We describe the survivorship of the Medial Rotation total knee replacement (TKR) at ten years in 228 cemented primary replacements implanted between October 1994 and October 2006, with their clinical and radiological outcome. This implant has a highly congruent medial compartment, with the femoral component represented by a portion of a sphere which articulates with a matched concave surface on the medial side of the tibial insert. There were 78 men (17 bilateral TKRs) and 111 women (22 bilateral TKRs) with a mean age of 67.9 years (28 to 90). All the patients were assessed clinically and radiologically using the American Knee Society scoring systems. The mean follow-up was for six years (1 to 13) with only two patients lost to follow-up and 34 dying during the period of study, one of whom had required revision for infection. There were 11 revisions performed in total, three for aseptic loosening, six for infection, one for a periprosthetic fracture and one for a painful but well-fixed replacement performed at another centre. With revision for any cause as the endpoint, the survival at ten years was 94.5% (95% CI 85.1 to 100), and with aseptic loosening as the endpoint 98.4% (95% CI 93 to 100). The mean American Knee Society score improved from 47.6 (0 to 88) to 72.2 (26 to 100) and for function from 45.1 (0 to 100) to 93.1 (45 to 100). Radiological review failed to detect migration in any of the surviving knees. The clinical and radiological results of the Medial Rotation TKR are satisfactory at ten years. The increased congruence of the medial compartment has not led to an increased rate of loosening and continued use can be supported

Aims. Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre. Methods. Using 3D templating software in 49 CT scans of non-deformed femora, we virtually implanted: 1) small uncemented calcar-guided stems with two offset options (Optimys, Mathys), 2) uncemented straight stems with two offset options (Summit, DePuy Synthes), 3) cemented undersized stems (Exeter philosophy) with three offset options (CPT, ZimmerBiomet), and 4) cemented line-to-line stems (Kerboul philosophy) with proportional offsets (Centris, Mathys). We measured the distance between the templated and the anatomical and 5 mm medialized hip rotation centre. Results. Both rotation centres could be restored within 5 mm in 94% and 92% of cases, respectively. The cemented undersized stem performed best, combining freedom of stem positioning and a large offset range. The uncemented straight stem performed well because of its large and well-chosen offset range, and despite the need for cortical bone contact limiting stem positioning. The cemented line-to-line stem performed less well due to a small range of sizes and offsets. The uncemented calcar-guided stem performed worst, despite 24 sizes and a large and well-chosen offset range. This was attributed to the calcar curvature restricting the stem insertion depth along the femoral axis. Conclusion. In the majority of non-deformed femora, leg length, offset, and anteversion can be restored accurately with non-modular stems during 3D templating. Failure to restore hip biomechanics is mostly due to surgical inaccuracy. Small calcar guided stems offer no advantage to restore hip biomechanics compared to more traditional designs. Cite this article: Bone Jt Open 2021;2(7):476–485

Background. The decision to resurface the patella during total knee arthroplasty remains controversial. Aim of our study was to evaluate the functional difference between patients undergoing medial rotation knee (MRK) replacement with and without patellar resurfacing at our hospital. Methods. We did a retrospective analysis of patients undergoing MRK total knee replacement (Matortho) at our hospital between 2008 and 2017 performed by 2 surgeons. Patients were recalled for a clinical review from Oct 2017 for recording of Oxford knee, Baldini and Ferrel scores. Mann-Whitney U test was used for non-parametric data (SPSS v24). Results. Of the 104(49 males) patients, 62 had patellar resurfacing. Age and sex distribution was similar in both groups. The mean follow up period was 74.45 months in non- resurfaced group and 54.93 months in resurfaced group. The Median (Range) pre-operative Oxford knee scores were similar in both groups − 15(4–42) in non-resurfaced group and 14(1–44) in resurfaced group. The median OKS at follow-up were 36(12–47) in non-resurfaced group and 37(9–48) in resurfaced group. The Patellar scores were slightly better in the resurfaced group – Baldini score median (range) (90 (25–100) in non resurfaced v/s 100(30–100) in resurfaced), Ferrel score (median (range) 25(12–30) in non-resurfaced v/s 28(10–30) in resurfaced, p 0.042). The patellofemoral component of the OKS (Q5 + Q7 + Q12) median (range) showed an improvement from 3(1–11) to 6.5 (3–11) in non-resurfaced group and from 3(0–12) to 8 (2–12) (p 0.039) in resurfaced group. Conclusion. Although the overall functional knee scores in non-resurfaced and resurfaced groups were same, we found a statistically significant difference in Ferrel score and in the patellofemoral component of OKS between the 2 groups of MRK knee replacement suggesting specific benefits of patellar resurfacing

