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The Bone & Joint Journal
Vol. 103-B, Issue 5 | Pages 902 - 907
1 May 2021
Marson BA Ng JWG Craxford S Chell J Lawniczak D Price KR Ollivere BJ Hunter JB

Aims

The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of ‘off-ended’ fractures in children with at least two years of potential growth remaining.

Methods

A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires.


The Bone & Joint Journal
Vol. 101-B, Issue 6 | Pages 635 - 638
1 Jun 2019
Marson BA Hunter JB Price KR

Aims

The aim of this study was to review the value of accepting referrals for children with ‘clicky hips’ in a selective screening programme for hip dysplasia.

Patients and Methods

A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant.


The Bone & Joint Journal
Vol. 98-B, Issue 1 | Pages 131 - 136
1 Jan 2016
Kurien T Price KR Pearson RG Dieppe C Hunter JB

A retrospective study was performed in 100 children aged between two and 16 years, with a dorsally angulated stable fracture of the distal radius or forearm, who were treated with manipulation in the emergency department (ED) using intranasal diamorphine and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs, the final radiographs and the clinical notes were reviewed. A successful reduction was achieved in 90 fractures (90%) and only three children (3%) required remanipulation and Kirschner wire fixation or internal fixation.

The use of Entonox and intranasal diamorphine is safe and effective for the closed reduction of a stable paediatric fracture of the distal radius and forearm in the ED.

By facilitating discharge on the same day, there is a substantial cost benefit to families and the NHS and we recommend this method.

Take home message: Simple easily reducible fractures of the distal radius and forearm in children can be successfully and safely treated in the ED using this approach, thus avoiding theatre admission and costly hospital stay.

Cite this article: Bone Joint J 2016;97-B:131–6.


The Bone & Joint Journal
Vol. 97-B, Issue 4 | Pages 558 - 563
1 Apr 2015
Windolf M Fischer MF Popp AW Matthys R Schwieger K Gueorguiev B Hunter JB Slongo TF

End caps are intended to prevent nail migration (push-out) in elastic stable intramedullary nailing. The aim of this study was to investigate the force at failure with and without end caps, and whether different insertion angles of nails and end caps would alter that force at failure.

Simulated oblique fractures of the diaphysis were created in 15 artificial paediatric femurs. Titanium Elastic Nails with end caps were inserted at angles of 45°, 55° and 65° in five specimens for each angle to create three study groups. Biomechanical testing was performed with axial compression until failure. An identical fracture was created in four small adult cadaveric femurs harvested from two donors (both female, aged 81 and 85 years, height 149 cm and 156 cm, respectively). All femurs were tested without and subsequently with end caps inserted at 45°.

In the artificial femurs, maximum force was not significantly different between the three groups (p = 0.613). Push-out force was significantly higher in the cadaveric specimens with the use of end caps by an up to sixfold load increase (830 N, standard deviation (SD) 280 vs 150 N, SD 120, respectively; p = 0.007).

These results indicate that the nail and end cap insertion angle can be varied within 20° without altering construct stability and that the risk of elastic stable intramedullary nailing push–out can be effectively reduced by the use of end caps.

Cite this article: Bone Joint J 2015;97-B:558–63.


The Bone & Joint Journal
Vol. 95-B, Issue 6 | Pages 846 - 850
1 Jun 2013
Price KR Dove R Hunter JB

Most centres in the United Kingdom adopt a selective screening programme for developmental dysplasia of the hip (DDH) based on repeated clinical examination and selective ultrasound examination. The Newborn Infant Physical Examination protocol implemented in 2008 recommends a first examination at birth and then a second and final examination at six to ten weeks of age. Due to concerns over an increase in late presentations we performed a retrospective review of our 15-year results to establish if late presentation increases treatment requirements. Of children presenting before six weeks of age, 84% were treated successfully with abduction bracing, whereas 86% of children presenting after ten months eventually required open reduction surgery. This equates to a 12-fold increase in relative risk of requiring open reduction following late presentation. Increasing age at presentation was associated with an increase in the number of surgical procedures, which are inevitably more extensive and complex, with a consequent increased in cost per patient. The implementation of an opportunistic examination at three to five months could help to reduce the unintended consequences of the Newborn Infant Physical Examination programme.

