Introduction. Degenerative disc disease results from mechanical alteration of the intervertebral disc. Biochemical modifications of the nucleus matrix are also incriminated. Furthermore, genetic predispositions as well as vascular factors have been advocated in the process of disc degeneration. A relationship between sciatica and Propionibacterium acnes has been described. However, it remains unclear if the hypothesis of a subclinical spondylodiscitis might play a role in the pathophysiology of degenerative disc disease. The purpose of this study was to analyze the possible presence of bacteria in lumbar discs of patients with degenerative disc disease. Methods. We prospectively analyzed the presence of bacteria in 83 patients (34 males and 49 females, average age 41 years) treated by lumbar disc replacement at L3-L4, L4-L5 or L5-S1. An intraoperative biopsy and microbiological culture were performed for each disc to determine if intradiscal bacteria were present. Great care was taken to avoid any source of contamination during the conditioning process of the biopsy. Microbiological results were compared to the magnetic resonance stages of disc degeneration according to the Pfirrmann and Modic classifications. Possible sources of previous iatrogenic disc contamination after discography or nucleotomy were analyzed. Results. The magnetic resonance stages were Pfirrmann IV or V, with Modic I signs in 32 and Modic II in 25 cases. A preoperative discography was performed in 49 patients, and 24 had previous nucleotomy. Germs were found in 40 discs, 43 cultures were steriles. The following bacteria were evidenced: Propionibacterium acnes 18, Staphylococcus coagulase negative 16, Staphylococcus aureus 3, Gram negative bacilli 3, Micrococcus 3, Corynebacterium 3, others 5. Ten biopsies presented several different germs. Bacteria were predominantly found in males (p=0.012). The mostly positive level was L4-L5 (p=0.075). Histological examination of 31 discs found inflammatory cells in 33 % of the biopsies with positive bacterial culture, versus 5 % of the sterile biopsies (p=0.038). There was no significant relationship between bacterial evidence and Modic sign. A preoperative discography or previous nucleotomies did not represent significant contamination sources. None of the patients presented clinical signs of infection. Conclusions. The finding of bacteria in 48 % of disc biopsies, presence of inflammatory cells at histological examination, the absence of responsibility of the discography as a factor of contamination, and the absence of clinical post-operative infection, defend the hypothesis of a low-grade spondylodiscitis which might play a role in the pathophysiology of degenerative disc disease. On the other hand, the presence of skin commensal bacteria, of ¼ of polymicrobial biopsies, and the fact that previous nucleotomy doesn't seem to be involved in inoculation, cannot allow to eliminate a contamination of the samples. Further studies are necessary to elucidate the responsability of intradiscal bacteria in degenerative disc disease. This could influence our treatment strategy of back pain, which could be based in the future on antibiotics

Introduction. Chronic pain is one of the adverse outcomes in surgery for degenerative lumbar pathology (DLP). Postoperative complications as DVT, and chronic pain in pathologies as thoracotomy or breast cancer have been associated with poor control of postoperative pain. Study design. Prospective study of patients undergoing surgery for DLP. Purpose. To evaluate the relationship of postoperative pain with final outcomes in terms of chronic pain and quality of life. Outcome measures. Visual analogue scales (VAS) to assess lumbar and leg pain, Short Form-36v2 (SF-36), Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI). Method. 263 patients with a mean age of 54.0 years (22–86 y) were reviewed and 131 patients were women (49.8%). Pain, quality of life and disability of patients were assessed in the immediate preoperative and 2 years after surgery. Epidemiological data collected were age, sex, educational level, employment status, diagnosis, treatment, and comorbidity (ASA). An external nurse evaluated postoperative pain four times every day and we selected the worst value of day. The reference value of postoperative pain was the VAS of third day when patient starts standing and PCA is removed. To compare means we used t-Student and Pearson's coefficient or Spearman's test was used to assess the correlation, and, finally, linear regression study (ANOVA) was performed with variables that showed statistically significant correlation. SPSS 15.0 statistical package. Results. The mean value of VAS on 3rd day (VAS-3) was 2.86 ± 2.2. Postoperative pain showed a moderately positive correlation with final pain, measured by Bodily Pain (r=0.310, p <0.05) and final VAS (r=0.318, p <0.001), and moderately negative with the Physical Component Scale of the SF36 (r=−0.269, p <0.05). No significant correlations existed with the other instruments. Preoperative pain, sex and MSC-SF36 was correlated with postoperative pain (r=0.262 p <0.05; r=− 0.261 p <0.003, r=− 0.306 p <0.001). According to linear regression studies each point in the VAS-3 will be an increase of 0.522 points in the final VAS (p <0.01). Conclusions. Postoperative pain has moderate but statistically significant influence in the final lumbar pain perception, assessed by VAS and Bodily Pain. Postoperative pain has an inverse relationship to the physical component of SF-36. However, postoperative pain is not correlated with disability measured by ODI or COMI

