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