The performance of total knee arthroplasty in deeply flexed postures is of increasing concern as the procedure is performed on younger, more physically active and more culturally diverse populations. Several implant design factors, including tibiofemoral conformity, tibial slope and posterior condylar geometry have been shown directly to affect deep flexion performance. The goal of this study was to evaluate the performance of a fixed-bearing, asymmetric, medial rotation arthroplasty design during kneeling activities. Thirteen study participants (15 knees) with primary total knee arthroplasty (Medial Rotation Knee, Finsbury, Surrey, UK) were observed while doing a step activity and kneeling on a padded bench from 90° to maximum comfortable flexion using lateral fluoroscopy. Subjects averaged 74 years of age and nine were female. Subjects were an average of 17 months post-operative, and scored 94 points on the International Knee Score and 99 on the Functional Score. Digitised fluoroscopic images were corrected for geometric distortion and 3D models of the implant components were registered to determine the 3D position and orientation of the implants in each image. During the step activity, the medial and the lateral femoral contact point stayed fairly constant with no axial rotation from 0 to 100° of flexion. At maximum kneeling flexion, the knees exhibited 119° of implant flexion (101°-139°), 7° (-7° to 17°) tibial internal rotation, and the lateral condyle translated backwards by 11 mm. Patients with medial rotation knee arthroplasty exhibited medial pivot action with no paradoxical translation. The knees exhibited excellent kneeling flexion and posterior translation of the femur with respect to the tibia. The axial rotation in MRK was within the range of normal knee kinematics from -10 to 120 (perhaps 140)

We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the introduction of botulinum toxin therapy to our unit. Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert shoulder scores for the two groups. Post-operatively, the patients who received the botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean follow-up of three years (1.5 to 9.8). It appears that botulinum toxin type A produces benefits which are sustained beyond the period for which the toxin is recognised to be active. We suggest that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improved

The medial rotation contracture caused by weak external rotation secondary to obstetric brachial plexus injury leads to deformation of the bones of the shoulder. Scapular hypoplasia, elevation and rotation deformity are accompanied by progressive dislocation of the humeral head. Between February and August 2005, 44 children underwent a new surgical procedure called the ‘triangle tilt’ operation to correct this bony shoulder deformity. Surgical levelling of the distal acromioclavicular triangle combined with tightening of the posterior glenohumeral capsule (capsulorrhaphy) improved shoulder function and corrected the glenohumeral axis in these patients. The posture of the arm at rest was improved and active external rotation increased by a mean of 53° (0° to 115°) in the 40 children who were followed up for more than one year. There was a mean improvement of 4.9 points (1.7 to 8.3) of the Mallet shoulder function score after surgical correction of the bony deformity

Purpose. To report clinical results and demonstrate any posterior femoral translation (PFT) in medial rotation total knee arthroplasty (TKA) of posterior cruciate ligament (PCL) retaining type. Materials and Methods. A prospective study was performed upon thirty consecutive subjects who were operated on with medial rotation TKA of PCL retaining type (Advance® Medial Pivot prosthesis with ‘Double High’ insert; Wright Medical Technology, Arlington, TN, USA) (Fig. 1). between March 2009 and March 2010 and had been followed up for a least 2 years. Inclusion criteria were age between 60 and 75 years and primary degenerative joint disease of knee graded as Kellgren Lawrence grade III or higher. Exclusion criteria were age under 60 years, any inflammatory joint disease including rheumatoid arthritis, early stage of primary degenerative joint disease of knee or any history of previous osteotomy around knee. Clinically, the knee society knee score and function score were used to evaluate pain and function. At last follow-up, all subjects performed full extension, thirty degree flexion and full active flexion sequentially under fluoroscopic surveillance. In each of these lateral radiographs, anteroposterior(AP) condylar position was pinpointed and the magnitude of PFT was determined by degree of transition of AP condylar position from full extension to full active flexion radiograph (Fig. 2 A–B). Statistical methods used were paired t-test, Pearson correlation, Steadman rank correlation and regression analysis. Component migration and radiolucent line were also observed. Results. At last follow-up, the mean knee society knee score and the mean function score improved significantly compared to preoperative scores (from 61.5 to 90.4 and from 57.8 to 84.7 respectively). The mean maximum flexion of knee increased postoperatively compared to preoperative one without any significant difference (105.5Ëš±11.2Ëšvs 109.3Ëš±9.8Ëš, p=0.051, β=0.387). Neverthless, regression analysis showed a good linear association (r = 0.53, p=0.0027) between the pre- and post-operative maximum flexions of knee. The AP condylar positions were consistently posterior to midline throughout the entire range of flexion. The mean maximum PFT was 10.5 mm (± 4.3 mm) and the magnitude of maximum PFT was greater in higher flexion cases (r = 0.57, p = 0.0009) (Fig. 3). There were no cases having either component migration or radiolucent line except for one case showing instability related to trauma. Conclusions. In medial rotation total knee arthroplasty of PCL retaining type, clinical outcomes were satisfactory and the maximum obtainable flexions tended to be in narrower ranges than those of preoperative ones and smaller than those of other TKA prostheses. Nonetheless, reliable posterior femoral translations were observed during progressive flexions of knees, which was considered to be one of important kinematic factors in increasing the level of knee flexion of medial-rotation TKA in longer follow-ups by providing greater posterior clearance and reduced femoro-tibial impingement

