Aims. A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of
We compared the intracompartmental pressures
(ICPs) of open and closed
There is no absolute method of evaluating healing
of a fracture of the tibial shaft. In this study we sought to validate a
new clinical method based on the systematic observation of gait,
first by assessing the degree of agreement between three independent
observers regarding the gait score for a given patient, and secondly
by determining how such a score might predict healing of a fracture. We used a method of evaluating gait to assess 33 patients (29
men and four women, with a mean age of 29 years (15 to 62)) who
had sustained an isolated fracture of the tibial shaft and had been
treated with a locked intramedullary nail. There were 15 closed
and 18 open fractures (three Gustilo and Anderson grade I, seven
grade II, seven grade IIIA and one grade IIIB). Assessment was carried
out three and six months post-operatively using videos taken with
a digital camera. Gait was graded on a scale ranging from 1 (extreme
difficulty) to 4 (normal gait). Bivariate analysis included analysis
of variance to determine whether the gait score statistically correlated
with previously validated and standardised scores of clinical status
and radiological evidence of union. An association was found between the pattern of gait and all
the other variables. Improvement in gait was associated with the
absence of pain on weight-bearing, reduced tenderness over the fracture,
a higher Radiographic Union Scale in Tibial Fractures score, and
improved functional status, measured using the Brazilian version
of the Short Musculoskeletal Function Assessment questionnaire (all
p <
0.001). Although further study is needed, the analysis of
gait in this way may prove to be a useful clinical tool.
Aims. Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of
Aims. Open
Aims. Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open
Aims. The aim of this study was to develop a psychometrically sound measure of recovery for use in patients who have suffered an open
Introduction. Management of complex fractures poses a significant challenge. Evolving research and changes to national guidelines suggest better outcomes are achieved by transfer to specialist centres. The development of Major Trauma Networks was accompanied by relevant financial arrangements. These do not apply to patients with closed fractures referred for specialist treatment by similar pathways. Despite a surge in cases transferred for care, there is little information available regarding the financial impact on receiving institutions. Materials & Methods. This retrospective study examines data from a Level 1 trauma centre. Patients were identified from our electronic referral system, used for all referrals. Transferred adult patients, undergoing definitive treatment of acute isolated closed
Aims. Using
Aims. The aims of this study were to quantify health state utility
values (HSUVs) after a
Aims. Type IIIB open
The aim of this study was to report the pattern
of severe open diaphyseal
Between 2005 and 2010 ten consecutive children
with high-energy open diaphyseal
Although it is widely accepted that grade IIIB open
Introduction. A significant burden of disease exists with respect to critical sized bone defects; outcomes are unpredictable and often poor. There is no absolute agreement on what constitutes a “critically-sized” bone defect however it is widely considered as one that would not heal spontaneously despite surgical stabilisation, thus requiring re-operation. The aetiology of such defects is varied. High-energy trauma with soft tissue loss and periosteal stripping, bone infection and tumour resection all require extensive debridement and the critical-sized defects generated require careful consideration and strategic management. Current management practice of these defects lacks consensus. Existing literature tells us that tibial defects 25mm or great have a poor natural history; however, there is no universally agreed management strategy and there remains a significant evidence gap. Drawing its origins from musculoskeletal oncology, the Capanna technique describes a hybrid mode of reconstruction. Mass allograft is combined with a vascularised fibula autograft, allowing the patient to benefit from the favourable characteristics of two popular reconstruction techniques. Allograft confers initial mechanical stability with autograft contributing osteogenic, inductive and conductive capacity to encourage union. Secondarily its inherent vascularity affords the construct the ability to withstand deleterious effects of stressors such as infection that may threaten union. The strengths of this hybrid construct we believe can be used within the context of critical-sized bone defects within tibial trauma to the same success as seen within tumour reconstruction. Methodology. Utilising the Capanna technique in trauma requires modification to the original procedure. In tumour surgery pre-operative cross-sectional imaging is a pre-requisite. This allows surgeons to assess margins, plan resections and order allograft to match the defect. In trauma this is not possible. We therefore propose a two-stage approach to address critical-sized tibial defects in open fractures. After initial debridement, external fixation and soft tissue management via a combined orthoplastics approach, CT imaging is performed to assess the defect geometry, with a