Introduction. Continuous compression implants (CCIs) are small memory alloy bone staples that can provide continuous compression across a fracture site, which change shape due to temperature changes. Reviews of CCIs in orthopaedics have documented their use in mainly foot and ankle surgery, with very limited descriptions in trauma. They could be beneficial in the management of complex or open injuries due to their low profile and quick insertion time. The aim of this case series were to clarify the use of CCIs in modern day limb reconstruction practice. Materials & Methods. This was a single centred study looking retrospectively at prospective data for patients who were treated for an acute fracture or non-union with a CCI between September 2019 and May 2023. Primary outcome was to determine the function and indication of the CCI as judged retrospectively and secondary outcomes investigated unplanned returns to theatre for infection or CCI failure. Results. Sixty patients were eligible with a mean age of 44.2 (range 8–89). Fifty-one patients were treated for acute fractures, nine for non-unions; and almost half (27 patients) had open injuries. There were seven different sites for treatment with a CCI, the most common being tibia (25 patients) and humerus (14 patients). Of the 122 CCIs used, 80 were used as adjuncts for fixation in 48 patients. Their indication as an adjunct fell into three distrinct categories – reduction of fracture (39 CCIs), fixation of key fragments (38 CCIs) and compression (3 CCIs). Of these 48 patients, 4 patients had a frame fixation, 19 had a nail fixation, 24 patients had a plate fixation. Forty-two CCIs were used in isolation as definitive fixation, all were for midfoot dislocations expect an open iliac wing fixation from a machete attack and an isolated paediatric medial malleolus fixation. Two patients returned to theatre for infection and two due to CCI failure. Conclusions. This series has demonstrated the versality of CCIs across multiple sites of the body and for a large variety of injuries. It has identified, when not used in isolation, three main indications to support traditional orthopaedic fixations. Given the unpredictability in limb reconstruction surgery, the diversity and potential of CCIs could form part of the staple diet in the modern-day practice

Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery. Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged <18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery. Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41). Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings

Distal interphalangeal joint (DIPJ) fusion using a k-wire has been the gold standard treatment for DIPJ arthritis. Recent studies have shown similar patient outcomes with the headless compression screws (HCS), however there has been no cost analysis to compare the two. Therefore, this study aims to 1) review the cost of DIPJ fusion between k-wire and HCS 2) compare functional outcome and patient satisfaction between the two groups. A retrospective review was performed over a nine-year period from 2012-2021 in Counties Manukau. Cost analysis was performed between patients who underwent DIPJ fusion with either HCS or k-wire. Costs included were surgical cost, repeat operations and follow-up clinic costs. The difference in pre-operative and post-operative functional and pain scores were also compared using the patient rate wrist/hand evaluation (PRWHE). Of the 85 eligible patients, 49 underwent fusion with k-wires and 36 had HCS. The overall cost was significantly lower in the HCS group which was 6554 New Zealand Dollars (NZD), whereas this was 10408 NZD in the k-wire group (p<0.0001). The adjusted relative risk of 1.3 indicate that the cost of k-wires is 1.3 times more than HCS (P=0.0053). The patients’ post-operative PRWHE pain (−22 vs −18, p<0.0001) and functional scores (−38 vs −36, p<0.0001) improved significantly in HCS group compared to the k-wire group. Literatures have shown similar DIPJ fusion outcomes between k-wire and HCS. K-wires often need to be removed post-operatively due to the metalware irritation. This leads to more surgical procedures and clinic follow-ups, which overall increases the cost of DIPJ fusion with k-wires. DIPJ fusion with HCS is a more cost-effective with a lower surgical and follow-up costs compared to the k-wiring technique. Patients with HCS also tend to have a significant improvement in post-operative pain and functional scores

