Systemic antibiotics reduce infection in open
fractures. Local delivery of antibiotics can provide higher doses
to wounds without toxic systemic effects. This study investigated
the effect on infection of combining systemic with local antibiotics
via polymethylmethacrylate (PMMA) beads or gel delivery. An established Staphylococcus aureus contaminated
fracture model in rats was used. Wounds were debrided and irrigated
six hours after contamination and animals assigned to one of three
groups, all of which received systemic antibiotics. One group had
local delivery via antibiotic gel, another PMMA beads and the control
group received no local antibiotics. After two weeks, bacterial
levels were quantified. .
Objective.
Aim of this study was to review a single surgeon series and analyse the results of hip reconstruction and compare them to an historical cohort. Retrospective review from a prospective database was undertaken of 113 CFD children since 1999. 31 of these patients had hip reconstruction with combined soft tissue and bony procedures akin to the Superhip. This cohort was compared to the results of the previous series using deformity planning methods on radiographic imaging, quantification of acetabular and femoral geometry, focussing upon the effects and results of hip reconstruction and lengthening. Compared to the previous series, this cohort achieved greater objective increases in length and significantly fewer complications involving the hip joint during the process.11 hips out of 45 (24.4%) that were treated in the previous cohort subluxed during lengthening. Since 1999 there were no subluxations with improved hip geometry. Primary difference between the cohorts was the recent group's preparatory hip surgery before the commencement of any lengthening even for borderline dysplasias. This had not been the case for all children in the previous cohort. This indicates a steep learning curve in the last 3 decades concerning the importance of primary hip reconstruction as a preparatory stage of treatment before lengthening in CFD with almost normalised acetabulae.Introduction
Methods and results
A total of 11 patients with combined traumatic injuries of the brachial plexus and spinal cord were reviewed retrospectively. Brachial plexus paralysis in such dual injuries tends to be diagnosed and treated late and the prognosis is usually poor. The associated injuries, which were all on the same side as the plexus lesion, were to the head (nine cases), shoulder girdle (five), thorax (nine) and upper limb (seven). These other injuries were responsible for the delayed diagnosis of brachial plexus paralysis and the poor prognosis was probably because of the delay in starting treatment and the severity of the associated injuries. When such injuries are detected in patients with spinal cord trauma, it is important to consider the possibility of involvement of the brachial plexus.
The options for the treatment of the young active patient with unicompartmental symptomatic osteoarthritis and pre-existing Anterior Cruciate Ligament (ACL) deficiency are limited. Patients with ACL deficiency and end-stage medial compartment osteoarthritis are usually young and active. The Oxford Unicompartmental Knee Replacement (UKA) is a well established treatment option in the management of symptomatic end-stage medial compartmental osteoarthritis, but a functionally intact ACL is a pre-requisite for its satisfactory outcome. If absent, high failure rates have been reported, primarily due to tibial loosening. Previously, we have reported results on a consecutive series of 15 such patients in whom the ACL was reconstructed and patients underwent a staged or simultaneous UKA. The aim of the current study is to provide an update on the clinical and radiological outcomes of a large, consecutive cohort of patients with ACL reconstruction and UKA for the treatment of end-stage medial compartment osteoarthritis and to evaluate, particularly, the outcome of those patients under 50. This study presents a consecutive series of 52 patients with ACL reconstruction and Oxford UKA performed over the past 10 years (mean follow-up 3.4 years). The mean age was 51 years (range: 36–67). Procedures were either carried out as Simultaneous (n=34) or Staged (n=18). Changes in clinical outcomes were measured using the Oxford Knee Score (OKS), the change in OKS (OKS=Post-op − Pre-op) and the American Knee Society Score (AKSS). Fluoroscopy assisted radiographs were taken at each review to assess for evidence of loosening, radiolucency progression, (if present), and component subsidence.Introduction
Methods
To improve patient pathways we have, in selected patients, begun to acutely apply circular (rather than temporary monolateral) fixators with simultaneous or subsequent soft tissue closure. We present early results. Adult patients treated using an Ilizarov frame prior to soft tissue management were identified from our Ilizarov database. This data was supplemented by medical record review.Background
Methods
Primary malign tumors and solitary metastatic lesions of the thoracic and thoracolumbar spine are indications for radical en bloc resections. Extracompartimental tumor infiltration makes the achievement of adequate oncological resection more difficult and requires an extension of the resection margins. We present a retrospective clinical study of patients that underwent chest wall resection in combination with vertebrectomy due to sarcomas and solitary metastases for assessing the clinical outcome especially focusing on onco-surgical results. From 01/2002 to 01/2009 20 patients (female/male: 8/12; mean age: 52 (range of age: 27–76yrs)) underwent a combined en bloc resection of chest wall and vertebrectomy for solitary primary spinal sarcoma and metastatic lesions. The median follow-up was 20,5 (3–80) months. Histological analysis revealed 17 primary tumors and 3 solitary metastatic lesions. In the group of primary tumors 10 sarcomas, 1 giant cell tumor, 2 PNET, 1 histiocytoma, 1 aggressiv fibrous dysplasia, 1 pancoast tumor and 1 plasmocytoma were histologically documented. We included 1 rectal carcinoma, 1 breast cancer metastases and 1 renal cell carcinoma. All patients underwent a chestwall resection en bloc with multilevel (1/2/3/4 segments: n=4/6/6/4) hemi (n=7) or total vertebrectomy (n=13) with subsequent defect reconstruction. Reconstruction of the spinal defect following total resections was accomplished by combined dorsal stabilization and carbon cage interposition. The chest wall defects were closed with a goretex ® -patch. One patient also received a musculocutaneus latissimus dorsi flap.Introduction
Method
Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients available for review. Mean follow up was 24 months(1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their overall experience as excellent or good. Mean return to work was at 100 days(0–280) and mean postoperative pain relief was 23 days(1–56). 55% returned to sport at their pre-injury level. There was one case (4.5%) of heterotopic calcification with 3 superficial infections(14%). There were no intra or postoperative radial fractures, metalwork failures or metalwork soft tissue irritations. Mean pre-operative Oxford Elbow Scores were 18(6–37) and post operative 43(24–48) (p<0.00001). Mean pre-operative Mayo scores were 48(5–95) and post-operative were 95(80–100)(p<0.00001). Our study supports that distal biceps repairs using the endobutton and interference screw technique appears to lead to high patient satisfaction rates with a relatively early return to function.
Wear particles are considered to be the major culprit for the aseptic loosening. Their characterization is thus crucial for the understanding of their bioreactivity and contribution to the development of aseptic loosening. Metal wear debris particles were analyzed directly in periprosthetic tissue resins by scanning electron microscopy (SEM) combined with back-scattered electron imaging (BSE) and energy dispersive X-ray spectroscopy (EDS). Four groups of tissue samples retrieved at revision operations of loosened hip implants with different bearing surfaces (metal-on-metal, ceramic-on-polyethylene and metal-on-polyethylene), and different material of the femoral stem (Ti alloy, CoCrMo and polymer combined with stainless steel) were investigated. Tissue samples were first analyzed histologicaly. Sections from the same paraffin blocks were then carbon coated and analyzed using SEM/BSE/EDS method.Background
Methods
We compared pain relief after total hip arthroplasty using periarticular intraoperative injection along with single dose post operative injection of local anesthetic (THA) with the well-established practice of epidural infusion. 70 patients undergoing elective THA under combined spinal anaesthesia were randomly assigned to receive either (1) continuous epidural infusion (group B) or (2) infiltration around the hip joint with a mixture of 100 ml of bupivacaine (2 mg/ml) + 1ml ketorolac (30mg/ml) and 0.5ml epinephrine (1mg/ml) at the conclusion of surgery combined with one postoperative intraarticular injection of 20 ml. of Bupivacaine 0.5% + 1ml ketorolac (30mg/ml)+ 0.5 ml. epinephrine (1mg/ml) through an intraarticular catheter (group A). All patients received acetoaminophen 1gm 8 hourly for 72 hrs and injection ketoralac 30mg every 6 hourly IV(15mg if >65 yr 30mg if <65 yr). Breakthrough pain in any group (VAS >7) was treated by injection fentanyl 20 μg bolus at 10 min. interval till VAS reduced to < 4. If VAS 4–7 injection tramadol 50mg IV was given if VAS continued to be >4 after 15 min. then injection fentanyl 20 μg bolus was given at 10 min interval till VAS <4.Background
Methods
The availability of seven-day NHS services for patients is currently receiving widespread national attention. Rehabilitation services including physiotherapy and occupational therapy are not routinely available at the weekend. The aim of this pilot study was to determine if seven-day rehabilitation services led to improved outcomes for hip fracture patients. All proximal femur fractures were included and formed into two cohorts. Data were collected prospectively in each cohort. Cohort one underwent standard five-day rehabilitation (n=79). Cohort two received seven-day rehabilitation (n=338). Both groups were followed up to 120 days. No significant differences were observed between the cohorts for pre-fracture place of residence, ASA score or age.
Femoral periprosthetic fractures are rising in incidence. Their management is complex and carries a high associated mortality. Unlike native hip fractures, there are no guidelines advising on time to theatre in this group. We aim to determine whether delaying surgical intervention influences morbidity or mortality in femoral periprosthetic fractures. We identified all periprosthetic fractures around a hip or knee arthroplasty from our prospectively collated database between 2012 and 2021. Patients were categorized into early or delayed intervention based on time from admission to surgery (early = ≤ 36 hours, delayed > 36 hours). Patient demographics, existing implants, Unified Classification System fracture subtype, acute medical issues on admission, preoperative haemoglobin, blood transfusion requirement, and length of hospital stay were identified for all patients. Complication and mortality rates were compared between groups.Aims
Methods
Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established.Aims
Methods
Fractures of the distal radius are common, and form a considerable proportion of the trauma workload. We conducted a study to examine the patterns of injury and treatment for adult patients presenting with distal radius fractures to a major trauma centre serving an urban population. We undertook a retrospective cohort study to identify all patients treated at our major trauma centre for a distal radius fracture between 1 June 2018 and 1 May 2021. We reviewed the medical records and imaging for each patient to examine patterns of injury and treatment. We undertook a binomial logistic regression to produce a predictive model for operative fixation or inpatient admission.Aims
Methods
Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.Aims
Methods
This study estimated trends in incidence of open fractures and the adherence to clinical standards for open fracture care in England. Longitudinal data collected by the Trauma Audit and Research Network were used to identify 38,347 patients with open fractures, and a subgroup of 12,170 with severe open fractures of the tibia, between 2008 and 2019 in England. Incidence rates per 100,000 person-years and 95% confidence intervals were calculated. Clinical care was compared with the British Orthopaedic Association Standards for Trauma and National Major Trauma Centre audit standards.Aims
Methods
Improving periprosthetic bone is essential for implant fixation and reducing peri-implant fracture risk. This studied examined the individual and combined effects of iPTH and mechanical loading at the cellular, molecular, and tissue level for periprosthetic cancellous bone. Adult rabbits had a porous titanium implant inserted bilaterally on the cancellous bone beneath a mechanical loading device on the distal lateral femur. The right femur was loaded daily, the left femur received a sham loading device, and half of the rabbits received daily PTH. Periprosthetic bone was processed up to 28 days for qPCR, histology, and uCT analysis. We observed an increase in cellular and molecular markers of osteoblast activity and decrease in adipocytic markers for both treatments, with small additional effects in the combined group. Loading and iPTH led to a decrease and increase, respectively, in osteoclast number, acting through changes in RANKL/OPG expression. Changes in SOST and beta-catenin mRNA levels suggested an integral role for the Wnt pathway. We observed strong singular effects on BV/TV of both loading (1.53 fold) and iPTH (1.54 fold).
Total knee arthroplasty (TKA) is an established and successful operation. However patient satisfaction rates vary from 81 to 89% 1,2,3. Pain following TKA is a significant factor in patient dissatisfaction 1. Many causes for pain following total knee arthroplasty have been identified 4 but rates of unexplained pain vary from 4 to 13.1% 5,6. Recently computerised tomography (CT) has been used to assess the rotational profile of both the tibial and femoral components in painful TKA. We reviewed 57 patients with an unexplained painful following TKA and compared these to a matched control group of 60 patients with TKA. Datum gathered from case notes and radiographs using a prospective database to identify patients. The CT information recorded was limb alignment, tibial component rotation, and femoral component rotation and combined rotation. The two matched cohorts of patients had similar demographics. A significant difference in tibial, femoral and combined component rotation was identified between the groups. The following mean rotations were identified for the painful and control groups respectively. Tibial rotation was 3.46 degrees internal rotation (IR) compared to 2.50 degrees external rotation (ER)(p=0.001). Femoral rotation was 2.30 IR compared to 0.36 ER(p=0.02).
Background. Anterior Cruciate Ligament Reconstruction is a commonly performed orthopaedic operation. The use of a four-strand semitendinosus and gracilis hamstring graft (STG) is a well established method of reconstruction to restore knee stability. Aim. To assess the ten year subjective knee function and activity level following STG anterior cruciate ligament reconstruction. Methods. 86 patients underwent anterior cruciate reconstruction by two knee surgeons in the year 1999. 80 patients meet the inclusion criteria of STG reconstruction by a standard operative technique. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up. Results. 80 patients underwent anterior cruciate reconstruction with average age 30.9 years +/− 8.8 (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire. The mean Lysholm Knee Score at ten years was 78.4 +/− 12.8 (39 to 90). The mean activity level had decreased from 8.3 to 5.3 at ten years according to the Tegner Activity Scale. 11 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a Lysholm Knee Score of 67.6 +/− 19.1 and Tegner Activity Scale of 3.9 at ten years following reconstruction. 17 of the 80 patients (21.25%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture. Conclusion. Anterior Cruciate Ligament Reconstruction with four-strand STG hamstring graft provides a reliable method of restoring knee function with a 5% revision rate for re-rupture at ten years.