We re-examined clinically and radiologically 88 patients with a fracture of the lower leg at a mean follow-up of 15 years. Forty-three fractures (49%) had healed with malalignment of at least 5°. More arthritis was found in the knee and ankle adjacent to the fracture than in the comparable joints of the uninjured leg. Malaligned fractures showed significantly more degenerative changes.

Eighteen patients (20%) had symptoms in the fractured leg. There was a significant correlation between symptoms in the knee and arthritis but not between symptoms and ankle arthritis or malalignment.

We conclude that fractures of the lower leg should be managed so that the possibility of angular deformity and thereby late arthritis is minimised.

Aims

The aim of this study was to report the three-year follow-up for a series of 400 patients with a displaced intracapsular fracture of the hip, who were randomized to be treated with either a cemented polished tapered hemiarthroplasty or an uncemented hydroxyapatite-coated hemiarthroplasty.

Aims

To assess the feasibility of a randomized controlled trial (RCT) that compares three treatments for acetabular fractures in older patients: surgical fixation, surgical fixation and hip arthroplasty (fix-and-replace), and non-surgical treatment.

There is limited long term evidence to support instrumented fusion as an adjunct to decompression for foraminal stenosis in the presence of single level degenerative disc disease. We report the long term outcome of a prospective randomised controlled trial. Forty-four patients with single-level disc disease were randomly assigned to three groups (spinal decompression (Group 1), decompression and instrumented posterolateral fusion (Group 2), or decompression and instrumented posterolateral fusion plus transforaminal interbody fusion (Group 3). Spinal disability (Dallas, Roland Morris, and Lower Back Outcome Score [LBOS]), and quality of life (EuroQol (EQ) and short form (SF-) 36 questionnaires) were assessed before and at after surgery by independent researchers. At mean of 15 years follow up 33 (75%) patients were available for assessment. All groups observed a significant improvement in the EQ-5D at final follow up. Group 1 demonstrated significantly better functional outcome at final follow up according to the Dallas, Roland Morris, LBOS, and EQ-5D (3L and VAS) scores when compared to the other two groups (p<0.01). The SF-36 score demonstrated that group 1 had significantly better generic health scores compared to groups 2 and 3. Regression analysis was used to adjust for the differences in general health between the groups and demonstrated no significant difference between the groups in the spine specific scores: Dallas (p>0.15), Roland Morris (p>0.37), or the LBOS (p>0.32). Fusion in combination with decompression for the treatment of foraminal stenosis and single level degenerative disc disease offers no long term functional benefit over decompression in isolation

Aims. We aimed to identify the pattern of nerve injury associated with paediatric supracondylar fractures of the humerus. Patients and Methods. Over a 17 year period, between 1996 and 2012, 166 children were referred to our specialist peripheral nerve injury unit. From examination of the medical records and radiographs were recorded the nature of the fracture, associated vascular and neurological injury, treatment provided and clinical course. Results. Of the 166 patients (111 male, 55 female; mean age at time of injury was seven years (standard deviation 2.2)), 26 (15.7%) had neurological dysfunction in two or more nerves. The injury pattern in the 196 affected nerves showed that the most commonly affected nerve was the ulnar nerve (43.4%), followed by the median (36.7%) and radial (19.9%) nerves. A non-degenerative injury was seen in 27.5%, whilst 67.9% were degenerative in nature. Surgical exploration of the nerves was undertaken in 94 (56.6%) children. The mean follow-up time was 12.8 months and 156 (94%) patients had an excellent or good clinical outcome according to the grading of Birch, Bonney and Parry. Conclusion. Following paediatric supracondylar fractures we recommend prompt referral to a specialist unit in the presence of complete nerve palsy, a positive Tinel’s sign, neuropathic pain or vascular compromise, for consideration of nerve exploration. . Take home message: When managed appropriately, nerve recovery and clinical outcomes for this paediatric population are extremely favourable. Cite this article: Bone Joint J 2016;98-B:851–6