Introduction. Recent retrieval studies and registry reports have demonstrated an alarming incidence of early failure of metal-on-metal THR. This appears to be due to fretting and corrosion at the taper junction (trunnion) between the neck and large diameter heads in metal-on-metal hip implants. It has been proposed that designs with lower bearing clearances and greater cup flexibility deform during implantation leading to increased frictional torque and micromotion at the head-neck taper junction. Small movements at the trunnion may suggest elastic deformation, but large movements may suggest slippage at the friction interface. This study was conducted using retrieved metal-on-metal components to test the hypotheses that: 1. Cup deformation through localized compression leads to increased bearing torque, and 2. Increased torques generated in large head metal-on-metal bearings cause motion of the head-neck taper junction. Materials and Methods. Nine metal-on-metal hip implants were received from a national joint retrieval service and tested in a mechanical testing machine. The components were of three different designs (ASR, BHR, and Durom) and ranged in diameter from 42–54 mm. A custom jig was constructed to generate controlled radial compression at opposite points on the rim of an acetabular component. The jig was positioned inverted to the normal anatomical position and was angled to simulate the anatomical orientation of the cup (35° inclination, 10° anteversion). With the exception of an initial compression load of 100N, the cups were compressed at 200N intervals to a maximum of 2000N. Three trials at each cup compression load were performed. The torque developed about the trunnion axis was measured as the head articulated through a motion arc of 60° and the friction factor was calculated. Head–neck micromotion was continuously monitored using a non-displacement inductive transducer. Changes in micromotion from the 100N compression load were calculated. Results. With increasing cup compression loads, higher bearing torques were observed (R. 2. = 0.191; p < 0.001). Higher bearing torques in turn showed higher levels of trunnion movement (R. 2. = 0.555; p < 0.001). (Figure 1) Two cups showed stable bearing torques (range: 2.32 Nm to 2.49 Nm) and trunnion movement (range: −1.13 μm to 0.82 μm). Three cups showed increasing torques (range: 2.35 Nm to 4.57 Nm) and trunnion movement (range: −2.20 Nm to 6.46 Nm) with increased compression loads while four cups responded to increased compression loads with jumps in torque (range: 2.37 Nm to 5.55 Nm) and trunnion movement (range: −1.39 μm to 12.56 μm). The latter four cups experienced jumps in torque and trunnion movement at compression loads greater than 1000N. (Figures 2 and 3). Conclusions. 1. Increased torque as a result of cup compression leads to increased motion at the head-neck junction. 2. Cup design may contribute to the degree of trunnion movement due to increased bearing torque via cup compression, as higher cup compression loads do not necessarily correspond to higher torques. 3. Cups in which increased flexibility is not offset by large bearing clearances are at risk for binding of the head when implanted in rigid acetabula in which compressive loads can range up to 1800N

Standard Ilizarov technique uses the tensioned olive wires to provide interfragmentary compression in the acute fracture setting and in non-union surgery. In osteopenic metaphyseal bone this can lead to the olive “cutting through” the thin attenuated cortex reducing compression and stability. We describe a technique placing a percutaneous 3 hole Synthes Mini-fragment plate against the outer cortex of the bone fragment. An olive wire is then placed through each of the outer two holes and through the bone fragment. The construct is then tensioned. This stops the olive cutting into the bone and allows increased compression which is particularly important in non-union surgery