Aim: To ascertain if a medial rotation platform knee replacement design (MRK; Finsbury Orthopaedics) exhibits improved range of motion (ROM) and functional outcome compared to a conventional single radius condylar knee replacement system (PFC Sigma; Depuy) at one year. Methods: Eighty patients undergoing total knee arthroplasty(TKA) were prospectively randomised and allocated to either receive the MRK or PFC Sigma pros-thesis. Patients were blinded to the choice of implant. Follow-up clinical and radiological evaluations were carried out by a single clinician so as to avoid interob-server error. Validated patient based scores including the Total Knee Function Questionnaire (TKFQ) were used to assess patient function. Results: The average ROM in the MRK group was 108.53°. In the PFC Sigma group it was 94.16°. Statistical significance was demonstrated between the two groups. The MRK group showed superior results in the TKFQ score which assesses activities of daily living as well as recreational and sporting activities. The movement and lifestyle component of the TKFQ, and the Knee Society Score were better in the MRK group with statistical significance. No difference was demonstrated between the two groups with respect to radiological analysis, WOMAC Knee, Oxford Knee and SF-36 scores. 6 out of 40 patients in the MRK group compared to 5 out of 40 patients in the PFC group said that they had forgotten about their TKA at one year. Conclusions: The medial rotation platform design confers increased ROM at one year with an associated benefit in movement and lifestyle and resultant patient satisfaction

Aims

Between 15% and 20% of patients remain dissatisfied following total knee arthroplasty (TKA). The SAIPH knee system (MatOrtho, Surrey, United Kingdom) is a medial ball and socket TKA that has been designed to replicate native knee kinematics in order to maximize the range of movement, stability, and function. This system is being progressively introduced in a stepwise fashion, with this study reporting the mid-term clinical and radiological outcomes.

Aims. This study aimed to answer the following questions: do 3D-printed models lead to a more accurate recognition of the pattern of complex fractures of the elbow?; do 3D-printed models lead to a more reliable recognition of the pattern of these injuries?; and do junior surgeons benefit more from 3D-printed models than senior surgeons?. Methods. A total of 15 orthopaedic trauma surgeons (seven juniors, eight seniors) evaluated 20 complex elbow fractures for their overall pattern (i.e. varus posterior medial rotational injury, terrible triad injury, radial head fracture with posterolateral dislocation, anterior (trans-)olecranon fracture-dislocation, posterior (trans-)olecranon fracture-dislocation) and their specific characteristics. First, fractures were assessed based on radiographs and 2D and 3D CT scans; and in a subsequent round, one month later, with additional 3D-printed models. Diagnostic accuracy (acc) and inter-surgeon reliability (κ) were determined for each assessment. Results. Accuracy significantly improved with 3D-printed models for the whole group on pattern recognition (acc. 2D/3D. = 0.62 vs acc. 3Dprint. = 0.69; Δacc = 0.07 (95% confidence interval (CI) 0.00 to 0.14); p = 0.025). A significant improvement was also seen in reliability for pattern recognition with the additional 3D-printed models (κ. 2D/3D. = 0.41 (moderate) vs κ. 3Dprint. = 0.59 (moderate); Δκ = 0.18 (95% CI 0.14 to 0.22); p ≤ 0.001). Accuracy was comparable between junior and senior surgeons with the 3D-printed model (acc. junior. = 0.70 vs acc. senior. = 0.68; Δacc = -0.02 (95% CI -0.17 to 0.13); p = 0.904). Reliability was also comparable between junior and senior surgeons without the 3D-printed model (κ. junior. = 0.39 (fair) vs κ. senior. = 0.43 (moderate); Δκ = 0.03 (95% CI -0.03 to 0.10); p = 0.318). However, junior surgeons showed greater improvement regarding reliability than seniors with 3D-printed models (κ. junior. = 0.65 (substantial) vs κ. senior. = 0.54 (moderate); Δκ = 0.11 (95% CI 0.04 to 0.18); p = 0.002). Conclusion. The use of 3D-printed models significantly improved the accuracy and reliability of recognizing the pattern of complex fractures of the elbow. However, the current long printing time and non-reusable materials could limit the usefulness of 3D-printed models in clinical practice. They could be suitable as a reusable tool for teaching residents. Cite this article: Bone Joint J 2023;105-B(1):56–63

