Displaced fractures of the forearm in children are often treated conservatively, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. We have performed percutaneous Kirschner (K) wire fixation in 72 such children under the age of 14 years, of which 57 were reviewed for our study. Both the radius and ulna were fractured in 45 (79%), the radius only in eight and the ulna only in four. The mean initial angulation was 19° in the lateral plane and 9° in the anteroposterior plane for the radius and 15° and 9°, respectively, for the ulna. In 42 patients (74%) we performed closed reduction. In the remaining 15 (26%) closed reduction failed and an open reduction, through a minimal approach, was required before K wiring. At a mean follow-up of 20 months all patients had good functional results with an excellent range of movement. Only five had angulation of from 10° to 15° and none had nonunion, premature epiphyseal closure or deep infection. Percutaneous intramedullary K wiring for forearm diaphyseal fracture is a convenient, effective and safe operation, with minimal complications

At-home softcast removal with no routine clinical follow-up has shown to be safe and effective following paediatric orthopaedic trauma. It minimises clinician contact time and reduces cost. However, there is limited data on the caregiver experience. Retrospective analysis of paediatric fractures requiring application of circumferential softcast that was later removed at home. Two time points were included: (1)July–September 2022, (2)February–April 2023. Demographics data included age, fracture classification, angulation, manipulation requirement, complications or unplanned re-attendance. Caregivers were given an information leaflet on cast removal. Caregivers completed a telephone Likert questionnaire reviewing time taken to remove cast, qualitative descriptors of cast removal and overall satisfaction. 77 families were contacted at mean 93 days post injury. Mean age was 7.5 years. 41(53%) were distal radius and 20(26%) both-bone forearm fractures. The remaining were hand, elbow or tibia injuries. 40(52%) injuries required manipulation under procedural sedation with mean sagittal angulation 24 degrees. 13(17%) patients re-attended with cast problems. Caregivers estimated a mean 13 minutes to remove cast. 83% found it ‘extremely’ or ‘somewhat’ easy. 75% were ‘extremely’ or ‘somewhat’ satisfied. 71% were ‘extremely’ or ‘somewhat’ likely to recommend at-home cast removal. Qualitative descriptors ranged from from ‘traumatising’ to ‘fun’ and ‘straightforward’. The experience at our tertiary centre confirms at-home softcast removal with no further orthopaedic follow-up is safe and feasible, even in those requiring manipulation under sedation. The majority of families reported a positive experience; this however is not universal. Adequate patient information resources are integral to a positive caregiver's experiences

Aims. The aim of this study was to statistically analyse the incidence and distribution of forearm fractures in the adult age group (3rd–10th Decades) between 1997 and 2009. Methods. Records of patients with forearm fractures were retrieved from the hospital audit department using the predetermined codes to identify patients. The data included total number of patients between 20 and 100 years who were either reviewed in the fracture clinics or admitted to the hospital with forearm fractures along with patient gender, age at the time of incident and time of the year the incident occurred. Incidence of total fractures per year and per each month in the year was calculated. The patients were divided into age groups between 2nd to 10th decades. Linear regression analysis was carried out to identify the relationship between fracture incidence and the age or time of the injury. Correlation coefficients(R) and r2 were calculated for all the regression analyses. Fractures were also classified according to the Orthopaedic Trauma Association (OTA) classification system. SPSS (version 16) and Microsoft Excel 2007 were used for statistics. Results. A total of 1815 fractures were identified that included 573 males and 1242 females (F/M=2.17). The average age of patients was 59.8 years. Comparing the different months of the year for fracture incidence, the incidence of fractures was found to be highest in september per year. There was a linear increase in the incidence of fractures from January to September (R=0.9, r2=0.81) followed by a drop in subsequent months. There was a linear increase in the incidence of fractures per year from 70 in 1997 to 200 in 2009 (R=0.94, r2=0.885). Comparing the slopes of linear equations for males and females, the rate of increase in fractures in females was found to be approximately 3 times that of males. In women, There was a linear increase in the fracture incidence from the 3rd decade to the 9th decade (R=0.91, r2=0.84) followed by a sudden drop in the 10th decade. In men, there was a linear decrease in the fracture incidence from the 3rd to the 9th decade (r2=0.9559, R=0.98). 177 fractures were classified according to the OTA classification. OTA 23 type of fractures accounted for 85.3% percent of the forearm fractures followed by OTA 21 type (11.9%) and 22 type (2.8%). Further analysis showed the distribution to be: 23A-43.7%, 23B-9.9%, 23C-46.4%. Conclusion. In the last 13 years, there has been an increase in the total incidence of forearm fractures in both men and women; however, the rate of increase in women is almost 3 times that of men. With increasing age, the incidence of fracture increases in women and decreases in men. The drop in fractures in women the 10th decade can be attributed to a reduced living population after 90 years. The obtained linear equations can be useful in predicting the number of forearm fractures occurring in a certain age group in community

Aims

The aim of this study was to assess whether it is possible to predict the mortality, and the extent and time of neurological recovery from the time of the onset of symptoms and MRI grade, in patients with the cerebral fat embolism syndrome (CFES). This has not previously been investigated.

