Introduction. The main symptoms in multiple myeloma are the result of skeletal destruction mainly the vertebral column. The current treatments for multiple myeloma include radiotherapy and chemotherapy but unfortunately it is still incurable. However, the symptoms and quality of life of these patients can be improved by cement augmentation which has gained popularity in the recent years. Aim. To analyse the efficacy and safety of cement augmentation and to assess the survival and outcome of the patients with vertebral fractures secondary to multiple myeloma. Material and Methods. In this retrospective study, we reviewed the data over the last 3 years. Medical records review included correction of vertebral angle (VA), assessment of disability, survival and postoperative improvement in pain and functional status. Results. We reviewed 12 patients with 48 vertebral compression fractures including 9 male and 3 female patients. Mean age was 62.5 years (41–85). 5 patients had single vertebral involvement while 7 had multiple fractures at different levels in thoracolumbar spine. Average length of follow-up was 20.3 months (14–33 months). Based on Modified Tokuhashi score, the expected survival was less than 12 months in 2 patients and more than 12 months in the remaining patients. 11 patients are alive till date with average survival of 26 months (18–42 months) while 1 patient died, 23 months after the initial correction surgery. Prior to correction, the average vertebral angle (VA) was 10.60 (2.30 to 25.20) and after cement augmentation the average VA was 7.00 (1.60–22.80). Mean correction achieved was 3.60. There was no loss of vertebral height in any patient until their latest follow-up. Karnofsky performance score was more than 70 in 5 patients, 50–70 in 6 and less than 50 in 1 patient preoperatively while it improved to more than 70 in all patients postoperatively which indicates improvement in their functional status. All patients reported improvement in their pain level after surgery. No cement leakage or major complication occurred in these patients. Conclusion. Cement augmentation is a safe and effective way of treating the symptoms of multiple myeloma which occur due to vertebral metastases. It results in excellent pain control and improvement in quality of life

Purpose. Surgical correction of upper limb deformities in severe osteogenesis imperfecta (OI) is technically difficult and less absolving, hence we aimed to analyse the surgical complications of rodding the humeri in severe OI. Methods and results. Retrospective analysis was carried out for consecutive humeral roddings for severe OI in last 3 years. Surgical technique for all humeri included retrograde telescopic nailing (female or both of FD or TST rods) with entry from olecranon fossa, exploration of radial nerve followed by osteotomies. Deformities were quantified and sub-classified as per level of deformity). Variables such as number of osteotomies, radiological union, intraoperative and postoperative complications, improvement in ROM and subjective patient satisfaction were recorded. Total 18 humeri in 12 patients with type III OI (except 1) with mean age of 8.9 years underwent nailing. All patients achieved radiological union at 6–10 weeks. Total 8 complications (44.4 %) were reported within mean 8.4 months follow up. Four segments (22.2 %) had intraoperative fractures at distal third of the humerus while negotiating the nail. Significantly higher intraoperative complications were encountered in humeri fixed with both components combined and upper third level deformities, deformities > 900 and more than 2 osteotomies. Other complications were prominent implant at upper end (2) with growth and one each of contralateral fracture and distal humeral varus. All patients reported improvement in ROM and functional status. Conclusion. Significant complications are associated with humeral nailing for severe OI. Quantification of the deformity with meticulous surgical planning and execution is advised. Despite these complications outcomes show benefits of the surgical treatment. Level of evidence. Therapeutic III

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This study aimed to describe practice variation in the use of total hip arthroplasty (THA) for older patients with femoral neck fracture and to determine the association between patient, surgeon, and institution factors and treatment with THA.

We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly

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The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement.

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National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD.

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Current levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care.

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The aims of this study were to assess quality of life after hip fractures, to characterize respondents to patient-reported outcome measures (PROMs), and to describe the recovery trajectory of hip fracture patients.

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The aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes.

Heterotopic ossification (HO) of the hip after injury to the central nervous system can lead to joint ankylosis. Surgery is usually delayed to avoid recurrence, even if the functional status is affected. We report a consecutive series of patients with HO of the hip after injury to the central nervous system who required surgery in a single, specialised tertiary referral unit. As was usual practice, they all underwent CT to determine the location of the HO and to evaluate the density of the femoral head and articular surface. The outcome of surgery was correlated with the pre-, peri- and post-operative findings. In all, 183 hips (143 patients) were included of which 70 were ankylosed. A total of 25 peri-operative fractures of the femoral neck occurred, all of which arose in patients with ankylosed hips and were associated with intra-articular lesions in 18 and severe osteopenia of the femoral head in seven. All the intra-articular lesions were predicted by CT and strongly associated with post-operative complications. The loss of the range of movement before ankylosis is a more important factor than the maturity of the HO in deciding the timing of surgery. Early surgical intervention minimises the development of intra-articular pathology, osteoporosis and the resultant complications without increasing the risk of recurrence of HO

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We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture.