Postoperative knee stability is critical in determining the success after reconstruction; however, only posterior and anterior stability is assessed. Therefore, this study investigates medial and lateral rotational knee laxity changes after partial and complete PCL tear and after PCL allograft reconstruction. The extending Lachman test assessed knee instability in six fresh-frozen human cadaveric knees. Tibia rotation was measured for the native knee, after partial PCLT (pPCLT), after full PCLT (fPCLT), and then after PCLR tensioned at 30° and 90°. In addition, tests were performed for the medial and lateral sides. The tibia was pulled with 130N using a digital force gauge. A compression load of 50N was applied to the joint on the universal testing machine (MTS Systems) to induce contact. Three-dimensional tibial rotation was measured using a motion capture system (Optotrak). On average, the tibia rotation increased by 33%-42% after partial PCL tear, and by 62%-75% after full PCL tear when compared to the intact case. After PCL reconstruction, the medial tibia rotation decreased by 33% and 37% compared to the fPCL tear in the case that the allograft was tensioned at 30° and 90° of flexion, respectively. Similarly, lateral tibial rotation decreased by 15% and 2% for allograft tensioned at 30° and 90° of flexion respectively, compared to the full tear. Rotational decreases were statistically significant (p<0.005) at the lateral pulling after tensioning the allograft at 90°. PCLR with the graft tensioned at 30° and 90° both reduced medial knee laxity after PCLT. These results suggest that while both tensioning angles restored medial knee stability, tensioning the Achilles graft at 30° of knee flexion was more effective in restoring lateral knee stability throughout the range of motion from full extension to 90° flexion, offering a closer biomechanical resemblance to native knee function

While numerous studies have examined dislocation caused by basic everyday movements, no objective studies have investigated body positions to minimize risk of dislocation during intercourse. We therefore used a four-dimensional motion analysis system to assess sexual activities in patients who had undergone total hip arthroplasty (THA), to identify body positions displaying less risk of dislocation. Five body-surface infrared sensors were placed on five healthy female volunteers, and maximum hip joint angle was measured. Subjects were asked to take the following three body positions: supine (missionary); top (woman on top); and kneeling (doggy-style). Angle data obtained using body surface markers were combined with three-dimensional skeletal models extracted using CT images obtained from the 24 joints of 16 patients who had undergone THA, to ascertain angles at which collision with the artificial joint or skeleton would occur. Collision angle for: supine position at maximum abduction in flexion was 77±16° in flexion and 82±57° in medial rotation; top position at maximum extension was 36±16° in flexion and 68±53° in medial rotation; top position at maximum flexion was 12±9° in flexion and 14±11° in medial rotation; kneeling position at maximum extension was 115±1° in flexion and 127±44° in medial rotation; and kneeling position at maximum flex-ion was 14±8° in flexion and 17±11° in medial rotation. The present study only assessed risk for dislocation caused by collision with the artificial joint or skeleton, and did not take into account the effects of soft tissue. However, we were able to quantitatively assess angle of the hip joint for some leg positions involved with various common coital positions. The results showed that the supine position at maximum abduction in flexion is relatively safe, since the range of motion before collision would occur was relatively wide. In addition, top and kneeling positions at maximum extension were relatively safe, but caution must be exercised at maximum flexion, as not much extra angle was available in flexion and medial rotation