Aims and objectives. The aim of this study was to statistically analyse the calcaneal fractures occurring in the community and distribution within the various age groups divided into decades. Methods and materials. Records of calcaneal fractures were retrieved from the audit department of the hospital using the various codes to identify patients reviewed in the clinics or admitted to the hospital between 1997 and 2009. The data collected included the total number of calcaneal fractures, total number in either gender, age at the time of incident, month of the year the incident occurred. Annual distribution of incidence of forearm fractures was calculated for every year and every month of the year. The age of the patients was divided into decades. Linear regression analysis and correlation coefficients were calculated between the incidence of fractures and different variables including age, gender and the time of the injury. Results. A total of 770 fractures were calculated including 511 males and 259 females (M/F=1.97). The average age of was 43.17 years (males=39.9 yrs, females=49.7 years). In both the sexes, there was a linear increase in the incidence of fractures in the first three decades of life with the rate of increase in males (R=0.999, r2=0.99) being 3 times that of females (R=0.96, r2=0.92). The incidence in females remained almost constant from 3rd decade to the 9th decade. The incidence in males reached a peak in the 3rd decade and then decreased steadily until the 10th decade. The incidence of fractures in females equalled that of males in the 8th decade; after which the incidence in males fell below females. There was a strong correlation between the increase in the incidence of fractures from February to August (R=0.9, r2=0.81) every year, after which the incidence reduced in the following months. There was a weak correlation between the increase in fractures from 1997 to 2009. Conclusion. There is a significant increase in the incidence of calcaneal fractures in the first three decades of life in both males and females. In males, the rate of increase in fractures is almost thrice than that of females. It can be said that men in their late twenties are more prone to sustain calcaneal fractures than any other age group or females. More injuries should be expected in August compared to the other months of the year. Further studies need to be done to look into the mechanism of injury. This could be helpful in prevention and reduction of the fracture incidence in the young and active age groups

Aims. The aim of this study was to statistically analyse the incidence and distribution of humerus fractures in the adult age group between 3rd and 10th decades. Methods. The total number of patients was retrieved from the audit department of the hospital using the codes to identify patients between 1997 and 2009. The data included total number of patients aged 20 to 100 years who were either reviewed in the fracture clinics or admitted to the hospital with forearm fractures along with patient gender, age at the time of incident and time of the year the incident occurred. Annual incidence of fractures along with the distribution of fracture incidence per year and per individual month was calculated. The patients’ age were classified in to 3rd to 10th decades. Linear regression analysis was carried out to identify the relationship between fracture incidence and the age or time of the injury. Correlation coefficients(R) and r2 were calculated for all the regression analyses. SPSS (version 16) and Microsoft Excel 2007 were used for statistics. Results. A total of 1280 fractures were identified that included 524 males and 756 females (F/M=1.44). The average age of patients was 60.87 years. Comparing the different months of the year for fracture incidence, the average of incidence of fractures was found to be highest in july per year. There was a linear increase in the incidence of fractures from january to september (R=0.94, r2=0.89) followed by a drop in subsequent months. The total number of humerus fractures per year increased from49 in 1997 to 137 in 2009. In both males and females, there was strong relation to linearity in the increase in the incidence of fractures per year from 1997 to 2009 (Females: R=0.89, r2=0.79, Males: R=0.87, r2=0.76). On comparison of the linear equations for males and females, the rate of increase in the incidence of fractures in females was found to be approximately 1.5 times that of males. In females, There was a linear increase in the fracture incidence from the 3rd to the 9th decade (R=0.96, r2=0.92) followed by a sudden drop in the 10th decade. In men, there was a linear decrease in the fracture incidence from the 3rd to the 9th decade (r2=0.81, R=0.90). Conclusion. In the last 13 years, there has been an increase in the incidence of humerus fractures in both men and women; however, the rate of increase in the incidence in women is almost 1.5 times that of men. There was a strong correlation between age and incidence of fractures in both men and women: with increasing age, the incidence of fracture increased in women and decreased in men. The drop in fractures in women the 10th decade can be attributed to a reduced living population after 90 years. The obtained linear equations can be useful in predicting the number of fractures occurring in a certain age group in a community

Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred. This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence. Cite this article: Bone Joint J 2013;95-B:151–9

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.

