Objectives. The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of
Aims. The primary aim of this study was to compare the postoperative systemic inflammatory response in conventional jig-based total knee arthroplasty (conventional TKA) versus robotic-arm assisted total knee arthroplasty (robotic TKA). Secondary aims were to compare the macroscopic
Introduction. While manual total knee arthroplasty (MTKA) procedures have demonstrated excellent clinical success, occasionally intraoperative damage to soft tissues can occur. Robotic-arm assisted technology is designed to constrain a sawblade in a haptic zone to help ensure that only the desired bone cuts are made. The objective of this cadaver study was to quantify the extent of soft tissue damage sustained during TKA through a robotic-arm assisted (RATKA) haptically guided approach and conventional MTKA approach. Methods. Four surgeons each prepared six cadaveric legs for CR TKA: 3 MTKA and 3 RATKA, for a total of 12 RATKA and 12 MTKA knees. With the assistance of an arthroscope, two independent surgeons graded the damage of 14 knee structures: dMCL, sMCL, posterior oblique ligament (POL), semi-membranosus muscle tendon (SMT), gastrocnemius muscle medial head (GMM), PCL, ITB, lateral retinacular (LR), LCL, popliteus tendon, gastrocnemius muscle lateral head (GML), patellar ligament, quadriceps tendon (QT), and extensor mechanism (EM). Damage was defined as tissue fibers that were visibly torn, cut, frayed, or macerated. Percent damage was averaged between evaluators, and grades were assigned: Grade 1) complete soft tissue preservation to ≤5% damage; Grade 2) 6 to 25% damage; Grade 3) 26 to 75% damage; and Grade 4) 76 to 100% damage. A Wilcoxon Signed Rank Test was used for statistical comparisons. A p-value <0.05 was considered statistically significant. Results. Significantly less damage occurred to the PCL in the RATKA than the MTKA specimens (p=0.004). RATKA specimens had less damage to the dMCL (p=0.186), ITB (p=0.5), popliteus (p=0.137), and patellar ligament (p=0.5). The sMCL, POL, SMT, GMM, GML, LR, LCL, QT, and EM were grade 1 in all MTKA and RATKA specimens. No intentional soft tissue releases were performed in either group to balance the knee. Discussion/Conclusion. The results of this study indicate that RATKA may result in less
Patients with bilateral femur fractures are known to be at a high risk for the Systemic Inflammatory Response Syndrome; however the impact of fracture-associated
The incidence of deep infections after internal fixation of ankle and lower leg fractures is estimated 1 to 2%. Hindfoot arthrodesis by retrograde intramedullary nailing (IMN) is a potential alternative to external fixation for post-infectious ankle destruction. The aim of this study was to evaluate the clinical results, complications and effects of soft tissue management with this treatment modality. This is a single-center retrospective review of routine hospital data from 21 patients (15 men, 6 women, median age 65 [range, 21 to 87] years) undergoing IMN arthrodesis of the hindfoot for post-traumatic infections between January 1st, 2012 and March 15, 2018. We observed four bimalleolar, eight trimalleolar, three pilon fractures, and six distal lower leg fractures. Six and three patients had sustained second- and third degree open fractures, respectively. Early- and late-onset surgical infections were observed in 8 and 13 cases. Four participants had diabetes mellitus, two arterial occlusive disease, and four had both. Six patients were smokers.Aim
Method
Introduction and Objective. Despite the low incidence of pilon fractures among lower limb injuries, their high-impact nature presents difficulties in surgical management and recovery. Current literature includes a wide range of different management strategies, however there is no universal treatment algorithm. We aim to determine clinical outcomes in patients with open and closed pilon fractures, managed using a treatment algorithm that was applied consistently over the span of this study. Materials and Methods. This retrospective study was conducted at a single institution, including 141 pilon fractures in 135 patients, from August 2014 to January 2021. AO/OTA classification was used to classify fractures. Among closed fractures, 12 had type 43A, 18 had type 43B, 61 had type 43C. Among open fractures, 11 had type 43A, 12 had type 43B, 27 had type 43C. Open fractures were further classified with Gustilo-Anderson (GA); type 1: n=8, type 2: n=10, type 3A: n=12, type 3B: n=20. Our treatment algorithm consisted of fine wire fixator (FWF) for severely comminuted closed fractures (AO/OTA type 43C3), or open fractures with severe