Slipped capital femoral epiphysiolysis (SCFE) is a rare condition with a unknown aetiopathogenesis. An early diagnosis and treatment is essential to minimize premature degeneration of the joint. The authors reviewed the cases treated between 1980 and 2005 in our institution. This study was aimed at evaluating patients with hip epiphysiolysis surgically treated by canullated screws or pinning and previously controlled by short-term follow-up, in order to evaluate radiographic medium/ long term evolution, looking for evidence of degenerative arthritis or femoroacetabular impingement. We performed a retrospective review of the clinical notes and radiographs of all patients with slipped upper femoral epiphysis who were surgically treated at our institution between January 1980 and December 2005. These patients performed radiographs to detect evidence of osteonecrosis, chondrolysis, degenerative arthritis or femoroacetabular impingment. To grade the radiological osteoarthritic changes the grading system of Kellgren and Lawrence was used. These changes were correlated with the existence of femoroacetabular impingement. The radiological results were correlated with the Loder'sclassification of stability and the morphological classification. 43 patients were reviewed, corresponding to 47 treated hips. AP and Lowenstein x-ray views were taken in all patients. The alfa angle and the head-shaft angle were measured in the Lowenstein view (frog-leg). Of 16 patients with impingement only 1 patient didn't present pistol grip deformity. 4 contralateral hips also presented the deformity. The mean alfa angle was 99,4. 43% of the patients with unstable hips have impingment. In stable hips this percentage is of 35%. The Patrick test was positive in 30% of the hips with SCFE and only 17% of the unafected hips. The Kellgren and Lawrence scale was very diferent between trhe SCFE and control groups, with 43% grade 2, 17% grade 3 and 6% grade 4, versus 30% grade 2, 6% grade 3 and 0% grade 4. Some patients show bilateral pistol grip deformity and clinical signs of impingment, despite only having one hip with SCFE

Introduction. An important number of factors affecting the outcome of surgical treatment have been identified, and these factors can affect the patient's selection for lumbar surgery. Study Design. Retrospective study with data collected prospectively on patients undergoing surgery for degenerative lumbar pathology (DLP). Purpose. Identification and evaluation of epidemiological factors that influence the quality of life improvement, disability and chronic pain. Outcome measures. Visual Analogue Scale (VAS) to assess pain in lower back and extremities, Short Form-36v2 (SF-36), Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI). Method. 263 patients were included in our study, with a mean age of 54.0 years (22–86 years). 131 patients were women (49.8%). Questionnaires were completed in the preoperative visit and 2 years after surgery. Epidemiological data collected were age, sex, educational level, employment status, diagnosis, treatment, and comorbidity measure by ASA. The most frequent diagnostics were degenerative discal disease (36,5%) and lumbar stenosis (30,4%) and a main surgical treatment was TLIF (31,9 %). To compare means we used t-Student and Pearson's coefficient or Spearman's test was used to assess the correlation, and, finally, linear regression study (ANOVA) was performed with variables that showed statistically significant correlation. SPSS 15.0 statistical package. Results. Sex and employment status was correlated with the improvement of COMI (r=− 0.257, p <0.05, r=0.272, p <0.05). Employment status was correlated with in ODI (r=0.249, p <0.05) and the degree of improvement physical component of SF-36 (PCS, r=− 0.254, p <0.05). Linear regression showed statistically significant influence of the age (r=0.334, p <0.05) and employment status (r=14.146, p <0.01) on ODI. COMI is statistically influenced by sex (r=− 0.869, p <0.01), age (r=0.027, p <0.05) and employment status (r=0.830, p <0.05). PCS is statistically influenced by the employment status (r=− 8.568, p <0.01), age (r=− 0.228, p <0.05) and sex (r=5.525, p <0.05). Conclusions. According to the present study we observed that the perception of change in the quality of life and disability after surgery of the lumbar spine is independent of the initial pathology, the type of surgery and previous pain and disability; but sex, age and employment status have an important influence