Background. Venous thromboembolism (VTE) is a common, costly, and morbid complication following TJA. Consequently, the current standard of care recommends that all TJA candidates receive some form of thromboprophylaxis postoperatively. Chemoprophylaxis, however, is not without its own risks and has been associated with greater risk of perioperative complications such as major bleeding, infection, stroke, and increased wound drainage. Mechanical compression devices serve as an alternative to chemoprophylaxis. Compression devices are thought to function by decreasing venous stasis and activating fibrinolysis. Intermittent pneumatic compression devices (IPCD) function by providing pressure at a constant cycle; whereas continuous enhanced circulation therapy (CECT) devices such as ActiveCare portable system (Medical Compression Systems, Or Akiva, Israel) function in a synchronized manner with the patient's own respiratory cycles. While both of these systems are widely utilized, there is scarce data comparing their effectiveness as thromboprophylatic agents following TJA. The purpose of this meta-analysis is to comparatively evaluate the efficacy of ActiveCare to IPCDs in the prevention of thromboembolic events following TJA. Methods. A literature search using PubMed, Cochrane, and EMBASE databases were used to identify all articles published between January 2000 and August 2016. Key words used to conduct the search were venous foot pump, intermittent pneumatic compression, total hip arthroplasty/replacement, total knee arthroplasty/replacement, deep vein thrombosis, thromboembolic disease and pulmonary emboli. Two independent investigators carried out the literature review using the PRISMA guidelines (Figure 1). Analysis of risk ratio was performed by evaluation of studies which compared IPCD with any control chemoprophylaxis regiment or ActiveCare with any control chemoprophlaxis regiment. Assessment of heterogeneity and analysis of data were operated by Review Manager 5.3. Results. Our primary search protocol yielded 968 individual studies by both reviewers of which 525 were duplicates. After screening the remaining 443 abstracts for relevancy 357 were excluded, leaving 86 for full text examination. After a thorough evaluation, 60 were further excluded, and a total of 24 studies, published between 2000 and 2014, were included for analysis, representing 9,134 patients. Of these, 13 were randomized controlled trials and 11 were retrospective studies. When compared to control chemoprophylactic groups, the risk ratio (RR) of DVT development was 0.51 (95% CI: 0.39 – 0.67; I. 2. =69%) with NSIPCDs and 0.47 (95% CI: 0.27 – 0.80; I. 2. =0%) with RSCDs. The RR for development of PE in these groups respectively were 0.24 (95% CI: 0.04 – 0.15) versus 0.55 (95% CI: 0.35 – 0.88) (Figure 3). Conclusion. When compared to chemoprophylaxis alone, compression devices appear to reduce the incidence of VTEs following TJA. The addition of mechanical prophylaxis to any chemoprophylactic regimen increased VTED prevention Following a comparative analysis of IPCDs and ActiveCare our study suggests that ActiveCare may be more effective at preventing VTE events, albeit not statistically significant. Thus, our results demonstrate that while both devices are effective thromboprophylactic modalities, more research is warranted to better elucidate the strengths and limitations of compression devices as thromboprophylatic agents. For any figures or tables, please contact the authors directly

In his classic monograph entitled Low Friction Arthroplasty of the Hip, which was published in 1979, John Charnley dedicated a chapter to thromboembolic complications. The overall incidence of pulmonary embolism (PE) was approximately 8% and the incidence of death from PE approximately 1%. Surveys of orthopaedic surgeons who undertake total joint replacement conducted by The American Association of Hip and Knee Surgeons (AAHKS), 30 years later, showed that there was still no consensus as to the best form of prophylaxis with a wide variation of methods being used. In the past 3 years, for the first time there is uniformity in the recommendations of the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). Both groups have reached an agreement that the rate of DVT formation is not the ideal endpoint to use when assessing the efficacy of thromboprophylaxis after joint replacement, as had been done in previous drug trials. Most of these DVTs are asymptomatic and of questionable clinical significance. At least one recent study brings into question the association between the rate of DVT formation and that of subsequent symptomatic events. Both groups also focus on minimizing iatrogenic bleeding complications, which can lead to compromised clinical results, including limited movement and pain in the case of knee replacement and increased risk of infection in both knee and hip replacement. To further complete the uniformity of approach in the United States, the Center for Medicare and Medicaid Services (CMS), which administers the Surgical Care Improvement Program (SCIP) that monitors hospital compliance with VTE prophylaxis of hospitalised patients, has also changed their policy. Beginning January 2014, either aspirin or a compression device has been considered as acceptable measures for THR, TKR and hip fracture. The remarkable success reported from many centers with the use of aspirin and/or the use of a mobile compression device in patients without major risk factors, such as a prior history of symptomatic VTE, clearly indicate that aggressive pharmacoprophylaxis is not necessary for the vast majority of patients who undergo joint replacement