Aims. The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. Methods. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. Results. The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and peroneal nerve injury incidence. The P-A screws, on the other hand, excelled in terms of VAS score improvements. Conversely, posterior buttress plate fixation showed the least incidence of osteoarthritis grade progression, postoperative articular step-off ≥ 2 mm, nonunions, and loss of ankle dorsiflexion ≥ 5°, though it underperformed in most other clinical outcomes. Conclusion. The NMA suggests that open plating is more likely to provide better radiological outcomes, while screw fixation may have a greater potential for superior functional and pain results. Nevertheless, clinicians should still consider the fragment size and fracture pattern, weighing the advantages of rigid biomechanical fixation against the possibility of
Intimate partner violence (IPV) causes significant morbidity and its unlikely to be reported compared to other forms of gender-based violence (GBV). For early detection, understanding Orthopaedic injuries from GBV is vital. This study assesses the pattern of musculoskeletal injuries from GBV and determines the factors associated with it. It is a retrospective observational study of patients aged ≥18 years, with GBV-related acute Orthopaedic injuries. Data was reviewed from January 2021 to December 2021, including, demographic information, soft tissue and bony injuries, relationship to assailant, substance abuse and the day and time of injury. Frequencies and percentages for categorical data were analysed. Chi-square test was used to calculate association. T-test was used to compare groups for continuous & categorical variables. Multivariate analysis was conducted to find the odds ratio and a p-value <0.05 was statistically significant. 138 patients were included, the mean age at presentation being 35.02 years (SD=11). 92.75% of GBV victims were females. Most were unemployed (66.7%). 30.43% (n-42) had a
Introduction. The objectives of this study were to compare the systemic inflammatory reaction, localised thermal response and macroscopic
Introduction. Open fractures of the tibia are disabling injuries with a significant risk of deep infection. Treatment involves early antibiotic administration, early and aggressive surgical debridement, and may require complex soft tissue coverage techniques. The extent of disruption to the skin and soft-tissue envelope often varies, with ‘simple’ open fractures (defined by the Orthopaedic Trauma Society (OTS) open fracture severity classification) able to be closed primarily, whilst others may require shortening or soft-tissue reconstruction. This study aimed to determine whether OTS simple tibial open fractures received different rates of adequate debridement and plastic surgical presence at initial debridement, compared with OTS complex injuries, and whether rates of fracture-related infection, nonunion, or reoperation differed between the groups. Materials & Methods. A consecutive series of open tibia fractures managed at a tertiary UK Major Trauma Centre between January 2021 and November 2022 were included. Patient demographics, injury characteristics, timing of antibiotic delivery, timing and method of definitive fixation, and frequency of plastic surgical presence at initial debridement were retrospectively collected. The delivery of bone ends at initial debridement was used as a proxy for adequacy of surgical debridement. The primary outcome measure was rate of fracture-related infection, secondary outcomes included rates of reoperation, nonunion, and amputation. Chi2 Tests and independent samples T-tests were used to assess nominal and continuous outcomes respectively between simple and complex injuries. Ordinal data was assessed using nonparametric equivalent tests. Results. 79 patients with open fractures of the tibia were included. 70.8% of patients were male, with mean age 50.4 years (SD 19.2) and BMI 26.4 Kg/m2 (SD 6.0). Injuries were mostly sustained by low-energy falls (n = 28, 35.4%) and from road traffic accidents (n = 26, 32.9%). 27 (34.2%) were OTS simple open fractures. Simple open fractures were most commonly Gustillo-Anderson grade 1 (38.5%), or 2 (30.8%), whilst complex open fractures were mostly grade 3B (66.7%) (p < 0.001). Fracture-related infection rates in OTS simple and complex open fractures were 25.9% and 25.5% respectively (p = 0.967), and nonunion rates were 32% and 37.8% (p = 0.637). Primary amputation was less common in simple (0%) than in complex open fractures (20%, p = 0.012), there were no differences in delayed amputation rates (7.4% and 6% respectively, p = 0.811). Simple open fractures were less likely to have plastic surgeons present at initial debridement compared to complex open fractures (18.5% and 44%, p = 0.025), and less likely to have bone ends delivered through the skin at initial debridement (25.9% and 61.2%, p = 0.003). There were no differences in patient age, delays to antibiotic administration, or reoperation rates between OTS simple and OTS complex fractures (p > 0.05). Conclusions. Despite involving less significant
Abstract. Objectives. Current literature on pilon fracture includes a range of different management strategies, however there is no universal treatment algorithm. We aim to determine clinical outcomes in patients with open and closed pilon fractures, managed using a treatment algorithm applied consistently over the span of this study. Methods. 135 patients over a 6-year period were included. Primary outcome was AOFAS score at 3, 6, 12-months post-injury. Secondary outcomes include time to partial weight-bear (PWB), full weight-bear (FWB), bone union time, follow-up time. AO/OTA classification was used (43A: n=23, 43B: n=30, 43C: n=82). Treatment algorithm consisted of fine wire fixator (FWF) for severely comminuted closed fractures (AO/OTA type 43C3), or open fractures with severe
Introduction. Being challenging, multifragmentary proximal tibial fractures in patients with severe
Introduction. Virtual fracture clinics (VFC's) aim to reduce the number of outpatient appointments while improving the clinical effectiveness and patients experience through standardisation of treatment pathways. With 4.6% of ED admissions due to trauma the VFC prevents unnecessary face to face appointments providing a cost savings benefit to the NHS. Methods. This project demonstrates the importance of efficient VFC process in reducing the burden on the fracture clinics. We completed preformed a retrospective cross-sectional study, analysing two cycles in May (n=305) and September (n=332) 2021. We reviewed all VFC referrals during this time assessing the quality of the referral, if they went on to require a face to face follow up and who the referring health care professional was. Following the cycle in May we provided ongoing education to A&E staff before re-auditing in September. Results. Between the two cycles there was an average 19% improvement in quality of the referrals, significant reduction in number of inappropriate referrals for soft tissue knee and shoulder injuries from 15.1% (n=50) to 4.5% (n=15) following our intervention. There was an 8% increase in number of fracture clinic appointments to 74.4% (n=247), primarily due to an increase number of referrals from nurse practitioners. Radial head fractures were targeted as one group that were able to be successfully managed in VFC, despite this 64% (n=27) of patients were still seen in the outpatient department following VFC referral. Conclusion. Despite the decrease in the number of inappropriate referrals, and the increase in quality of referrals following our intervention. The percentage of VFC referrals in CAVUHB is still higher than other centres in with established VFCs in England. This possibly highlights the need for further education to emergency staff around describing what injuries are appropriate for referral, specifically
Determine the prevalence, etiologies, and risk factors of unplanned return to the OR (UROR) in adult orthopaedic trauma patients. Retrospective review of a trauma prospective registry from 2014 – 2019 at a Level 1 academic hospital. An UROR was defined as a patient returning to OR unexpectedly following a planned definitive surgery to either readdress the presenting diagnosis or address a complication arising from the index procedure. Univariate and multivariate logistic regression was performed comparing those patients with an UROR versus those without. A total of 1568 patients were reviewed. The rate of UROR was 9.8% (153 patients). Symptomatic implant was the leading cause of UROR (60%). Other significant UROR causes were infection (15%) and implant failure (9%). The median time between index procedure and UROR was 301 days. For the univariate and multivariate analysis, open fracture (p< 0.05), fracture complexity (p<0.01), and weekend procedure (p< 0.01) were all associated with increased risk of UROR. All other variables were not statistically significant for any associations. Those patients with an UROR for reasons other than symptomatic implants were more likely to have polyorthopaedic injuries (p < 0.05), ISS > 15 (p < 0.05), osteoporosis (p < 0.01), ICU status (p < 0.05), psychiatric history (p < 0.05), compartment syndrome (p < 0.05), neurovascular injury (p < 0.01), open fracture (p < 0.05), and fracture complexity (p < 0.05). The rate of UROR in the orthopaedic trauma patient population is 10%. Most of these cases are due to implant-related issues. UROR for reasons other than symptomatic implants tend to be polytraumatized patients with higher-energy injuries, multiple complex fractures, and associated
Standard fixation for intra-articular distal humerus fracture is open reduction and internal fixation (ORIF). However, high energy fractures of the distal humerus are often accompanied with