Cite this article: Bone Joint J 2013;95-B:846–50.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_24 | Pages 2 - 2
1 May 2013
Price K Dove R Hunter JB
Full Access

Aim

The objective was to assess whether late presentation of DDH leads to an increase in treatment magnitude and cost.

Method

This was a retrospective review of prospectively collected data from our hip instability clinic database. All patients presenting to our hip instability clinic that required any form of treatment for DDH between 1990 and 2005 were included. Children were grouped according to age at presentation and then treatment requirements were reviewed. Average costs were calculated based on procedures performed.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 153 - 153
1 Feb 2003
Davy AR Goldberg A Hunter JB Wenham PW Moran CG
Full Access

To investigate the incidence of PTS in patients with veno-graphically proven DVT following hip or knee replacement surgery, patients were derived from a randomised controlled trial of LMWH versus unfractionated heparin prophylaxis in 500 total hip or knee replacement patients. Surveillance venogram at 10 days detected DVT in 93 patients, and these were warfarinised for 3–6 months. At a minimum follow-up of 7 years, patients were assessed by clinical examination, questionnaire and application of two scoring systems; a modified PTS score based on the Browse score, and the clinical component of the International Consensus Committee on Chronic Venous Disease classification (ICC-CVD).

70 patients (21 deaths and 2 non-responders, follow-up rate 97%) with 32 THR and 38 TKR were studied. 63% patients were female, and average age was 74 years. Leg ache (46%) and swelling (42%) were the most common subjective complaints, but 40% patients had no complaints. Objectively, leg swelling was observed in 52% of patients, varicose veins in 26%, but ulceration was seen in only 3% of patients. The modified PTS score showed 14% patients had no symptoms, 64% mild symptoms, 19% moderate and 3% severe symptoms of PTS. The ICC-CVD score revealed 27% with no symptoms, 53% mild symptoms, 17% moderate and 3% severe symptoms of PTS. There was good correlation between the scoring systems for moderate and severe disease, but the modified PTS may have overestimated the incidence of mild PTS.

Severe symptomatic PTS is rare following early detection and treatment of DVT after total hip and knee replacement.


The Journal of Bone & Joint Surgery British Volume
Vol. 84-B, Issue 8 | Pages 1173 - 1175
1 Nov 2002
Forward DP Hunter JB

The operative treatment of septic arthritis of the shoulder in infants has been facilitated by the use of a 30° wrist arthroscope. We have treated three children under the age of three years using this technique. After initial aspiration of the joint, an arthroscope was inserted using the posterior approach. Washout was performed under direct vision and complete clearance of pus allowed assessment of the inflammation and the damage to articular cartilage. The procedure was minimally invasive and gave excellent cosmesis without compromising care. Full recovery was achieved with a single intervention.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 6 | Pages 934 - 934
1 Aug 2001
Hunter JB


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 7 | Pages 1083 - 1083
1 Sep 2000
CHELL J HUNTER JB


The Journal of Bone & Joint Surgery British Volume
Vol. 82-B, Issue 5 | Pages 643 - 645
1 Jul 2000
Mohan N Hunter JB Colton CL

Our study describes a posterolateral approach to the distal humerus for open reduction and internal fixation of displaced fractures of the lateral condyle. A total of 20 patients had open reduction and internal fixation over a four-year period using this approach, and at a mean follow-up of 12 months had full union, range of movement and no complications, either clinical or radiological. This approach is well suited to the exact visualisation and accurate reduction of this difficult fracture with minimal dissection of tissues.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 603 - 608
1 Jul 1997
Massoud SN Hunter JB Holdsworth BJ Wallace WA Juliusson R

We have studied aseptic loosening of the femoral component in 76 patients with primary total hip replacement using the Capital prosthesis. The mean follow-up was 26 months (10 to 37).

Twelve femoral components (16%) were definitely and eight (10%) were possibly loose. They were characterised by a thin cement mantle (p < 0.001) and excessive residual cancellous bone in the proximomedial region (p < 0.01).

We recommend that the cement mantle around the prosthesis should be 2 to 3 mm and that further long-term studies are needed to evaluate the wear properties of titanium-nitride-coated titanium femoral heads.