Aims. Compression and absolute stability are important in intra-articular fractures such as transverse olecranon fractures. This biomechanical study aims to compare tension band wiring (TBW) with plate fixation by measuring compression within the fracture. Methods. A cross-over design and synthetic ulna models were used to reduce variation between samples. Identical transverse fractures were created using a 0.5mm saw blade and cutting jig. A Tekscan(tm) force transducer was calibrated and placed within the fracture gap. Twenty TBW or Acumed(tm) plate fixations were performed according to the recommended technique. Compression was measured while the constructs were static and during simulated elbow range of movement exercises. Dynamic testing was performed using a custom jig reproducing cyclical triceps contraction of 20N and reciprocal brachialis contraction of 10N. Both fixation methods were tested on each sample. Half were randomly allocated to TBW first and half to plating first. Data was recorded using F-scan (v 5.72) and analysed using SPSS(tm) (v 16). Paired T-tests compared overall compression and compression at the articular side of the fracture. Results. The mean overall compression for plating was 819N (+/− 602N 95%CI), TBW overall compression: 77N (+/−19N 95%CI) (P=0.039). Articular side compression for plating: 343N (+/− 276N 95%CI), TBW: 1N (+/− 2N 95%CI). (P=0.038). During simulated movements, overall compression reduced in both groups: TBW -14N (+/−7N) Plating -173N (+/−32N) and no increase in articular side compression was detected in the TBW group. Conclusion. Precontoured plates such as the Acumed(tm) olecranon system can provide significantly greater compression, compared to TBW in transverse olecranon fractures. This was significant for compression over the whole fracture surface and specifically at the articular side of the fracture. Also, in TBW, overall compression reduced and articular side compression remained negligible during simulated triceps contraction, challenging the tension band principle

Introduction. BAG-S53P4 has similar mechanical properties as cortical bone tissue and can be used as an additive to bone allografts. The aim of this study was to evaluate the effect of adding BAG-S53P4 to chemically treated allografts with controlled grain size distribution. Methods. Allografts were prepared and chemically cleaned under sterile conditions. 30 samples were mixed with BAG-S53P4 additive (BG) and compared to a control group (CG) with similar grain size distribution and composition in weight. All samples underwent a uniaxial compression test after compaction with a dropped weight apparatus. The yield limit was determined by a uniaxial compression test and density was recorded. The two groups were tested for statistical differences with the student's t-Test. Results. Adding BAG-S53P4 to the chemically treated allografts with controlled grain size distribution did not affect the yield limit after compaction. No statistically significant difference regarding the yield limit could be found between CG and BG after compaction (p=0.432).). The yield limit yield limit showed an increase of approximately 96% in CG and 93 % in BG, which confirms the importance of impacting bone chips used for load bearing applications like in hip arthroplasty. Conclusions. Adding BAG-S53P4 seems to have a less profound impact on the yield stress limit. In BG particles smaller than 4 mm were substituted with BAG-S53P4. Achieving a high density may not be the major goal for the bone remodeling process as it may actually obstruct new osteocytes from growing into the allograft material. Adding BAG-S53P4 seems to have limited impact on the yield stress limit. From a biomechanical point of view, BAG-S53P4 can be used as a substitute in total hip replacement if access to bone allograft material is limited

We report decreased clinical VTE rates following increased use of mechanical prophylaxis in elective kip and knee arthroplasty. Usage of intermittent pneumatic compression (IPC) increased due to the increased availability of pump machinery. Timing of IPC use also changed with IPC used intraoperatively on the unoperated limb and for a longer period postoperatively Clinical VTE rates are assessed for two years prior to the change in practice (1140 procedures) and two years afterwards (1285 procedures). There was no other change in practice (chemical thromboprophylaxis, anesthetic technique, use of compression stockings, usage of tourniquet or usage of cement) or in patient profile. Overall clinical VTE rates during admission dropped from 2.98% to 0.62% (p<0.0001). This decrease was seen in both hips 1.77% to 0.2% (p=0.029) and knees 3.97% to 0.89% (p=0.0002). There was a decrease in both pulmonary emboli 1.14% to 0.16% (p=0.0043) and symptomatic DVT 1.84% TO 0.47% (p=0.0023). There was no change in the rate of post discharge VTE events recorded 1.07% (p=0.57), either for DVT or PE (P=0.74 for each). We conclude that IPC with non-sequential calf compression is effective in reducing the rates of clinical in-hospital VTE after elective hip and knee arthroplasty

Background. Venous thromboembolism deterrent (TED) stockings are recommended for all orthopaedic patients. Clinical evidence supporting their use is limited and the risk of DVT increases four-fold if pressure gradients are reversed. This study aims to investigate the efficacy of TED stockings and their application using pressure gradients as the outcome measure. Methods. We audited TED stockings over two discrete periods. In the first, cases were assessed for sizing, cutting in and tolerance. In the second we added pressure measurements along the saphenous vein; before and 2 and 3 days after surgery. Between the 2 series, a more rigorous sizing and re-sizing protocol was implemented. Results. In the first period, 80% of TED stockings were incorrectly sized, 48% cut in and compliance was 60%. In the second period, 34% of stockings were incorrectly sized, 20% cut in and compliance was 93%. Reverse gradients were observed in 21% of patients. Conclusion. Previous studies had shown reverse gradients in 54% of cases however we found significantly fewer (P=0.000). We attribute this to better fitting rather than quality of the stockings. The effectiveness of graduated compression stockings is more practice than device dependent

