with loss of the normal fascicular pattern in five. The ultrasonographic findings were confirmed at operation in those who had surgery. Ultrasound may be used for the evaluation of peripheral nerve injuries in the
Neurological examination in children presenting with
Although there have been many studies of the epidemiology of hip fractures in the older population, including the assessment of bone density and the predictive value of a Cole’s fracture in particular for later hip fracture, there has not previously been an analysis of combined presentation of hip and
Neurological examination is essential in patients with upper limb injuries and should be clearly documented. We aimed to assess the quality and documentation of neurological examination performed for children presenting with
The management of
We report the effect of padding on the efficiency of the pneumatic tourniquet for the
Myotome values for the
Introduction Ewing’s sarcoma family of tumors was first described by James Ewing in 1921. It is a rare tumor and no one center can hope to accrue sufficient numbers over a reasonable period of time to accurately review them. Objectives A retrospective analysis of all Ewing’s sarcomas of the
Background: The Ilizarov Method is well established for lower limb trauma and reconstruction. However, although the same principles apply, its use in the
Purpose. We retrospectively evaluated the outcome of fibula grafts in
Purpose: Therapeutic options for shaft reconstruction are allografts, shaft prosthesis, and autografts, which may be vascularised or not. The purpose of this work was to assess mid-term results and complications after
We describe the development of a body-powered
Aims: To describe the proþle of patients older than 65 years of age with a fracture of the
Aims: To examine vibration levels produced by orthopaedic air tools and the prevalence of
Background: Chondrosarcoma is the second most frequent primary malignant tumor of bone. The biologic evolution of these tumors is slow, requiring long follow up for meaningful survival analysis. Methods: The clinicopathologic profiles of 84 (41 male, 45 female/M: F, 1:1.09) chondrosarcomas of the
Background: The dorsal wrist ganglion is one of the commonest tumours to be found in the
We reviewed 42 consecutive children with a supination deformity of the forearm complicating severe birth lesions of the brachial plexus. The overall incidence over the study period was 6.9% (48 of 696). It was absent in those in Narakas group I (27.6) and occurred in 5.7% of group II (13 of 229), 9.6% of group III (11 of 114) and 23.4% of group IV (18 of 77). Concurrent deformities at the shoulder, elbow, wrist and hand were always present because of muscular imbalance from poor recovery of C5 and C7, inconsistent recovery of C8 and T1 and good recovery of C6. Early surgical correction improved the function of the
The Stanford
Purpose of the study: Clinical assessment of the
Biomechanical models have been successfully applied to screen potential risk factors for injuries and to plan and evaluate the effects of orthopedic surgical procedures.[. 1. ] These models have made apparent the feasibility and necessity for the generation of subject specific models that are aimed at custom clinical applications. In order to develop such models a methods needs to be developed that allows accurate geometrical visualization and reconstruction of position and characteristics of bone and soft tissues, including neurovascular structures.[. 2. ] In this study, we present our approach to obtain both bony as soft tissue features necessary for
INTRODUCTION. Musicians' hand problems are as old as music itself. These problems involve functional motor disorders which have been underestimated by musicians, who do not want to accept the possibility of reducing their professional activity and doctors who are either not knowledgeable about musicians' characteristics or underestimate this artistic activity. The aim of this study is to determine the causes of the pathologies instrumentalist musicians have, and their distribution according to age group, instrument and type of music, and thus infer the main risk factors in the occurrence of medical problems related to musicians' activity. MATERIALS AND METHODS. We consider musicians those who devote themselves to the study, teaching and playing of a musical instrument. In Argentina there are about 50.000 instrumental musicians. Since over 14 years the members of “Las Manos del Músico” have treated 574 musicians. The 84% of the medical problems related to the playing of the instrument. Ages are between 13 and 78 years. The musicians treated belong to different conservatories, symphonic and popular orchestras. Each musician was studied with the same protocol, filled in by the same professional. Variables such as type of music, age, sex, instrument, dominance andrelated variables were taken into account. RESULTS. The 47% of those treated are devoted to popular music and the 53% to classical music. The prevailing age group is 31–40 years, there being a variation between popular and classical performers (43% in the case of classical performers and 39% in that of popular performers). Traumatic pathology is of the 16%, and a clear predominance of chronic pathology (78%) was observed with 43% of musculotendinous injuries, 16% of nervous pathology andb18.% of joint pathology. Focal dystonia affected to 15% of the musicians treated. Within the musculotendinous pathology a 50% was due to overuse syndromes. CONCLUSIONS. In 86% of the cases the causes of injuries in musicians'