Introduction: Upper root injuries (C5–C6±C7) account for 75 % of all obstetric brachial plexus palsies (OBPP). Among them, about thirty percent develop a medial contracture of the shoulder due to an imbalance between strong internal rotators and weak external rotators. This causes glenohumeral deformities. To decrease the internal contracture it had been proposed either to release the subscapularis (Sever procedure) or to perform a capsular release (Fairbank procedure). Arthroscopic capsular release was proposed in young patient to reduce the medial contracture. Material & methods: Six children with an average age of 23 months and 1 case aged 12 years old, had a medial contracture of the shoulder secondary to a C5–C6 ( 3 cases) or C5–C7 (4 cases) obstetrical palsy. An arthroscopic evaluation of the deformities was performed in 3 cases. Next a surgical subscapularis release was applied in association with a latissimus dorsi transfer. An arthroscopic evaluation of the joint associated with an arthroscopic capsular release (release of the coracohumeral ligament) was performed in 4 cases. In addition, the latissimus dorsi was transfered. Pre and Post operative passive external rotation were measured in degrees in R1 position. Pre and post operative medial rotation were evaluated according to the Mallet classification. A comparative evaluation of the glenohumeral deformities were performed between pre-operative MRI and arthroscopic results. Results: An arthroscopic evaluation of the glenohumeral joint was performed in 6 cases. In one case the arthroscopic evaluation could not be performed. In the 6 cases, arthroscopy confirmed the MRI lesion : 3 posterior subluxations, 1 posterior luxation and 2 normal joints. The subscapularis release allowed an increase in the passive lateral rotation of an average of 50°. However, a decrease of 1 point in the medial rotation was noted according to Mallet evaluation. The coracohumeral ligament arthroscopic release allowed an increase in the passive lateral rotation of an average of 60° without decreasing the passive medial rotation. Whatever the method used, a reduction of the subluxation of the glenohumeral joint was obtained. Discussion & Conclusion: Medial contracture of the shoulder may begin in the first two years of life and an early reduction with muscular release and transfers was proposed. However, the precise nature of the progressive limitation of the external passive rotation remains unclear. Is the limitation due to a contracture of the medial rotators or a capsular retraction or a combination of both? Harryman demonstrated the role of the rotator interval capsule and coracohumeral ligament in limiting the external rotation. Our hypothesis was that capsular retraction occurred before the muscular contracture. As a result we decided to perform a capsular release in patients under 24 months. The results on the passive external rotation were similar with both methods. Although, the technique of an arthroscopic release was difficult and demanding, it appears that this technique is beneficial as it allows an evaluation of the joint deformity and treatment of the contracture in the same time. Arthroscopic release is a safe but demanding technique which allows an increase in the external passive rotation in OBPP. It should be noted that this technique requires a significant practice

Symptomatic impingement of the rotator cuff between the humeral head and the coracoid process has been studied and three varieties recognised: idiopathic, iatrogenic and traumatic. In all three the clinical findings consisted of pain in front of the shoulder, referred to the upper arm and forearm, and especially felt during forward flexion and medial rotation; the pain could be reproduced by medial rotation with the arm in 90 degrees of abduction, or by adduction with the shoulder flexed to 90 degrees. Patients were relieved of their symptoms by restoring adequate subcoracoid clearance

Hip rotation in extension and flexion was studied in 23 patients with idiopathic intoeing gait. In extension all the hips had markedly increased medial rotation and limited lateral rotation, fulfilling the criteria of excessive femoral anteversion. In flexion, however, rotation varied widely; in one group of patients medial rotation remained greater than lateral, but in the second group lateral rotation was equal to or greater than medial. CT scans showed that the hips in the first group were significantly more anteverted than those in the second. Clearly measurement of hip rotation in extension alone does not provide a dependable indication of femoral anteversion in children with intoeing gait; rotation in flexion also needs to be measured