Introduction. Osteoporosis (OP), osteoarthrosis (OA), and rheumatoid arthritis (RA) are the most common age-related degenerative bone diseases, and major public health problems in terms of enormous amount of economic cost. RA is considered as a major cause of secondary osteoporosis. At late stage, OP often leads to skeletal fractures, and OA and RA result in severe joint disability. Over the last a few decades, much significant research on the properties has been carried out on these diseases, however, a detailed comparison of the microarchitecture of cancellous bones of these diseases is not available. In this study, we investigated three-dimensional (3-D) microarchitectural properties of OP, OA and RA cancellous bone. We hypothesized that there were significant differences in microarchitecture among OP, OA and RA bone tissues that might lead to different bone quality. Materials and Method. Twenty OP, fifty OA, and twelve RA femur heads were harvested from patients undergone total hip replacement surgery. Cubic cancellous bone samples (8∗8∗8 mm3) were prepared and scanned with a high resolution microtomographic system (vivaCT 40, Scanco Medical AG., Brüttisellen, Switzerland). Then micro-CT images were segmented using individual thresholds to obtain accurate 3-D data sets. Detailed microarchitectural properties were evaluated based on novel unbiased, model-free 3-D methods. For statistical analysis, one-way ANOVA was used, and a p<0.05 was considered significant. Results. Significant differences in the microarchitecture of cancellous bone were observed among the OP, OA and RA groups. Compared with the other groups, OP cancellous bone had lowest density, thinner, typical rod-like structure and less connectivity (all p<0.01). Interestingly, there were no significant differences in the microarchitectural properties measured between the OA and RA cancellous bones. Both OA and RA cancellous bones had significant higher bone volume fraction and were thicker, typical plate-like structure compared with the OP group (all p<0.01), even though there was clearly bone erosion observed in RA cancellous bone. Discussion. Quantification of the alterations in bone properties and quality will help to gain more insights into the pathogenesis of degenerative bone diseases and to target and develop novel approaches for the intervention and treatment, and for the design, fixation and durability of total joint prosthesis. Our study demonstrated that there were significant differences in the microarchitecture of the OP, OA and RA femur head cancellous bone. The OA and RA cancellous bone had similar bone density and microarchitecture despite apparent bone erosion in the RA cancellous bone. These results from femur head did not support the traditional notion that RA and OP had similar low bone density. Thus, whether femur head bone tissues from these diseases have similar bone collagen, mineral and mechanical properties, more importantly bone quality, should be clarified in the future

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 union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management.

A total of 30 patients with lateral compression fractures of the pelvis with intra-articular extension into the anterior column were followed for a mean of 4.2 years (2 to 6), using the validated functional outcome tools of the musculoskeletal function assessment and the short-form health survey (SF-36). The functional outcome was compared with that of a series of patients who had sustained type-B1 and type-C pelvic fractures. The lateral-compression group included 20 men and ten women with a mean age of 42.7 years (13 to 84) at the time of injury. Functional deficits were noted for the mental component summary score (p = 0.008) and in the social function domain (p < 0.05) of the SF-36. There was no evidence of degenerative arthritis in the lateral-compression group. However, they had high functional morbidity including greater emotional and psychological distress

Tibial plateau fractures are common intraarticular fractures. The principal long-term complication is post-traumatic osteoarthritis (PTOA) with the usual salvage procedure being total knee arthroplasty (TKA). Our aim was to define the incidence of PTOA requiring TKA following tibial plateau fractures and identify the risk factors. We looked at all tibial plateau fractures between 1995 and 2008. There were 888 tibial plateau fractures. 23% were Schatzker I, 25% II, 14% III, 22% IV, 8% V and 8% VI. To date 25 have undergone TKA (2.8%). The mean age of patients at time of fracture was 56 in the overall cohort and 65 in those requiring TKA; this was statistically significant (p=0.04). 4% of females with tibial plateau fractures required TKA in comparison to 2% of males. The Schatzker I fractures were the least likely to require TKA at 1% with the most likely requiring arthroplasty surgery being type III at 6%. Only 1% of the patients treated non-operatively later underwent TKA. The overall incidence of TKA after tibial plateau fractures was 3%. For displaced fractures requiring internal fixation this rose to 4%. Risk factors were increasing age, split depression fractures and female gender. Although tibial plateau fractures are commonly associated with degenerative radiographic changes, we concluded that the incidence of symptomatic OA severe enough to require TKA is low