Over half of postpartum women experience pelvic ring or hip pain, with multiple anatomic locations involved. The sacroiliac joints, pubic symphysis, lumbar spine and pelvic girdle are all well documented pain generators. However, despite the prevalence of postpartum hip pain, there is a paucity of literature regarding underlying soft tissue intra-articular etiologies. The purpose of this systematic review is to document and assess the available evidence regarding underlying intra-articular soft tissue etiologies of peri- and postpartum hip pain. Three online databases (Embase, PubMed and Ovid [MEDLINE]) were searched from database inception until April 11, 2021. The inclusion criteria were English language studies, human studies, and those regarding symptomatic labral pathology in the peri- or postpartum period. Exclusion criteria were animal studies, commentaries, book chapters, review articles and technical studies. All titles, relevant abstracts and full-text articles were screened by two reviewers independently. Descriptive characteristics including the study design, sample size, sex ratio, mean age, clinical and radiographic findings, pathology, subsequent management and outcomes were documented. The methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) instrument. The initial search identified 2472 studies. A systemic screening and assessment of eligibility identified 5 articles that satisfied the inclusion criteria. Twenty-two females were included. Twenty patients presented with labral pathology that necessitated hip arthroscopy with labral debridement or repair with or without acetabuloplasty and/or femoroplasty. One patient presented with an incidental labral tear in the context of osteitis condensans illi. One patient presented with post-traumatic osteoarthritis necessitating a hip replacement. The mean MINORS score of these 5 non-comparative studies was 2.8 (range 0-7) demonstrating a very low quality of evidence. The contribution of intra-articular
Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant
Background. Use of a robotic tool to perform surgery introduces a risk of unexpected soft tissue damage due to the uncommon tactile feedback for the surgeon. Early experience with robotics in total hip and knee replacement surgery reported having to abort the procedure in 18–34 percent of cases due to inability to complete preoperative planning, hardware and soft tissue issues, registration issues, as well as concerns over actual and potential soft tissue damage. These can result in significant morbidity to the patient, negating all the desired advantages of precision and reproducibility with robotic assisted surgery. The risk of soft tissue damage can be mitigated by haptic software prohibiting the cutting tip from striking vital soft tissues and by the surgeon making sure there is a clear workspace path for the cutting tool. This robotic total knee system with a semi-active haptic guided technique was approved by the FDA on 8/5/2015 and commercialized in August of 2016. Two year clinical results have not been reported to date. Objective. To review an initial and consecutive series of robotic total knee arthroplasties for safety in regard to avoidance of known or delayed
Aims. We wished to quantify the extent of
Aims. Complex fractures of the femur and tibia with associated severe
Virtual Fracture Clinic (VFC) is a consultant-led orthopaedic trauma outpatient triage and management service. The use of VFC has recently become commonplace in the United Kingdom. It allows multiple referral sources to the orthopaedic team, with clinical information and imaging reviewed by a consultant in VFC who formulates an appropriate management plan with the patient contacted; either to attend clinic for consultation or discharged with advice over the phone. The VFC is more efficient than a traditionally delivered outpatient fracture clinic service. We have utilized VFC for 1 year at our hospital, East Kent University Hospital Foundation Trust (EKHUFT), and undertook a closed loop audit to evaluate the service and highlight potential areas of improvement. The Objective of the study was to identify whether the implementation of new re-designed VFC referral guidelines together with teaching set across one of the hospitals in EKHUFT improved the effectiveness and standards of VFC referrals. An initial audit was performed of all referrals made to VFC over a 2 weeks period in December 2018. Changes to the VFC referral pathway were implemented, and teaching sessions performed by the orthopaedic team to all referring units, including minor injury units (MIU) and the emergency department (ED). After implementation, re-audit of VFC referrals was performed in February 2019 over a similar 2 weeks period. Patient demographics, diagnosis and outcomes were collected from the online patient record with images reviewed using PACS software. Following intervention, referral rates dropped by 27.7% (136 vs 188 patients) over the 2 weeks periods. Patient demographics, injury type and severity remained the same between the 2 groups. 51.5% (70/136) did not meet VFC pathway criteria after the intervention and were considered inappropriate, compared to 70% in the original group. 15.4% (21/136) referrals could have been managed in the emergency department using the new guidelines and leaflet discharge. 5.1% (7/136) of the referrals should have been referred to orthopaedic on-call acutely and 22% (30/136) of the referrals had a
Osteosynthesis of high-energy metaphyseal proximal tibia fractures is still challenging, especially in patients with severe
Introduction: Wrist injuries are common presentations at Accidents and Emergencies. Distal radius fractures are by far the most common. Scaphoid injuries constitute about 60% of carpal injuries. 35% occult wrist fractures are undiagnosed on 2nd visit radiography (50% distal radius/ulna). Moreover 30% patients with significant
There is a high incidence of ipsilateral knee injuries with the Floating knee, which makes these fractures even more challenging to manage. We present the impact knee injuries have on the final outcome of the floating knee. We propose a protocol for assessment &
management of knee injuries with the Floating knee. This prospective study included 29 patients with floating knee injuries. Knee injuries encountered were divided into bony, ligamentous and soft tissue. Bony injuries were assessed with radiographs and managed surgically along with the floating knee injury. Patients were assessed clinically for knee ligament injuries after fixation of the fractures intra-operatively and managed surgically.
29 cases of complex elbow injuries were reviewed at a mean period of 15 months. Outcome measures included MEPS and DASH score. Patients who had defined early surgery were significantly better than those in whom surgery was delayed. We concluded that Management of complex elbow injuries can be improved by early definitive surgery. The magnitude and type of
Introduction. Different techniques for fixation of lateral malleolus have been described. We report our results of using fibula rod for unstable ankle fractures in level one major trauma centre. Methods. We reviewed the results of 40 ankle fractures (14 open and 26 closed) with significant
Introduction: Rotational forces in ankle injuries can present as isolated lateral malleolus fracture with talar shift or ankle subluxation. It results in medial joint space [clear space] widening, and more than 4 mm is considered significant. The extent of medial
Introduction. The COL5A1 gene encodes for the α1 chain of type V collagen, a minor fibrillar collagen that is an important regulator of collagen fibrillogenesis. Several polymorphisms, including rs12722 (C/T), within the 3′-UTR of COL5A1 are associated with chronic Achilles tendinopathy and other musculoskeletal
Introduction/Aim. The NAVIO robotic-assisted TKA (RA-TKA) application received FDA clearance in May 2017. This semi-active robotic technique aims to improve the accuracy and precision of total knee arthroplasty. The addition of robotic-assisted technology, however, also introduces another potential source of surgery-related complications. This study evaluates the safety profile of NAVIO RA-TKA. Materials and Methods. Beginning in May 2017, the first 250 patients undergoing NAVIO RA-TKA were included in this study. All intra-operative complications were recorded, including: bleeding; neuro-vascular injury; peri-articular
A reverse total shoulder arthroplasty (RSA) is frequently performed in the revision setting. The purpose of this study was to report the clinical outcomes and complication rates following revision RSA (RRSA) stratified according to the primary shoulder procedure undergoing revision, including failed hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA), RSA, soft tissue repair (i.e., rotator cuff repair), and open reduction internal fixation (ORIF). A systematic review of the literature was performed using four databases (EMBASE, Medline, SportDISCUS, and Cochrane Controlled Trials Register) between January 1985 and September 2017. The primary outcomes of interest included active range-of-motion (ROM), pain, and functional outcome measures including the American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), and Constant-Murley (CS) Score. Secondary outcomes included complication rates, such as infection, dislocation, perioperative fracture, base plate failure, neurovascular injury,
Introduction. Ligament reconstruction following knee
The aim of this study was to document our experience of acute forearm compartment syndrome, and to determine the risk factors for requiring split skin grafting (SSG) and developing complications post fasciotomy. We identified from our trauma database all patients who underwent fasciotomy for an acute forearm compartment syndrome over a 22-year period. Diagnosis was made using clinical signs and/or compartment pressure monitoring. Demographic data, aetiology, management, wound closure, complications and subsequent surgeries were recorded. Outcome measures were the use of SSG and the development of complications following forearm fasciotomy. 90 patients were identified with a mean age of 33 yrs (range, 13–81 yrs) and a significant male predominance (n=82, p<0.001). A fracture of one or both of the forearm bones was seen in 62 (69%) patients, with
Purpose. The recent emergence of autologous blood concentrates, such as platelet rich plasma (PRP), as a treatment option for patients with orthopaedic injuries has led to an extensive debate about their clinical benefit. Our objective was to determine the effectiveness of autologous blood concentrates compared with control therapy in improving pain in patients with orthopaedic bone and
The vast majority of fractures around the knee will heal with well-done internal fixation. TKA has a role in several scenarios. Acute TKA can be effective for fractures of the distal femur (especially periprosthetic) in very elderly patients where internal fixation attempts are likely to fail. Acute TKA for tibia plateau fractures may have a role in fractures in the elderly with pre-existing DJD and relatively simple fracture patterns. There is very little published literature regarding the outcomes of TKA for acute tibial plateau fracture and caution is advised until more data is available. TKA is commonly indicated for failed fixation and post-traumatic arthritis. Challenges include managing retained hardware,
We describe a new surgical approach designed for use with minimally invasive fixation and a circular frame. Tibial pilon injuries are often associated with significant
Treatment of tibial plateau fractures Schatzker type V and VI or with
The primary aim was to assess whether robotic total knee arthroplasty (rTKA) had a greater early knee-specific outcome when compared to manual TKA (mTKA). Secondary aims were to assess whether rTKA was associated with improved expectation fulfilment, health-related quality of life (HRQoL), and patient satisfaction when compared to mTKA. A randomized controlled trial was undertaken, and patients were randomized to either mTKA or rTKA. The primary objective was functional improvement at six months. Overall, 100 patients were randomized, 50 to each group, of whom 46 rTKA and 41 mTKA patients were available for review at six months following surgery. There were no differences between the two groups.Aims
Methods
Objective and Purpose: Pilon fractures are complex fractures of the tibial articular surface usually associated with high energy trauma and major
The South Wales Air ambulance is a charity-funded helicopter service that started functioning on 1 April 2001. There are 10 staff involved in the running of the service, including pilot and paramedics. The territory covered is the South and Mid-Wales regions. The service costs on average £500 per flight and the net cost per year is approximately £750,000. A retrospective study was performed to evaluate the extent and appropriateness of the air-ambulance call-outs over a 12-month period. The guidelines for call-out are based on medical and non-medical criteria. During this period the helicopter made 315 sorties. On 159 occasions the helicopter was stood down once airborne or following landing at the scene. £80,000 has been spent on non-patient -carrying call-outs. Of the 156 patient-carrying sorties 70% were transferred to Mor-riston Hospital, Swansea. 67% of these patients were categorised as trauma patients. Transfer distance averaged just 15 miles (range 2.6-41.2 miles). The majority of trauma cases were categorised as spinal
Introduction: Classification systems are useful in research and clinical practise as it provides a common mode of communication and evaluation. Tibial pilon injuries are a complex group of fractures, whose classification and radiological assessment in clinical practise remains undetermined. Methods: 50 CT scans and radiographs of tibial pilon fractures were evaluated independently by 6 orthopaedic surgeons, comprising 3 consultants, 2 registrars and 1 research fellow. Fractures were classified according to ruedi allgower, AO, Topliss et al. Each surgeon was given a period of 48 hours to review copy of the original article as well as written and diagrammatic representations. Assessment was done on two occasions, 4 weeks apart. The kappa coefficient of agreement was calculated with SPSS to determine interobserver reliability and intraobserver reproducibility of the classification systems. The evaluator was blinded as to treatment and functional outcome. Each evaluator was also asked to decide upon the fracture management based on the classification types and was compared with the actual management. Result: The interobserver agreement for ruedi allgower, Ao and Topliss et al., was fair, moderate and poor respectively. The intraobserver agreement for ruedi allgower, AO and Topliss et al., classifications was moderate at best. There was poor agreement amongst observers regarding definite management plan based on these classification systems. Discussion: The interobserver agreement was directly proportional to the familiarity and inversely proportional to the specificity of the classification system. The intraobserver agreement improved with experience. CT scan helped in delineating the fracture segments accurately but did not significantly affect inter or intraob-server agreement. Conclusion: Existing classification systems help in understanding the pathoanatomy of osseous part of tibial pilon fracture complex. However,