Background. In the late 1980's Michael Freeman conceived the idea that knee replacement would most closely replicate the natural knee joint, if the medial Tibio-Femoral articulation was configured as a “ball-in-socket”. Over the last three decades, medial rotation and medial pivot designs have proved successful in clinical use. Freeman's final iteration of the medial ball-in-socket concept was the Medial Sphere knee. We report the three-year survivorship, clinical outcomes, patient reported outcome measures (PROMs) and radiographic analysis of this implant in a multi-centre, multi-surgeon, prospective observational study. Methods. Patients awaiting total knee replacement were recruited by four centres. They had no medical contraindication to surgery, were able to provide informed consent and were available for follow-up. Primary outcome was implant survival at six months, one, two, three and five years. Secondary outcomes were patient reported outcome measures: Oxford Knee Score (OKS), Euroqol (EQ-5D), International Knee Society Score (IKSS), IKSS Functional score and Health State score, complications and radiographic outcomes. Radiographic analysis was undertaken using the TraumaCad software and data analysis was undertaken using SPSS. Results. To date, 328 female and 202 male patients with a mean age 66.9 years and mean body mass index 30.0 were recruited. Three year Kaplan-Meier survivorship analysis of cumulative failure showed an implant survival of 99.46% (95% confidence interval 100 – 96.74), when deaths and withdrawals were treated as censored data. Twelve patients withdrew (2.26%), seven died (1.32%) and two knees were revised (0.38%). The mean EQ5D, Health State Scores, OKS, IKSS & IKSS Function scores at three years improved significantly from pre- operative scores (Health State Score: 9.91 (65.59 pre-op to 75.50); OKS: 18.82 (19.90 pre-op to 38.72); IKSS: 39.87 (44.39 pre-op to 92.09); IKSS Function Score: 35.03 (49.42 pre-op to 84.45). The mean improvement of EQ5D at three years was: 0.34 (0.48 pre-op to 0.82). Discussion. Survival of the GMK Sphere to three years in this study was over 99%. Risk of revision compares favourably with UK National Joint Registry (NJR) data. The improvements that are seen in patient reported outcome measures reflect an enhancement in patient function and quality of life. Conclusion. At three years follow-up, the implant demonstrates satisfactory survival and outcomes. Patient matching and evaluation of more cases, at more time points will allow outcome comparison with other implant options

The pathogenesis of Perthes' disease has been related to increased intra-articular pressure secondary to a joint effusion. The pressure within the hip in different positions was measured in eight children with transient synovitis and four with the synovial stage of Perthes' disease. In the position of comfort for the hip this pressure was always less than the arteriolar blood pressure and in a supine position it did not exceed the systolic blood pressure. However, in extension with medial rotation the intra-articular pressure always became several times the systolic blood pressure. This high pressure was also recorded in the stable lateral position which occurs normally during sleep. It is concluded that in the presence of a synovial effusion in the hip, a position of extension and medial rotation causes an increase in intra-articular pressure which may compromise the blood supply to the capital epiphysis of the femur

We describe the results of surgical treatment in a prospective study of 183 consecutive cases of subluxation (101) and dislocation (82) of the shoulder secondary to obstetric brachial plexus palsy between 1995 and 2000. Neurological recovery was rated ‘good’ or ‘useful’ in all children, whose lesions fell into groups 1, 2 or 3 of the Narakas classification. The mean age at operation was 47 months (3 to 204). The mean follow-up was 40 months (24 to 124). The mean gain in function was 3.6 levels (9.4 to 13) using the Mallet score and 2 (2.1 to 4.1) on the Gilbert score. The mean active global range of shoulder movement was increased by 73°; the mean range of active lateral rotation by 58° and that of supination of the forearm by 51°. Active medial rotation was decreased by a mean of 10°. There were 20 failures. The functional outcome is related to the severity of the neurological lesion, the duration of the dislocation and onset of deformity

The factors involved in the mechanism leading to traumatic posterior dislocation of the hip are examined. In 47 adult patients who had previously suffered such a dislocation, ultrasound scans were used to measure femoral anteversion on both the affected and the uninjured side. In 36 normal adult volunteers, used as controls, similar measurements were made. Femoral anteversion on both the injured and uninjured side was significantly reduced in the patients compared with the volunteers. These findings are discussed in the light of previous work which indicates that medial rotation is a factor in the mechanism of posterior dislocation of the hip. It is suggested that reduced anteversion acts like medial rotation to make the hip more susceptible to posterior dislocation, and that the less the anteversion the more likely is the injury to be a dislocation rather than a fracture-dislocation. It is concluded that patients who suffer such dislocated hips belong at one extreme of the normal population, having either reduced femoral anteversion or even retroversion, and that this anatomical feature selects towards hip dislocation rather than to injury of the femoral shaft, knee or tibia during the appropriate type of accident

Aims

This study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.