We invited 1604 randomly selected women, all 75 years of age, to participate in a study on the risk factors for fracture. The women were divided into three groups consisting of 1044 (65%) who attended the complete study, 308 (19%) respondents to the study questionnaire only and 252 (16%) who did not respond. The occurrence of the life-time fracture was ascertained from radiological records in all groups and by questionnaires from the attendees and respondents.

According to the radiological records, fewer of the questionnaire respondents (88 of 308, 28.6%) and non-respondents (68 of 252, 27%) had sustained at least one fracture when compared with the attendees (435 of 1044, 41.7%; chi-squared test, p < 0.001). According to the questionnaire, fewer of the respondents (96 of 308, 31.1%) had sustained at least one previous fracture when compared with the attendees (457 of 1044, 43.7%; chi-squared test, p < 0.001).

Any study concerning the risk of fracture may attract those with experience of a fracture which explains the higher previous life-time incidence among the attendees. This factor may cause bias in epidemiological studies.

Fractures in patients aged ≥ 65 years constitute an increasing burden on health and social care and are associated with a high morbidity and mortality. There is little accurate information about the epidemiology of fractures in the elderly. We have analysed prospectively collected data on 4786 in- and out-patients who presented with a fracture over two one-year periods. Analysis shows that there are six patterns of the incidence of fractures in patients aged ≥ 65 years. In males six types of fracture increase in incidence after the age of 65 years and 11 types increase in females aged over 65 years. Five types of fracture decrease in incidence after the age of 65 years. Multiple fractures increase in incidence in both males and females aged ≥ 65 years, as do fractures related to falls.

Analysis of the incidence of fractures, together with life expectancy, shows that the probability of males and females aged ≥ 65 years having a fracture during the rest of their life is 18.5% and 52.0%, respectively. The equivalent figures for males and females aged ≥ 80 years are 13.3% and 34.8%, respectively.

Cite this article: Bone Joint J 2014;96-B:366–72.

Heterotopic ossification (HO) is perhaps the single most significant obstacle to independence, functional mobility, and return to duty for combat-injured veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Recent research into the cause(s) of HO has been driven by a markedly higher prevalence seen in these wounded warriors than encountered in previous wars or following civilian trauma. To that end, research in both civilian and military laboratories continues to shed light onto the complex mechanisms behind HO formation, including systemic and wound specific factors, cell lineage, and neurogenic inflammation. Of particular interest, non-invasive in vivo testing using Raman spectroscopy may become a feasible modality for early detection, and a wound-specific model designed to detect the early gene transcript signatures associated with HO is being tested. Through a combined effort, the goals of early detection, risk stratification, and development of novel systemic and local prophylaxis may soon be attainable.

Objectives

Small animal models of fracture repair primarily investigate indirect fracture healing via external callus formation. We present the first described rat model of direct fracture healing.

This study aimed to evaluate the use of pin leverage in the reduction of Gartland type III supracondylar fractures of the humerus in children. The study comprised 95 children, who were split into three groups according to the type of method of reduction used. Group 1, had an open reduction, group 2, had closed reduction and percutaneous pin fixation and group 3, the pin leverage technique. Each group was analysed according to the time to surgery, the duration of the procedure, the incidence of complications, and the clinical and radiological outcome.

The mean duration of the operative procedure in groups 1, 2 and 3 was 119 minutes (80 to 235), 57 minutes (20 to 110) and 68 minutes (30 to 90), respectively. At a mean follow-up of 30 months (12 to 63) the clinical results were declared excellent or good in all children and the radiological results intermediate in five patients in group 2. The results of the closed reduction using the pin leverage technique was classified as failure in two children.

Our findings lead us to believe that the pin leverage method of reduction gives good results in the treatment of Gartland type III fractures.

Although supracondylar fracture is a very common elbow injury in childhood, there is no consensus on the timing of surgery, approach for open reduction and positioning of fixation wires. We report our ten-year experience between 1993 and 2003 in 291 children.

Most fractures (285; 98%) were extension injuries, mainly Gartland types II (73; 25%) and III (163; 56%). Six (2%) were open fractures and a neurovascular deficit was seen in 12 (4%) patients. Of the 236 children (81%) who required an operation, 181 (77%) were taken to theatre on the day of admission. Most (177; 75%) of the operations were performed by specialist registrars. Fixation was by crossed Kirschner wires in 158 of 186 (85%) patients and open reduction was necessary in 52 (22%).

A post-operative neurological deficit was seen in nine patients (4%) and three (1%) required exploration of the ulnar nerve. Only 22 (4%) patients had a long-term deformity, nine (3%) from malreduction and three (1%) because of growth arrest, but corrective surgery for functional limitation was required in only three (1%) patients.