INTRODUCTION. This study describes the prevalence of pain, functional loss and rotator cuff tears (RCTs) in a general population cohort. It is the first multidisciplinary assessment in such a cohort. METHODS. The Chingford cohort is a 19-year old longitudinal population study comprising 1003 women aged between 44 and 67 at baseline. To date 183 consecutive subjects (366) shoulders have been interviewed about their shoulders. Myometric strength assessment and high-definition ultrasound examination (US) have been performed on all shoulders. Additionally pain thresholds and perceptions of pain have been tested using quantitative sensory testing (QST) and a number of validated questionnaires, including the illness attitudes scale and the pain detect score. RESULTS. The population prevalence of at least one full-thickness RCT was 24%, with 19% being unilateral and 5% bilateral. Of the 366 shoulders: 56% had no tendon abnormality on ultrasound: Of which, 68% were asymptomatic, 23% had pain, and 24% had functional loss. 20% had abnormalities of the tendon-bone attachment: Of which, 56% were asymptomatic, 35.6% had pain and 36.1% had functional loss. 9% had a partial-thickness RCT: Of which, 53% were asymptomatic, 29% had pain and 38% had functional loss. 7% had a full-thickness RCT (less than 2cm): Of which, 58% were asymptomatic, 29% had pain and 29% had loss of function. 8% had a full-thickness RCT (greater than 2cm): Of which, 38% were asymptomatic, 55% had pain and 48% had functional loss. The pain and functional loss was significantly greater in the abnormal tendon-bone attachment group, and the full-thickness RCT (greater than 2cm) group, compared to those with no abnormality on high-definition ultrasound examination. Strength testing showed progressive weakness through all disease stages. Pain thresholds from the QST data will be presented. DISCUSSION. In a unique normal population-cohort study 44% of patients were found to have some form of degenerative tendon abnormality on high-definition ultrasound. Of these significant pain and/or loss of function was found in 48% of shoulders. High-definition US has allowed us to identify a group of tendons with an abnormality at the tendon bone interface. The pain and functional loss increases at this early stage and then only further increases once a tear is greater than 2cm. However over 50% remain asymptomatic

Introduction. The degeneration of the adjacent segment in lumbar spine with spondylodesis is well known, though the exact incidence and the mechanism is not clear. Several implants with semi rigid or dynamic behavior are available to reduce the biomechanical loads and to prevent an adjacent segment disease (ASD). Randomized controlled trials are not published. We investigated the biomechanical influence of dynamic and semi rigid implants on the adjacent segment in cadaver lumbar spine with monosegmental fusion (MF). Materials and Methods. 14 fresh cadaver lumbar spines were prepared; capsules and ligaments were kept intact. Pure rotanional moments of ±7.5 Nm were applied with a Zwick 1456 universal testing machine without preload in lateral bending and flexion/extension. The intradiscal pressure (IDP) and the range of motion (ROM) were measured in the segments L2/3 and L3/4 in following situations: in the native spine, monosegmental fusion L4/5 (MF), MF with dynamic rod to L3/4 (Dynabolt), MF with interspinous implant L3/4 (Coflex), and semi rigid fusion with PEEK rod (CD Horizon Legacy) L3-L5. Results. Under flexion load all implants reduced the IDP of segment L2/L3, whereas the IDP in the segment L3/4 was increased using interspinous implants in comparison to the other groups. The IDP was reduced in extension in both segments for all semi rigid or dynamic implants. Compared under extension to the native spine the MF had no influence on the IDP of the adjacent disc. The rod instrumentation (Dynabolt, PEEK rod) lead to a decreased IDP in lateral bending tests. The ROM in L3 was reduced in all groups compared to the native spine. The dynamic and semi rigid stabilization in the segment L3/4 limited the ROM more than the MF. Discussion. The MF reduced the ROM in all directions, whereas the IDP of the adjacent segment remained unaffected. The support of the adjacent segment by semi rigid and dynamic implants decreased the IDP of both segments in extension mainly. This fact is an agreement with other studies. Compared to our data, no significant effect on the adjacent levels was observed. Interestingly, in our study, the IDP of the adjacent segment is unaffected by MF. The biomechanical influence in the view of an ASD could be comprehended, but is not completely clear. The fact of persistent IDP in the adjacent segment suggests that MF has a lower effect on the adjacent segment degeneration as presumed. Biomechanical studies with human cadaver lumbar spines are limited and depend on age and degenerative situation. The effect on supporting implants on adjacent segment disease in lumbar spine surgery has to be investigated in clinical long term studies

Aims

Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses.

