A Morel-Lavallee lesion (MLL) is a benign cystic lesion that occurs due to injury to the soft-tissue envelope's perforating vascular and lymphatic systems, resulting in a distinctive hemolymphatic fluid accumulation between the tissue layers. The MLL has the potential to make a significant impact on the treatment of orthopaedic injuries. A 79-year-old male patient community ambulatory with assisting aid (cane) known case of Diabetes mellitus, hypertension, bronchial asthma and ischemic heart disease. He was brought to the Emergency, complaining of right hip discomfort and burning sensation for the last 5 days with no history of recent trauma at all. Patient had history of right trochanteric femur fracture 3 years ago, treated with DHS in a privet service. Clinical and Radiological assessment showed that the patient mostly has acute MLL due to lag screw cut out. We offered the patient the surgical intervention, but he refused despite explaining the risks of complications if not treated and preferred to receive the conservative treatment. Compression therapy management explained to him including biker's shorts (instructed to be worn full-time a day) and regular follow up in clinic. Symptom's improvement was reported by the patient in the subsequent visits. In the polytrauma patient, a delayed diagnosis of these lesions is conceivable due to the presence of more visible injuries. It's located over the greater trochanter more commonly, but sometimes in other areas such as the lower lumbar region, the thigh, or the calf. Incorrect or delayed diagnosis and care can have unfavorable outcomes such as infection, pseudocyst development, and cosmetologically deformity. Magnetic resonance imaging (MRI) and ultrasound will aid in MLL diagnosis. However, the effectiveness of MLL therapy remains debatable. We strongly believe that the MLL caused due to tangential shear forces applied to the soft tissue leads to accumulation of the blood and/or lymph between the subcutaneous and overlying fascia and it often misdiagnosed due to other distracting injuries. Nontheless, in our case we reported MLL occur due to internal pressure on the fascia caused by cut out of DHS lag screw.
The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients >60 years with a minimum follow up of one year. We retrospectively reviewed 51 consecutive patients >60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin (hb), creatinine and comorbidities were analysed.Abstract
Background
Methods
The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year. We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test. There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle > 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two conversions to arthroplasty, one fixation failure during the immediate post-op period). The 30-day and one year mortality rates were 1.9 % and 11.7 % respectively. 2-hole DHS fixation in undisplaced NOF fractures has excellent union rates. A pre-operative posterior tilt angle of >200 and a greater difference in pre and post operative haemoglobin were found to correlate positively with the progression to AVN . No correlation was observed between AVN and time to surgery, laterality, quality of reduction and comorbidities.
What was our rate of cut out and implant failure? Where we achieving an acceptable screw position and TAD? Was there any difference between TAD and grade of surgeon?
Aims. To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing
We biomechanically investigated whether the standard
Background.
A number of techniques have been developed to improve the immediate mechanical anchorage of implants for enhancing implant longevity. This issue becomes even more relevant in patients with osteoporosis who have fragile bone. We have previously shown that a
Extracapsular Hip Fractures (EHF's) are a significant health burden on healthcare services. Optimal treatment is controversial with conflicting evidence being reported. Currently treatment is undertaken with Intramedullary Nail (IMN) or
The incidence of hip fractures in the elderly is increasing. Minimally displaced and un-displaced hip fractures can be treated with either internal fixation or hemiarthroplasty. The aim was identifying the revision rate of internal fixation and hemiarthroplasty in patients 60 years or older with Garden I or II hip fractures and to identify risk factors associated with each method. A retrospective analysis was conducted from 2 Major Trauma Centres and 9 Trauma Units between 01/01/2015 and 31/12/2020. Patients managed conservatively, treated with a total hip replacement and missing data were excluded from the study. 1273 patients were included of which 26.2% (n=334) had cannulated hip fixation (CHF), 19.4% (n=247) had a
Aims. To develop a core outcome set of measurements from postoperative radiographs that can be used to assess technical skill in performing
The aim of the study was to compare mortalitiy and complication rate after operative treatment of pertrochanteric fractures with primary cemented arthroplasty,
Objectives. The use of two implants to manage concomitant ipsilateral femoral
shaft and proximal femoral fractures has been indicated, but no
studies address the relationship of
Background. Hip fractures cause significant morbidity and mortality, affecting 70,000 people in the UK each year. The
Background. Radiation exposure remains a significant occupational hazard for Orthopaedic surgeons. There are no references values for trauma procedures performed with Image Intensifier (II). We aimed to determine and compare reference values for patient radiation exposure for common trauma operations, and to analyse the effect of surgeon grade on II usage. Methods. Data collected prospectively from 849 cases between 01/05/2013 and 01/10/2014 were analysed. Statistical analysis was performed to calculate reference values for dose area product (DAP), screening time (ST), and number of II images taken for common trauma procedures where n>9 (n=808). Results.