Prospective Randomised Control trial of 300 patients over a period of 3 years, 1 year post op follow up. Local ethic approval was attained for the study. Inclusion criteria: Age > 60, Consented to Participate in the study, Unstable Inter trochanteric fracture a) Sub trochanteric b) Medial Comminution c) Reverse Obliquity D)Severe Osteoporosis. Patients selected were randomized to Intra medullary Nail vs Hips screw. Variety of markers have been assessed: Pre OP: - Mechanism of injury, Mobility status, Pre OP ASA, Pre Op haemoglobin, living Conditions. Intra OP:- I.I Time, Time taken, Surgeon experience, Intra OP complications. Post OP:- Haemoglobin, mobility, radiographic analysis-Fracture stability and Tip Apex Distance, Thrombo embolic Complications. Follow up: - 6 weeks, 3,6,12 month follow up. There is considerable debate in literature regarding superiority of Compression Hip screw over Intra medullary nail for fixation of stable per trochanteric fractures of the femur. Biomechanical studies have shown superiority of Intra medullary device over a Compression Hip screw. Tenser et all showed an advantage over combined bending and compression failure. Mohammad et al found unstable subtrochanteric fractures with a gamma nail were stiffer. Kerush-Brinker showed that gamma nail had significantly greater fatigue strength and fatigue life. In unstable fractures Baumgartner et al found less intra op complications and less fluoroscopic time for a compression hip screw compared to a short intra medullary nail. There have been significant reports of fracture at the Tip of a short intra medullary nail. We think this complication can be avoided by using a long intra medullary device. Both in Australia and abroad the choice of which device to use depends largely on the preference of the surgeon

Scaphoid fractures accounts for approximately 15% of all fractures of hand and wrist. Proximal pole fractures represent 10–20% of scaphoid fractures. Non –operative treatment shows high incidence of non-union and avascular necrosis. Surgical intervention with bone graft is associated with better outcome. The aim of this study was to evaluate the radiological and functional outcome of management of proximal pole scaphoid non-union with internal fixation and bone grafting. We included 35 patients with proximal pole scaphoid non-union (2008–2015). All patients underwent antegrade headless compression screw fixation and bone grafting at King's College Hospital, London (except one, who was fixed with Kirschner wire). 33 patients had bone graft from distal radius and two from iliac crest. Postoperatively patients were treated in plaster for 6–8 weeks, followed by splinting for 4–6 weeks and hand physiotherapy. All the patients were analysed at the final follow-up using DASH score and x-rays. Mean age of the patients was 28 years (20–61) in 32 men and 3 women. We lost three patients (9%) to follow up. At a mean follow up of 16 weeks (12–18) twenty three patients (66%) achieved radiological union. All patients but three (91%) achieved good functional outcome at mean follow up of 14 weeks (10–16). A good functional outcome can be achieved with surgical fixation and bone graft in proximal pole scaphoid fractures non-union. Pre-operative fragmentation of proximal pole dictates type of fixation (screw or k wire or no fixation). There was no difference in outcome whether graft was harvested from distal radius or iliac crest

Background. Vertebral body compression fractures (VCFs) impair quality of life (QOL) and increase patient morbidity and mortality. The international, multicentre, randomised, controlled Fracture Reduction Evaluation (FREE) trial was initiated to compare effectiveness and safety of Balloon kyphoplasty (BKP) to non-surgical management (NSM) for the treatment of acute painful VCFs. We describe the primary endpoint of the ongoing 2-year study. Methods. Patients with 1-3 non-traumatic VCFs (< 3 months old) were randomised to either BKP or NSM. The primary endpoint was the change in QOL as measured by the SF-36 Health Survey Physical Component Summary (PCS) at one month, and device/procedure-related safety. Secondary endpoints included SF-36 subscales, the EQ-5D, self-reported back pain and function using the Roland Morris Disability Questionnaire (RMDQ). All patients were given osteoporosis medical therapy. Results. Among the BKP (N=149) and NSM (N=151) cohorts, mean patient age was 73 years and 77% were female. Most patients had VCFs due to primary osteoporosis; 8 patients due to corticosteroid-induced osteoporosis, and 4 had cancer-related fractures. Thirty-nine BKP (26%) and 36 NSM (24%) patients had >1 VCF treated. At one month follow-up, the mean improvement in the PCS was in favour of BKP over NSM (p<0.0001). All physical component SF-36 subscales and the total EQ-5D score were significantly improved for BKP compared to NSM. Mean improvements in back pain at 7 days and 1 month were significantly greater for BKP compared to NSM (p<0.0001 at both time points). The improvement in RMDQ for BKP over NSM was also significant (p<0.0001). There was one soft tissue haematoma and urinary tract infection, with no bone cement-related serious adverse events. Conclusions. Compared to non-surgical management, balloon kyphoplasty demonstrated superior short-term pain, function and quality of life outcomes with no difference in serious adverse events for the treatment of acute, painful vertebral compression fractures. (Clinical trials.gov number, NCT00211211)

Aim. The aim of this study was to compare the results of humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of humerus. Material & methods. 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were Grade 1.2a compound fractures; Polytrauma; Early failure of conservative treatment; Unstable fracture. Patients with pathological fracture, Grade 3 open fracture, refracture or old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. Results. The outcome was assessed in terms of union time, union rate, functional outcome and incidence of complications. Functional outcome was assessed using the American Shoulder and Elbow Surgeons Score (ASES). On comparing the results by independent samples t test, there was no significant difference in ASES score between the two groups. The average union time was found to be significantly lower for IMN compared to DCP(P<.05). The union rate was found to be similar in both the groups. Complications like infection were found to be higher with DCP compared to IMN, while shortening of the arm (1.5-4cm) and restriction of shoulder movements due to impingement of the nail were found to be higher with DCP compared with IMN. However, this improved in all patients following removal of the nail once the fracture healed. Conclusion. This study proves that IMN can be considerd as a better surgical option for these fractures as it offers shorter union time and less incidence of serious complications like infection. However, there appears to be no difference between two groups in union rate and functional outcome

Introduction. In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty(BH), compression hip screw(CHS) and proximal femur nail antirotatory(PFNA) in treating comminuted intertrochanteric fractures(AO type, A2(21, 22, 23)). Materials and Methods. We retrospectively evaluated total 150 patients(BH:50, CHS:50, PFNA: 50) who were operated due to intertrochanteric fractures from March 2010 to Dec 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris hip score, ability of ambulation(Koval stage), visual analogue scale and radiologic limb length discrepancy(shortening). Landmark and radiologic length was checked. –A: postoperative length. –A’: POD 1year. –B: immediate posteopative contralateral length(from hip center to distal tip of lesser trochanter). –B’: POD 1year contralateral length(from hip center to distal tip of lesser trochanter). –. Limb length(shortening) was adjusted considering difference of magnification. = {A × (B’/B)}− A’. Results. There was no statistical significance among three groups in clinical outcomes including Harris hip score, ability of ambulation(Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively.(radiologic shortening- BH: 2.3mm, PFNA: 3.0mm, CHS:5.1mm, p=0.000). Conclusions. There were no clinical differences among BH, PFNA and CHS in this study. However, notable differences were observed in limb length discrepancy according to selection of operative methods

Background

Periprosthetic fracture fixation can be a difficult and complex procedure. The incidence of such fractures is increasing relative to the high prevalence of elderly patients with joint arthroplasty and osteoporosis. Locking plates were introduced for the management of complex periarticular fractures in osteoporotic bone, but there is little information on the use of these plates for the management of periprosthetic fractures. The purpose of this study was to review the early experience with these plates in managing complex Vancouver B1 and C periprosthetic fractures at our academic centre to determine the effectiveness in achieving union, and to identify any potential complications associated with their use.