1. The indications for the use of lively splints in
Introduction. Distal radius fractures (DRF) are a common injury in the A&E departments, being a major cause of disability of the
Aim: The aim of this study was to look at the presenting features, histological grade, size of primary tumour, method of treatment and patient and doctor delays in
Introduction. Pneumatic tourniquets (PTs) are commonly used in local anaesthetic cases in the
This work examines the
Aim: To assess the functional outcomes for patients treated by limb salvage surgery for sarcomas of the
Between 1988 and 1998, a total of 12 patients (6 men and six women, of average age 36 years) underwent surgery for schwannoma of the peripheral nerves of the
Using a scintigraphic technique based on anautologous injection of . 99m. Tc-labelled erythrocytes, we have evaluated the efficiency of different exsanguination procedures in the
1. Orthotic systems for the
We describe our experience with vascularised bone grafting for the treatment of fibrous dysplasia of the
Complex injuries of
1. A description of the planning for the application of a powered prosthesis to a child with bilateral
To review indications and outcomes of all Ilizarov arm fixators applied by the two limb reconstruction surgeons. All patients treated with an
Drug injection often results in soft tissue infections of the
A review is presented of 41 patients with traumatic tetraplegia on whom reconstructive surgery of the
Aims: There are no large published studies examining the complication rates associated with use of Kirschner wires in þxation of a wide variety of paediatric fractures. The aim of this study is to analyse the outcomes of fracture þxation using K-wire in
Aim of Study: The clinical and radiological assessment of the results of the operative treatment of fractures of the
The clinical features, management and outcome of bleeding into the muscles of the
Purpose: Appropriate management of complex trauma of the
The concept of non-anatomic reversed arthroplasty is becoming increasingly popular. The design medializes and stabilizes the center of rotation, and lowers the humerus relative to the acromion, and lengthens the deltoid muscle up to 18%. Such a surgically created global distraction of muscles is likely to affect nervous structures. When nerves are stretched up to 5–10%, axonal transport and nerve conduction starts to be impaired. At 8% of elongation, venous blood flow starts to diminish and at 15% all circulation in and out of the nerve is obstructed. [. 1. ] To understand nerve dynamics following reversed arthroplasty, we investigated nerve strain and excursion in a cadaver model. In a formalin-embalmed female cadaver specimen, the brachial plexus en peripheral
Background: A recent change in the Belgian law lead to the obligation of evaluating the musculoskeletal system among employees using visual display terminal (VDT) during the routine annual visit. We conducted a cross-sectional study to determine prevalence of and risk factors for musculoskeletal symptoms (MSS) and disorders (MSD) in general, and carpal tunnel syndrome (CTS) in particular. Methods: During the routine annual visit all VDT employees of different kinds of companies and occupations were asked about
Aim: As the shoulder and elbow joints share a common objective – spatial positioning of the hand – can the Modified Constant Score of shoulder function be applied to function at the elbow?. Method &
Results: All patients with isolated elbow pathology over an eighteen-month period were assessed. Acute fractures and patients with shoulder and/or wrist pathology were excluded.
For decades the treatment of chronic posttraumatic osteomyelitis associated with bone exposure has been one of the most serious problems in the field of orthopedic surgery. “Sterilization” of the osteomyelitic site, that is radical debridement of all infected tissue, is the basic requirement of the treatment; in the past, the remaining defect of the debrided area was closed with skin grafts, which were removed in a further stage, when the infection was ceased; then the defect was filled with muscle flap and bone graft of various types. Both soft tissue and osseous reconstruction took a relatively long period of time requiring several-stage treatment. We performed a retrospective study on 9 patients treated for chronic osteomyelitis of the
Introduction: Musculoskeletal tumours and lesions resembling tumours present exceptionally difficult diagnostic and treatment problems in children. Presenting symptoms are usually a poor guide to diagnosis, and are often misleading. Methods: A review of benign bone lesions of the
Summary.
Following resection of primary malignant bone tumours of the humerus, limb salvage can be performed by vascularized fibula graft for reconstruction of large segmental defects. In 12 patients with malignant bone tumour of the proximal humerus, tumour was resected and the bone defect reconstructed by vascularized fibula graft. Median age of the patients was 23 years. Median follow up was 114 months. In 10 patients humeral head had to be resected and was replaced by fibular transplant including head and shaft of the ipsilateral fibula. Humeral head could be left in place in 2 patients. Median length of transplant was 17.2 cm. Radiographic union could be seen after 8 months in median. In 7 patients partial necrosis of the fibular head occurred, in 4 patients fracture of the transplant happened following trauma. In these 4 cases revision surgery was required. Partial necrosis of the head of fibula had no significant influence on shoulder function. One patient died of disease, the others are disease free. Enneking Index was 61% in median at time of last follow up. At donor side 3 cases of transient peroneal palsy could be seen. We conclude that vascularized fibula graft is a successful surgical procedure for
Background: The overall goal in the treatment of RA is to minimize the loss of function and preserve the quality of life. In addition to drug therapy orthopaedic surgery may offer an opportunity to improve functioning in varies parts of the skeletal system. Objective: To examine the overall magnitude of change in quality of life over a ten years period, with special focus on the changes in physical functioning in different joint areas. Methods: Data from the Oslo RA register with 1600 living patients were used as basis for the study. Self-reported questionnaires were sent to the patients in 1994, 1996, 2001 and 2004, including the SF36, the AIMS2, the MHAQ, and three 100 mm visual analogue scales (pain, fatigue and patient global). 310 patients (mean (SD) age 56.4 (13.0) years, and disease duration 12.0 (9.9) years, 85.5% women) who completed questionnaires at baseline and after 10 years were eligible for the current analyses. Changes in health status were adjusted for age, sex and duration of disease. Magnitude of change was analysed by standardized response mean (SRM), i.e. the change divided by the standard deviation. AIMS2 comprises physical scales for different parts of the body and was used to examine changes in physical functioning in different areas of the musculoskeletal system. Results: The overall physical functioning was deteriorated with MHAQ SRM 0.25 and AIMS2 physical SRM 0.11. Larger average deterioration in physical functioning was seen in mobility and walking and bending, than for
Amputation was caused by war (287), civil trauma or illness (123) and congenital (44). Age ranged from 3 – 96 years, with mean of 67.8. Distribution regarding sex and side was 411m/43 f and and 211 right/223 left. 20 had bilateral amputation. In 216 patients the dominant side was affected. Level of amputation was: wrist 36, BE 164, elbow 9, AE 201, shoulder 23, forequarter 3, unknown 18. Prosthetic devices were classified as passive (i.e. cosmetic and passive work prostheses) or active, i.e. electrically- or body-powered prostheses as well as the combination of the two. In the statistical analysis null hypothesis was that no factor influences the acceptance rate. Significant differences are accepted when p<
0.05.
Acceptance rate was influenced by: Country of origin, religious affiliation, sex, learned occupation, therapist involved in training, return to work, incapacity for work, job held after amputation, own initiative in initiating prosthetic care, loss of friends or partners, level of amputation and the combined parameters AE-amputation and non-dominant side. No influence was found for education, age at amputation, marital status, side of amputation, recommendation of prosthesis, time until first prosthetic fitting, phantom pain and phantom feeling, return to sports or hobbies, consumption of tobacco, alcohol or sedatives.
Our aim was to determine if a tourniquet placed on the forearm has any advantage in clinical practice over the usual position on the upper arm. We randomised 50 patients who were undergoing an open operation for carpal tunnel syndrome under local anaesthesia into two groups. One had a tourniquet on the upper arm and the other on the forearm. The blood pressure, pulse, and level of pain were recorded at intervals of five minutes during the operation. The surgeons were also asked to evaluate the quality of the anaesthesia, the bloodless field, and the site of the tourniquet. The patients tolerated the tourniquet on the upper arm and forearm equally well. The surgeons had some difficulties when it was placed on the forearm. We therefore recommend placement of a tourniquet on the upper arm for operations on the hand and wrist which are carried out under local anaesthesia.