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The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population.

Background. pelvic fractures in elderly patients often result in poor prognosis due to immobilization associated complications. Thus, the target of the treatment in this patient group is early mobilization in order to reduce the risk of these complications. We report outcomes of 4 cases of pelvic fracture in elderly patients, who were treated with percutaneous screw fixation. Material and method. We examined medical records and images of 4 elderly patients between January 2012 and May 2012 in our center. Mean age of the patients was 88.8 years old (range 86–92 years). The causes of injury were motor vehicle accident in 3 patients, and a fall in 1 patient. Fracture types were ao type a in 1 patient, type b in 2 patients and type c in 1 patient. Mean injury severity score was 25 (10–57). We assessed functional status after the follow-up period using majeed. s. grading score for pelvic fractures. Result. No major complication including sever infection and deep vein thrombosis was observed during the follow-up period. Minor complication observed was screw loosening in 1 case, and screw prominence in another. Functional outcome by majeed. s. score were excellent in 1 case, and fair in 3 cases. The mean period between the operation and the first ride on the wheel chair was 3.5 (2–6) days. Conclusion. Early mobilization significantly affects the prognosis in multiple trauma patients. Percutaneous screw fixation may improve the prognosis in elderly patients with pelvic fracture

There is no absolute method of evaluating healing of a fracture of the tibial shaft. In this study we sought to validate a new clinical method based on the systematic observation of gait, first by assessing the degree of agreement between three independent observers regarding the gait score for a given patient, and secondly by determining how such a score might predict healing of a fracture. We used a method of evaluating gait to assess 33 patients (29 men and four women, with a mean age of 29 years (15 to 62)) who had sustained an isolated fracture of the tibial shaft and had been treated with a locked intramedullary nail. There were 15 closed and 18 open fractures (three Gustilo and Anderson grade I, seven grade II, seven grade IIIA and one grade IIIB). Assessment was carried out three and six months post-operatively using videos taken with a digital camera. Gait was graded on a scale ranging from 1 (extreme difficulty) to 4 (normal gait). Bivariate analysis included analysis of variance to determine whether the gait score statistically correlated with previously validated and standardised scores of clinical status and radiological evidence of union. An association was found between the pattern of gait and all the other variables. Improvement in gait was associated with the absence of pain on weight-bearing, reduced tenderness over the fracture, a higher Radiographic Union Scale in Tibial Fractures score, and improved functional status, measured using the Brazilian version of the Short Musculoskeletal Function Assessment questionnaire (all p < 0.001). Although further study is needed, the analysis of gait in this way may prove to be a useful clinical tool

Introduction. There has been renewed interest in the unicompartmental knee arthroplasty with reports of good long term outcomes. Advantages over a more extensive knee replacement include: preservation of bone stock, retention of both cruciate ligaments, preservation of other compartments and better knee kinematics. However, a number of authors have commented on the problem of osseous defects requiring technically difficult revision surgery. Furthermore, a number of recent national register studies have shown inferior survivorship when compared to total knee arthroplasty. The purpose of this study was to review the cases of our patients who had a revision total knee arthroplasty for failed unicompartmental knee arthroplasty. To determine the reason for failure, describe the technical difficulties during revision surgery and record the clinical outcomes of the revision arthroplasties. Methods. Between 2003 and 2009 our institute performed thirty three revisions of a unicompartmental knee arthroplasty on thirty two patients. The time to revision surgery ranged from 2 months to 159 months with a median of 19 months. Details of the operations and complications were taken form case notes. Patient assessment included range of motion, need for walking aids and the functional status of the affected knee in the form of the Oxford knee score questionnaire. Results. The reasons for failure were aseptic loosening of tibial component, persistent pain, dislocated meniscus, mal-alignment and osteoarthritis in another compartment. Of the 33 revision knee arthroplasties 18 required additional intra-operative constructs. 11 knees required a long tibial stem while 1 required a long femoral stem. 10 knees required medial wedge augmentation and bone graft was used in 6. Mean 1 year Oxford knee scores for failed unicompartmental knee replacements was 29 compared to 39 for primary total knee replacements performed at the same institute. Of the revision knee replacements 2 required further revision due to infection and loosening. Conclusion. From the evidence of our group of failed unicompartmental knee replacements, revision surgery is technically difficult and often requires intra-operative constructs. Clinical outcome of revision total knee arthroplasty following failed unicompartmental knee arthroplasty is not comparable to primary total knee arthroplasty