The mechanism of traumatic amputation (TA) from explosive blast has traditionally been considered to be a combination of blast wave induced bone injury – primary blast - followed by limb avulsion from the blast wind – tertiary blast. This results in a transosseous TA, with through joint amputations considered to be extremely rare. Data from previous conflicts has also suggested that this injury is frequently associated with a non-survivable primary blast lung injury (PBLI), further linking the extremity injury to the primary blast wave. However, our current experience in the Middle East would suggest that both the mechanism of TA and the link with fatal primary blast exposure need to be reconsidered. The aim of this study was to analyse the injury profile of the current cohort of TA fatalities to further investigate the underlying blast injury mechanism and to allow hypotheses on injury mechanisms to be developed for further analysis. With the permission of the coroners, 121 post-mortem CT (PMCT) scans of UK Armed Forces personnel who died following an IED blast were analysed. All orthopaedic injuries were identified, classified and the anatomical level of any associated
Background. Use of a robotic tool to perform surgery introduces a risk of unexpected soft tissue damage due to the lack of tactile feedback for the surgeon. Early experience with robotics in total hip and knee replacement surgery reported having to abort the procedure in 18–34 percent of cases due to inability to complete preoperative planning, hardware and soft tissue issues, registration issues, as well as concerns over actual and potential soft tissue damage. These damages to the soft tissues resulted in significant morbidity to the patient, negating all the desired advantages of precision and reproducibility with robotic assisted surgery. The risk of soft tissue damage can be mitigated by haptic software prohibiting the cutting tip from striking vital soft tissues and by the surgeon making sure there is a clear workspace path for the cutting tool. This robotic total knee system with a semi-active haptic guided technique was approved by the FDA on 8/5/2015 and commercialized in August of 2016. One year clinical results have not been reported to date. Objective. To review an initial and consecutive series of robotic total knee arthroplasties for safety in regard to avoidance of known or delayed
Study Design: A prospective randomised controlled trial. Objective: The early management of acute
The aim was to assess whether robotic-assisted total knee arthroplasty (rTKA) had greater knee-specific outcomes, improved fulfilment of expectations, health-related quality of life (HRQoL), and patient satisfaction when compared with manual TKA (mTKA). A randomized controlled trial was undertaken (May 2019 to December 2021), and patients were allocated to either mTKA or rTKA. A total of 100 patients were randomized, 50 to each group, of whom 43 rTKA and 38 mTKA patients were available for review at 12 months following surgery. There were no statistically significant preoperative differences between the groups. The minimal clinically important difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score was defined as 7.5 points.Aims
Methods
Purpose: The injury occurs when a child passenger sits behind or in front of the rider; his leg gets caught in the rotating wheel’s spokes, and crushed against the frame. The study aimed at reviewing our experience in managing this common injury. Patients and Methods: Between 2000–2005, 43 children were treated following bicycle spoke injury. All cases were thoroughly reviewed. Results: Mean age was 5.1 years (range 1–15). Twenty-seven were up to 5 years. Thirty-seven were males, and 7 were females. The right leg was injured in 30 children, and the left in 13. Twenty one were seated behind the rider, and 6 in front of him. Most children were injured in the afternoon and between April and September. Twenty six injured the antero-medial aspect of the ankle and lateral calcaneal region. Twenty nine children had deep abrasions, 11 had abrasion with skin defect, and 3 had laceration. All children had edema and ecchymosis. Eighteen children had fractures. Greenstick fracture of the distal and fibula with anterior and varus angulation was observed in 6 cases. Hospital stay ranged 2–12 days. All fractures were treated non-operatively and healed uneventfully.