Introduction. Despite the established guidelines on lower extremity free flap reconstruction by the British Orthopaedic Association Standard for Trauma (BOAST-4) the post-operative care has yet to be standardised. There is currently no coherent evidence in the literature regarding clinical monitoring, warming, dangling and compression; the optimal regimes and their respective physiological benefits. The aim of this study is to survey all UK Major Trauma Centres (MTCs) with regards to the post-operative care of lower extremity free flaps and elucidate the current protocols for clinical monitoring, warming, dangling and compression. Materials & Methods. All UK-based adult MTCs were surveyed. We formulated a detailed questionnaire to enquire about the post-operative care of lower extremity free flap reconstructions; the number of free flap reconstructions per month and take backs per month and for which post-operative methods a protocol is used in each MTC. We asked specific questions concerning: clinical monitoring, warming, dangling and compression. This questionnaire was distributed to consultant leads in the form of multiple choice questions, with an option of free-text box for further comments, using JISC online surveys. Results were analysed in Excel and presented in percentages. Results. The 28 adult MTCs were contacted. The results showed a lack of formal regional protocols with great variability, suggesting there is no general consensus on post-operative care of lower extremity free flap reconstructions with regards to clinical monitoring, warming, dangling and compression. Conclusions. This survey of UK MTCs on the post-operative protocols for lower extremity free flap reconstruction demonstrated lack of evidence, consensus and large variability in common practice which requires standardisation

Cryocompression therapy is a non-invasive and non-pharmacological modality used in managing acute post-operative inflammation and pain. A prospective, randomised controlled trial (RCT) was undertaken to evaluate the effectiveness of a post-operative cryocompression protocol using the Game Ready™ (GR) device versus usual care on recovery following total knee arthroplasty (TKA). A single centre RCT was conducted with 70 TKAs (68 patients) randomised to a 2-week intervention period consisting of treatment with GR cryocompression (n=33, 33.3% males) or a usual care protocol of ice with static compression using tubigrip (n=35, 54.3% males). Knee range of movement (ROM) (flexion and extension), a visual analogue pain score (VAS) and limb circumference were documented at day 1, 2 and 14, as well as 6 and 12 weeks post-surgery. ROM was also recorded at day 90, while medication use and length of hospital stay were documented. Patient reported outcome measures (PROMs) including the KOOS and patient satisfaction questionnaire were employed. The GR group demonstrated 2.3° more (p=0.05) knee extension ROM overall, as well as 2. 8° more at day 1 (p=0.048), 3.8° at day 14 (p=0.007) and 5.4° at 3 months (p=0.017). There were no group differences (p>0.05) observed in pain (VAS), flexion ROM, limb circumference, opioid use or other PROMs. Across the full cohort, higher pain levels resulted in increased opioid intake (p=0.002), older patients used significantly less opioids (p<0.001) and males reported significantly less pain (VAS) than females (p=0.048). Using GR following TKA is a safe, non-invasive tool that can be used to aid in the post-operative recovery period. Patients using the GR cryocompression device gained significantly more extension ROM compared to the conventional ice with compression group, despite no other group differences

Abstract. A study was done to test the strength of various configurations of tension band wiring (TBW) and we report clinical results of ‘Horizontal Figure of Eight TBW’ (H – 8 TBW). In an experimental lab, a model of the fractured patella was mounted on a Nene tensile testing machine and various configurations of TBWs were tested in different positions of Kirschner wires. The strength of TBW and various knots securing the ends of wires were analysed on load/displacement graphs. The experimental results were compared with the theoretical results using trigonometry and mathematical equations. Since 1986, H – 8 TBW (Sonanis and Bhende modification) was used clinically in 42 patients (40 fractured patella, and 2 greater trochanteric osteotomies) in 26 males and 16 females and all patients were followed up to average 18 months. Experimentally H – 8 TBW (0.8mm wire) could resist maximum distraction force of 700 N and achieved maximum compression. Placement of the two Kirschner wires at the mid way between centre and edge of patella at the level of fracture site achieved optimum rotational stability and compression. Crimping method of gripping the ends of wires was the most secured method (120 N). Clinically bony union using H-8 TBW was achieved in all 41 patients. Complications seen were wire discomfort in 3 patients and one death. We conclude that H – 8 TBW achieved maximum compression, optimum K wire placement was at the 1/4th distance from the edge of the patella, and crimping the ends of wire secured best fixation