Background. The advantages of treatment by open reduction and internal fixation for intertrochanteric fractures of the proximal femur have been well known for several decades. Failure of fixation can result in revision surgery, prolonged inpatient stay and has major socio-economic consequences. There are many new devices on the market to help deal with this problem. Expandable hip screw (EHS) is one such device, which is an expanding bolt that may offer superior fixation in osteoporotic bone compared to the standard
A tip-apex distance (TAD) greater than 25 mm is a strong predictor of screw cut-out in patients with intertrochanteric femoral fracture treated with a
Background. Training within surgery is changing from the traditional Halstedian apprenticeship model. There is need for objective assessment of trainees, especially their technical skills, to ensure they are safe to practice and to highlight areas for development. In addition, due to working time restrictions in both the UK and the US, theatre time is being limited for trainees, reducing their opportunities to learn such technical skills. Simulation is one adjunct to training that can be utilised to both assess trainees objectively, and provide a platform for trainees to develop their skills in a safe and controlled environment. The insertion of a
We have prospectively compared the fixation of 100 intertrochanteric fractures of the proximal femur in elderly patients with random use of either a
The aim of this retrospective study was to evaluate the failure rate among different fixation devices for undisplaced fracture neck of femur. All 52 patients with Garden I and II hip fractures who underwent surgery in a teaching hospital in London from January 2007 to June 2012 were included. Electronic patient records were accessed to collect the patient data. There were 52% females and the mean age of patients was 70 years. Thirty patients had cannulated screws, 18 –
Aims: To compare the results between intramedullary hip screw (IMHS) and
Intra-operative Tip-Apex Distance (TAD) estimation optimises
Three Cannulated Screws (3CS),
Background. Hip fractures affect 1.6 million people globally per annum, associated with significant morbidity and mortality. A large proportion are extracapsular neck of femur fractures, treated with the
The aim of this study was to establish any association between implant cut-out and a Tip Apex Distance (TAD), ≥25mm, in proximal femoral fractures, following closed reduction and stabilisation, with either a
Objectives: To compare the biomechanical properties of lag screw insertion in a laboratory model. Two blades, the Synthes Dynamic Helical Hip Screw (DHHS) and Proximal Femoral Nail Antirotation (PFNA), and two screws, the Synthes
Introduction. Osteoporotic intertrochanteric fracture (ITF) is frequent injuries affecting elderly, osteoporotic patients leading to significant morbidity and mortality. Successful prognosis including union and alignment is challenging even though initial successful reduction with internal fixation. Although many factors are related to the patient's final prognosis. Well reduction with stable fracture fixation is still the goal of treatment to improve the quality of life and decrease morbidity in patients with hip fractures, but this in turn depends on the type of fracture and bone quality. Poor bone quality is responsible for common complications, such as failure of fixation, varus collapse and lag screw cut-out, in elderly patients. Kim et al. found that the complication rate when using conventional DHS in unstable ITFs can be as high as 50% because of screw cut-out. We used the
Aims:
Aims:
Purpose: Numerous implants used in repairing a trochanteric fracture of the hip are currently available. The purpose of this prospective study was to determine the complications and results of the percutaneous compression plate (PCCP), a relatively new device versus the conventional
It is widely accepted that a tip apex distance of greater than 25mm is associated with
Introduction: Decreasing the length of the side plate of the
Introduction: While recent guidelines for the treatment of such fractures do not recommend load-bearing devices, there is little evidence actually condemning them, and there is still a lack of literature on the reconstruction nails now generally used. Aim: To evaluate the clinical outcome of pathological (metastatic) proximal femoral fractures treated by either a long Gamma nail, an AO nail with a spiral blade plate (AO-SBP), or a
Introduction: The use of intramedullary nailing (IMHS) has increased at the expense of the
Purpose: To compare failure rates, and patient functional outcomes, using the
Introduction:
Although
Purpose of the study: Percutaneous compression plating (PCCP) is a new method for minimally invasive fixation of intratrochanteric fractures. Fixation is achieved with two neck screws and a 3-hole plate. This prospective study of a non-randomized series was designed to compare results in a monocentric cohort of patients treated by PCCP or
We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked, long intramedullary nail with those treated with a