Introduction. This study reviews the orthopaedic care of the thirteen patients who were admitted and treated at Royal Manchester Children's' Hospital following the Manchester Arena Bomb blast. Methods. We included all children admitted to Royal Manchester Children's Hospital injured following the bomb blast who either suffered upper limb, lower limb or pelvic fractures, or penetrating upper or lower limb wounds. The nature of each patient's bone and
The purpose of this prospective clinical study was to identify the true incidence, pattern, and location of the injury and nature of fracture following hand injuries in different paediatric age groups attending a hand unit. Three hundred and sixty children (237 boys and 123 girls) under 16 years of age who presented with hand injuries between 1st April 2000 and 30th September 2000 were included in the study. Bony injuries accounted for 65.5% (236 injuries), 33.3% (120 injuries) were
Ankle fractures are among the most common type of fractures of our musculoskeletal system, and their rate has been constantly increasing over the past decades, not only in the young active patients but also in the elderly ones. The stability of the ankle joint is assured by the configuration of the fibula, tibia and talus, as well as by its complex ligamentous system. The optimal treatment of these fractures follows the basic rules of all joint fractures: it is achieved by restoring the ankle mortise and its stability, in order to prevent pain and the development of secondary arthritis. Stable ankle fractures (e.g., isolated fractures of lateral maleolus) can be satisfactorily treated by closed methods, whereas unstable fractures (e.g., bimaleolar, bilameolar equivalents, trimaleolar) must be treated by open reduction and internal fixation. However, one of the aspects that influence the final outcome of these fractures is the coexistence of
The aim of this study was to evaluate the effect of traction on the compartment pressures during intramedullary nailing of closed tibial shaft fractures. The study design was a randomised prospective trial. The period of the study was Sept ’99 to Dec 2000. 30 consecutive patients with Tscherne C1 fractures were randomised into two groups.16 patients underwent intramedullary nailing of the tibia with traction and 14 patients without traction. Compartment pressures were measured before the application of traction or commencement of the procedure and at the end of the procedure. The method described by Gulli and Templeman was used to measure all the four compartments of the injured limb. The pressures were measured with a Stryker® pressure monitor. The absolute and differential compartment pressures were recorded. All patients were followed up for the duration of at least 8 months and until fracture union. The data collected was analysed using paired student t-test. There was no statistically significant difference (p>
0.05) in the preoperative mean compartment pressures for both groups when all the four compartments were measured individually. The mean postoperative measurements were higher (range 9–10 mmHg) in all four compartments in the traction group. This was statistically significant (p<
0.05). None of the pressures reached the critical level as they were more than 30 mmHg below the diastolic pressure (differential pressure). These results show that traction increases compartment pressures during intramedullary nailing of tibial shaft fractures. The group considered did not have compartment syndrome possibly due to less
During the second Lebanon war, between 12/07/06 to 14/08/06, 241 war injuries were admitted to Rambam Medical Center emergency room: 202 soldiers and 39 citizens. (Post traumatic stress disorders victims were not included). Majority of the injured soldiers (98%) were mobilized by the Israeli Air Force helicopters. More then 40 helicopters had landed in the hospital heliport during the war. Distribution of injuries according to the injury type:. 110 patients (44% of all injured) had Orthopedic injuries (including hand injuries). 76 patients (31% of all injured) had Orthopedic injuries combined with other injuries. Not orthopedic injury – 63 patients (25%) Majority of all wounded (75%) had suffered from an orthopedic injury. Distributions of soldier’s injuries among soldiers were similar to the above :. 81 soldiers (41%) Orthopedic injuries (including hand injuries). 64 soldiers (33%) Orthopedic injuries combined with other injuries. 50 soldiers (26 %) Not orthopedic injury. About 75 % of the injured soldiers suffered from orthopedic injuries. Vast majority of the injuries were shrapnel injuries, which were divided to 3 levels:. Mild soft tissue damage due to few or superficial shrapnel injury – 107 (49%) soldiers. Moderate