polymethylmethacrylate (PMMA) spacer placed at index procedure to maintain soft tissue tension, alignment and deliver local antibiotics. Once comfortable that no further debridement is required and the risk of infection is appropriate then 3D printing technology can be used to mill custom jigs. Appropriate tibial allograft is ordered based on CT measurements. A pedicled fibula graft is raised through a lateral approach. The peroneal vessels are mobilised to the tibioperoneal trunk and passed medially into the bone void. The cadaveric bone is prepared using the custom jig on the back table and posterolateral troughs made to allow insertion of the fibula, permitting some hypertrophic expansion. A separate medial incision allows attachment of the custom jig to host tibia allowing for reciprocal cuts to match the allograft. The fibula is implanted into the allograft, ensuring nil tension on the pedicle and, after docking the graft, the hybrid construct is secured with multi-planar locking plates to provide rotational stability. The medial window allows plate placement safely away from the vascular pedicle. Results. We present a 50-year-old healthy male with a Gustilo & Anderson 3B proximal
Aims. The BOA/BAPRAS guidelines for the management of open
Aims. Compartment syndrome (CS) is a well-recognised, serious complication of long bone fractures. The association between CS and
We evaluated changes in bone mineral density (BMD) after
Aims. This 501-patient, multi-centre, randomised controlled trial sought
to establish the effect of low-intensity, pulsed, ultrasound (LIPUS)
on
An account is given of 38 patients with complicated
Of 110 consecutive open
Reamed intramedullary nailing was carried out on 57 Gustilo grade-IIIB
An analysis of 51 type III open
We present two cases of metastatic lung cancer which occurred at the site of a previously united
We performed an epidemiological analysis of 523 fractures treated in the Edinburgh Orthopaedic Trauma Unit over a three-year period using modern descriptive criteria. The fractures were defined in terms of their AO morphology and their degree of comminution, location and cause. Closed fractures were classified using the Tscherne grading system and open fractures according to the Gustilo classification. Further analysis of fractures caused by road-traffic accidents and football was carried out. The use of the AO classification allowed the common fracture patterns to be defined. Correlation of the classification systems showed an association between the AO morphological system and the Tscherne and Gustilo classifications. The relative rarity of severe
We measured fracture stiffness in 212 patients with
We studied the effect of 'dynamisation' on
Aim. To quantify the micro-motion at the fracture gap in a
We report the use of Grosse-Kempf reamed intramedullary nailing in the treatment of 41 Gustilo type II and III open
Seventy-nine open
Aims. Proper preoperative planning benefits fracture reduction, fixation, and stability in
Classification systems for
Purpose: Radiographic healing is a common outcome measure in orthopaedic trials and adjudication by outcome assessors is often conducted using only plain radiographs. We explored the effect of adding clinical notes to radiographs in the adjudication process of a pilot trial of
We report our experience of the use of the Ilizarov technique to treat nine patients with severe compound
Purpose. We explored the role of patients beliefs and attitudes towards their likelihood of recovery from severe physical trauma. Method. We developed and validated an instrument designed to capture the impact of patients beliefs and attitudes towards functional recovery from injury; the Somatic Pre-Occupation and Coping (SPOC) questionnaire. At six weeks post-surgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed
We studied the outcome and functional status of 33 patients with 34 severe open
We made a prospective study of 208 patients with
Introduction: The role of continuous compartment pressure monitoring to detect compartment syndrome associated with tibia fractures is unclear. Our study aims to assess the impact of continuous compartment pressure monitoring in patients with acute
A total of 45
We reviewed the results of the treatment of 30
Aims. The primary aim of this study was to identify independent predictors associated with nonunion and delayed union of
Objective: To compare the mechanical stability of fixation of bicondylar
The effect of calcaneal traction on the compartmental pressure in the legs of five individuals with
Severe open fractures of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilisation is by external fixation, but the advent of small diameter locking intramedullary nails has introduced a new option. We report the early results of a randomised, prospective study comparing external fixation with non-reamed locked nails in grade-IIIb open
Serial serum C-reactive protein (CRP) measurements were made, for three weeks, in 42 consecutive patients with solitary
We used dual-energy X-ray absorptiometry (DEXA) to measure the bone mineral content (BMC) of both tibiae in 13 patients who had been treated for a
Aim of the study. To estimate and compare the cost implications of the first attempt of treatment of
The changes in serum adjusted ionised calcium and parathyroid hormone (PTH) were prospectively studied in 32 patients with isolated
A case is described in which a large area of unstable skin overlying a