Introduction. Modern cementless press fit stems rely on early fixation and stability for osteointegration and longterm success with early migration increasing the risk of failure. The Ein Bild Roentegen Analyse Femoral Component Analysis (EBRA-FCA) methods allow accurate measurement of femoral stem subsidence without the need for Tantalum markers. The degree of subsidence of femoral stems in the first two years has been shown to be highly predictive of failure when using the cut off value of 1.5 mm. We aimed to measure the early migration pattern of a titanium alloy, tapered, plasma and hydroxyapatite coated femoral stem and any factors associated with subsidence. Methods. Between January 2005-June 2007, 387 Accolade cementless femoral stems (Stryker, Allendale NJ) were implanted at our institution. Seventy-seven had a minimum of two years post operative follow up and a complete set of pre and postoperative radiographs for analysis. Our group inlcuded 45 females with a mean age of 71.4 years, and 32 males with a mean age of 68.5 years. The primary diagnosis was degenerative osteoarthritis in 71 patients, avascular necrosis in two, and post fracture in four patients. The average BMI was 27.1. We measured the canal index to assess bone quality and the canal calcar index to assess the proximal femoral morphology. Immediate postoperative radiographs were assessed for canal fill of the prosthesis and implantation varus/valgus angles. The EBRA-FCA software was used to obtain migration curves for each stem. Results. The mean follow up was 29.3months (24–48). The mean canal index was 0.55 (0.36–0.68) with a mean canal calcar index of 0.54 (0.39–0.79). The average canal fill index at the midpoint of the stem was <0.8 in 37 stems and >80 in 40 stems. The average subsidence at 24 months was 2 mm and this had risen to 2.4 mm by 36 months postoperatively. When analysed using a Kaplan Meier curve using 1.5 mm as an end point we found a survivorship of 63.4% (52.3–74.5) at 24 months and this had worsened to 41.6% (26.6–56.5) by 36 months. Multivariate and univariate regression analysis of measured variables did not reveal any significant hazard for any factor other than the larger stem sizes doing worse. Discussion. Although several cementless tapered stem designs have had an excellent track record, our migration analysis of the Accolade stem is somewhat concerning. Thirty three percent of stems had reached the 1.5 mm subsidence point by two years. This is of concern as work has previously shown this to predict failure of stems with aseptic loosening at ten years with an accuracy of 79%. If these stems go on to fail at the predicted rate this would represent an unacceptably high level of failure. Our data raises serious concerns about the overall clinical performance of this stem design due to poor initial stability and integration

Between 1995 and 2000, 19 consecutive patients with fractures of the distal humerus were treated by primary total elbow replacement using the Coonrad-Morrey prosthesis. No patient had inflammatory or degenerative arthritis of the elbow. The mean age at the time of injury was 73 years (61 to 95). According to the AO classification, 11 patients had suffered a C3 injury, two a B3 and two an A3. One fracture was unclassified. Two patients died from unrelated causes and one was unable to be assessed because of concurrent illness. The mean time to follow-up was three years (1 to 5.5). At follow-up 11 patients (68%) reported no pain, four (25%) had mild pain with activity and one had mild pain at rest. The mean flexion arc was 24° to 125°. The mean supination was 90° (70 to 100) and pronation 70° (50 to 110). No elbow was unstable. The mean Disabilities of the Arm, Shoulder and Hand score was 23 (0.92 to 63.3) and the mean Mayo elbow performance score was 93 (80 to 100). Of the 16 patients, 15 were satisfied with the outcome. Radiological evaluation revealed only one patient with a radiolucent line at the cement-bone interface. It was between 1 and 2 mm in length, was present on the initial postoperative radiograph and was non-progressive at the time of follow-up. Primary total elbow arthroplasty is an acceptable option for the management of comminuted fractures of the distal humerus in elderly patients when the configuration of the fracture and the quality of the bone make reconstruction difficult

Aims

We aimed to determine the effect of dementia and Parkinson’s disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population.

Aims

The aim of this prospective randomised controlled trial was to compare non-operative and operative management for acute isolated displaced fractures of the olecranon in patients aged ≥ 75 years.