The incidence of comminuted proximal femur fractures is increasing, due to the growing proportion of elderly people in the general population. Severely depleted cancellous bone in the femoral head and neck prevent stable proximal purchase, mandatory for intertrochanteric and subtrochanteric fractures. Osteoporotic bones are associated with high implant failure rates, evidenced by cutout and upward screw penetration of the hip joint. A new method for femoral head fixation is described. The peg consists of a distal end that can expand in diameter from 7.8mm to 10.5mm by using pressurized saline, allowing good abutment into the femoral head. The peg may be connected to a side plate or an intramedullary device for inter or subtrochanteric fractures. Materials and Methods: Ten femoral heads were retrieved from patients who underwent hip hemiarthroplasty due to subcapital fracture. The heads were covered with a transparent epoxy resin until full solidification was obtained. An 8mm drill-hole was used to drill from the distal femoral neck along the femoral head axis, not penetrating the subchondral bone and cartilage. Afterwards, 1.4mm drill was used to penetrate the cartilage and subchondral bone of the femoral head for insertion of a pressure gage. Intraosseous pressure measurements were then recorded. The peri-prosthetic bone density was evaluated by Dual Energy X-ray Absorptiometry (DEXA) and Microradiography Computer Analysis in two stages: 1) with the peg unexpanded, and 2) with the peg expanded. In addition, Instron 8871 tested axial load, pullout and rotatory strengths of the peg. Results: Increased periprosthetic bone density following peg expansion was demonstrated on DEXA and microradiography with no increase in the intraosseous pressure. The friction coefficient of the bone implant interface, calculated by axial load measurements, was less than the coefficient of steel to steel. Pullout and rotatory strengths were as good as those reported for the
Introduction and aim. Avascular necrosis (AVN) of femoral head remains a major post-operative complication of the surgical fixation of femoral neck fractures (#NOF). In order to reduce the incidence of AVN following this type of fracture, the National Institute for Clinical Excellence (NICE) has stated that fixation must occur within 6 hours. However, there is a paucity of information concerning whether time to fixation influences the development of AVN. The aim of the present study was to assess whether time to fixation affects the development of AVN in patients aged under 60 who had sustained a fracture (#)NOF. Methods. We looked retrospectively at 101 patients (61 female, 40 male aged under 60 (mean age 47 years) who were admitted to a multi-tertiary centre having sustained an intracapsular #NOF. The underlying co morbidity of the patient sample was varied, as was the mechanism of trauma, though in the majority of cases the cause was a simple fall. The time delay (TD) between the time of injury and the time of operation for each patient was determined. Results. 72 patients sustained an intracapsular displaced fracture and 29 an intracapsular undisplaced fracture. Of these, 33 patients were treated with a
Purpose: The purpose of this study was to analyse mechanical failures involving dismonted osteosynthesis materials implanted to fix pertrochanteric or subtrochanteric fractures with a
Background: To determine patients clinical and haematological characteristics that could affect the use of blood and infection incidence with hip fractures (HF) treated with a
Because of the decreased holding power of the screws, fixation of osteoporotic fractures has a high failure rate (10%–25%). It should also be reported that even if fixation does not fail, several osteoporotic patients with fractures have unsatisfactory functional results due to bony malunion. Elderly patients with osteoporosis demand better fixation techniques. Treatment goals in this particular patient population include: proper fracture alignment, stable fixation and early rehabilitation. A surgeon should adopt a minimally-invasive technique in order to relieve the patient of physiological stress and allow for full-weight bearing of the fractured limb. Several fixation augmentation techniques have been proposed such as the use of PMMA, calcium phosphate cement, oblique screw insertion and cannulated ported screws. Our studies indicated that osteoporotic bone fixation can be greatly improved by using implants coated with calcium phosphates such as hydroxyapatite. Hip fractures are the most severe form of fracture in patients with osteoporosis. Cut-out of the load-bearing implant is seen more frequently compared to patients with good bone quality often leading to revision surgery. We compared
Digital radiographs are routinely used for preoperative planning, both in trauma and elective patients; particularly in preoperative templating for total hip replacement. Traditional wisdom holds that radiographs are oversized, though the degree to which this occurs is unclear. Although digital templating systems offer the use of calibration markers, this option is not always availed. We aimed to ascertain the typical magnification in departmental xrays of the hip, both to determine the typical degree of magnification as well as ascertain its consistency. All patients undergoing
Total hip arthroplasty (THA) is considered the preferred treatment for displaced proximal femoral neck fractures. However, in many countries this option is economically unviable. To improve outcomes in financially disadvantaged populations, we studied the technique of concomitant valgus hip osteotomy and operative fixation (VOOF). This prospective serial study compares two treatment groups: VOOF versus operative fixation alone with cannulated compression screws (CCSs). In the first series, 98 hip fixation procedures were performed using CCS. After fluoroscopic reduction of the fracture, three CCSs were placed. In the second series, 105 VOOF procedures were performed using a closing wedge intertrochanteric osteotomy with a compression lag screw and lateral femoral plate. The alignment goal was to create a modified Pauwel’s fracture angle of 30°. After fluoroscopic reduction of fracture, lag screw was placed to achieve the calculated correction angle, followed by inter-trochanteric osteotomy and placement of barrel plate. Patients were followed for a minimum of two years.Aims
Methods