Introduction. Interest in platelet-derived growth factors has been increasing as an adjunct in surgical techniques for tissue repair. Its use in ligament injuries repair has been studied mainly in animals. The authors intend to study growth factors influence in ACL repair using BTB graft. Material. 20 individuals underwent ACL rupture BTB arthroscopic repair, using Double Incision Mini-Invasive Technique. MRI (3-Tesla) images. GPSIII ® System to obtain Platelet-Rich Plasma (PRP) thrombin activated. Methods. Prospective study consisting of 2 groups of 10 patients each. Surgical technique, fixation method and postoperative protocol were the same. In the study group (SG-10 patients) graft was imbued with PRP and the remaing plasma was intra-articularly injected. The MRIs took place 6 weeks and 6 months after the procedure with and without gadolinium-DTPA enhancement. Evaluation was performed blindly by independent radiologists concerning femoral tunnel integration, sinovialization process and nonspecific synovitis. Clinical and functional status evaluation: IKDC. Statistical analysis in SPSS®. Results. Radiological evaluation was similar in both groups. In the Study Group at 6 weeks we verified less joint effusion and synovitis. At 6 months: no diference in integration in femoral tunnel, and in granulation tissue around the femoral tunnel in graft sinovialization. IKDC (mean ± SD) with PRP: pre-operative −45,66 ±6,98, post-operative −94,35 ±3,54 (Age-29 ± 10), without PRP: preoperative −48,02 ±12,68, post-operative −91,7 ±6,99 (Age −31 ±10). There are no statistical differences between the groups with and without PRP in clinical and functional assessments and MRI images. Discussion. The use of technology to accelerate and improve the processes of tissue repair and integration is of great interest in repairing the ACL. Studies in humans are rare, with low level of evidence and contradictory results. Although the limitations of this study, it seems to us that the use of growth factors has no advantages in the process of PT graft integration at 6 months. Conclusion. PRP doesn't seem to contribute to enhancement of the ligamentation process and articular rehabilitation when used as a step of BTB technique

INTRODUCTION. In recent years the age of world's population has risen and with it there has been a significant increase in the frequency of hip fractures in the elderly. These fractures are known to increase morbidity and mortality. However, little is known about the frequency and characteristics of patients who sustain a second hip fracture. We examined the incidence and the underlying associated medical disorders of patients with a second fracture in the other hip. MATERIAL & METHODS. This study consists of 132/1208 Pts. (10.9%) treated in our department between 1998–2006 that had a secondary hip fracture 1–9 years following the first hip fracture. We examined the most common complications following surgery of this type, the most common related illnesses among these patients, and the influence of post-surgical rehabilitative care on the patients' return to daily functioning. RESULTS. 132 Pts (10.9%) of this series (34 M, 98 F; 64–101 year old; mean 81Y) had a second hip fracture. Most of them (82%) had chronic associated disorders such as heart problems, dementia, old CVA, sight problems and renal failure. Of those with a second hip fracture- 9/132 (6.8%) had the second hip fracture within the first year following surgery, 35/132 (26.5.3%) after 2 years and the remaining 102/132 (66.7%) after 3–6 years. 70.8% of the second hip fracture were of the same type and location of the first hip fracture. 65% of the single hip-fracture patients returned to the same type of daily functioning that they had had prior to injury within one year following surgery. 52% of the patients with the second hip fracture returned to the same level of daily functioning they had had during the period between the first and the second hip fracture Furthermore, we also found that sub-capital fractures are more characteristic of a younger population than are intertrochanteric fractures. DISCUSSION. Based on this study it seems that the frequency of a second fracture in the other hip was 10.9%. The length of time between occurrence of the first and second fractures ranged from one to six years, a third of them within the first 2 years and two thirds of them after 3–6 years. Age and medical status of the patient may be important predictors of a second hip fracture. It is therefore imperative to improve bone quality, medical and functional status of the patients following the first hip fractures in order to reduce the risk of the second hip fractures

We studied the outcome and functional status of 33 patients with 34 severe open tibial fractures (Gustilo grade IIIb and IIIc). The treatment regime consisted of radical debridement, immediate bony stabilisation and early soft-tissue cover using a muscle flap (free or rotational). The review included standardised assessments of health-related quality of life (SF-36 and Euroqol) and measurement of the following parameters: gait, the use of walking aids, limb-length discrepancy, knee and ankle joint function, muscle wasting and the cosmetic appearance of the limb. Personal comments and overall patient satisfaction were also recorded. The mean follow-up was 46 months (15 to 80). There were 30 Gustilo grade IIIb fractures and and four grade IIIc fractures. Of the 33 patients, 29 had primary internal fixation and four, external fixation; 11 (34%) later required further surgery to achieve union and two needed bone transport procedures to reconstruct large segmental defects. The mean time to union was 41 weeks (12 to 104). Two patients (6.1%) developed deep infection; both resolved with treatment. The mean SF-36 physical and mental scores were 49 and 62 respectively. The mean state of health score for the Euroqol was 68. Patients with isolated tibial fractures had a better outcome than those with other associated injuries on both scoring systems. Knee stiffness was noted in seven patients (21%) and ankle stiffness in 19 (56%); 12 patients (41%) returned to work. Our results compare favourably with previous outcome measurements published for both limb salvage and amputation. All patients were pleased to have retained their limbs

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Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery.

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Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques.