Open talus fracture are notoriously difficult to manage and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons, however, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion. A review of electronic hospital records for open talus fractures from 2014-2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was four years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data was analysed using the software PRISM. Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients

In our department, currently there is variation in the number of xrays that patients receive following ORIF of distal radius fractures. This audit investigated the use of xrays following ORIF of distal radius fractures. Patients were identified from daily trauma lists. Patients who had a primary ORIF or ORIF following failed conservative management were included in the study. PACS was used to identify the number of post-operative xrays performed. These were correlated with clinic letters to see if there was any change in management following xray review. Between July and November 2013, 102 patients were admitted with distal radius fracture. Of these, 35 (mean age:51 years) had an ORIF. Four were not followed-up in Scotland. Of the remaining 31 patients, eleven had one post-operative xray, seventeen had two and three had three xrays. Of the patients who had one xray, seven had the xray in the first three weeks, the rest at six weeks. Patients who had two xrays had an xray at two and 6 weeks. Of the three patients who had three xrays, two had comminuted fractures that required further CT investigation, one for a suspicion of an intra-articular screw, the other for possibility of non-union. The third patient had no apparent reason for requiring three xrays. Thus of the 31 patients in the study, 29 did not require any further investigations. The results show a variation in the frequency of post-operative xrays after fixation of distal radius fractures. In most cases the management plan was unchanged after plain xrays were undertaken. This suggests that a protocol driven approach to follow-up after fixation of distal radius fractures could reduce the burden on fracture clinic and radiology departments. We propose that unless indicated by intra-operative findings or post-operative concerns, patients should have xrays at the two week review appointment

Introduction: Treatment and outcome of patients with rheumatoid arthritis and distal humerus fractures is not well established. Methods: Between 1982 and 2002 twenty-four elbows in twenty-two patients (eleven men, eleven women) treated for acute distal humerus fractures were retrospectively reviewed. The average age at time of the fracture was 64 years. Eleven elbows were immediately treated with a total elbow arthroplasty (TEA) type Coonrad-Morrey (CM), six elbows had underwent open reduction and internal fixation (ORIF), and seven elbows were referred to our institution after failed ORIF elsewhere and were revised with an TEA (CM). Results: At an average follow-up of 52 months the Mayo Elbow Performance Score (MEPS) averaged in the eleven elbows with an immediate TEA 96 points and in the six elbows with ORIF 93 points (p=0.79). In the seven elbows with TEA after failed ORIF there was a trend towards a less favorable outcome (MEPS: 86 points) but the differences was not significant compared to immediate TEA (p=0.31) and ORIF (p=0.53). Patients with failed ORIF and a subsequent TEA had an average of 3 operation per elbow with one patient ending in elbow resection after an infected TEA. Patients with immediate TEA had an average of 1.3 operations and patients with successful ORIF 1.2 interventions. Discussion and Conclusion: Distal humerus fractures in patients with rheumatoid arthritis can be treated successfully with an immediate TEA or ORIF. There is a trend towards a poorer clinical outcome in patients with TEA after failed ORIF

Aim: To compare the outcome of open reduction and internal fixation with MUA and k-wire stabilisation of dorsally displaced distal radial fractures. Methods: A review of patients that had ORIF or MUA and k-wire stabilisation for dorsally displaced distal radial fractures was carried out and patients with a follow period of more than 6 months were selected for this study. The patient history and the management of the injury were obtained and the wrist examined. Each patient completed a patient-rated wrist evaluation form and the range of movement and strength of the wrist was determined by the senior occupational therapist. Standard radiographs were obtained and volar tilt, radial inclination and radial length were measured. Results: This study provides results on 24 patients, which were grouped according to the two different surgical procedures; ORIF and MUA and k-wire stabilisation. The procedure undertaken depended on consultant preferences and in the majority of cases patients were treated with MUA and k-wire stabilisation. Patients of both groups were of similar age and all sustained either a low or medium energy injury. All patients from each group received physiotherapy post operatively. There was no significant difference between both groups for range of movement and grip strength. There was also no difference between the patient’s perception of pain and function which was assessed using the patient rated wrist evaluation (PRWE). Radiologically, the k-wire stabilisation group averaged better volar tilt compared with the ORIF group. For radial height and inclination the outcome was similar. Conclusion: MUA and k-wire stabilisation has been the most popular surgical management for unstable dorsally displaced fractures of the distal radius. More recently ORIF with the locking compression plate has been used with good results. This study showed that the outcome of ORIF and MUA and k-wire stabilisation were similar and therefore either surgical management can be used with good results

Few will disagree that the best femoral head that a young patient can have is his or her own, native femoral head. In the active, healthy patient under age 60 with a displaced femoral neck fracture, well-done, timely ORIF presents the best chance of preserving the patient's native femoral head. Arthroplasty is generally reserved for older patients, over age 60, where attempts at ORIF in this setting have demonstrated failure rates over 40%. Recent studies have documented that approximately 80% of young patients with displaced femoral neck fractures treated with ORIF will keep their own femoral head for 10 years after injury. The variables under the surgeon's control include timing of fixation, quality of reduction, accurate implant placement and implant selection, and capsulotomy. All of these variables potentially affect outcomes. Fractures in this young age group are frequently high shear angle (vertical) Pauwels type 3 fractures, and benefit from fixed angle fixation. The author prefers anatomic reduction and stabilization with a sliding hip screw and a superiorly placed derotation screw. Careful attention to detail is important to obtain an anatomic reduction, which is the most important variable in the outcome of these challenging injuries

Few will disagree that the best femoral head that a young patient can have is his or her own, native femoral head. In the active, healthy patient under age 60 with a displaced femoral neck fracture, well-done, timely ORIF presents the best chance of preserving the patient's native femoral head. Arthroplasty is generally reserved for older patients, over age 60, where attempts at ORIF in this setting have demonstrated failure rates over 40%. Recent studies have documented that approximately 80% of young patients with displaced femoral neck fractures treated with ORIF will keep their own femoral head for 10 years after injury. The variables under the surgeon's control include timing of fixation, quality of reduction, accurate implant placement and implant selection, and capsulotomy. All of these variables potentially affect outcomes. Fractures in this young age group are frequently high shear angle (vertical) Pauwels type 3 fractures, and benefit from fixed angle fixation. The author prefers anatomic reduction and stabilization with a sliding hip screw and a superiorly placed derotation screw. Careful attention to detail is important to obtain an anatomic reduction, which is the most important variable in the outcome of these challenging injuries

The proper management of radial head fractures is difficult and controversial. The radial head is intra-articular, part of the forearm ring and participates in both flexion and extension as well as in pronosupination. Our main goal in treating those fractures is anatomic restoration of the joint surface and early mobilization. Excision of the radial head, a well described procedure, may result in elbow instability and proximal migration of the radius. In this work we tried to avoid those complications by either conserving the head (ORIF) or by using a Radial head prosthesis. Material and Methods: 20 Patients were enrolled into the study between 2003–2004. They were divided into 2 groups. 10 patients had ORIF and in patients the Corin Radial head prosthesis was used. Post-op all patients started immediate CPM. All patients were followed-up for 12–28 months (average 18.6). XR were taken each time and clinical examination was done, ROM was noted as well as muscle strength. Elbow stability was tested only on the 2. nd. month post op. Patient satisfaction was noted based of their function ability, and the amount of pain. Pain was rated on a scale of 1–10. Results: Both groups passed the surgery uneventfully. No neurovascular damage nor infection were noted. In clinical examination the elbow was found to be stable in both groups. Decreased ROM in compare with the other elbow was found in both groups, but was more prominent in he ORIF group. One patient in the ORIF group in which biodegradable rod was used developed moderate synovitis that passed without intervention after 9 weeks. XR reveled that one patient in the ORIF group developed Heterotopic ossification, no dislocation or subluxation of the prosthesis was seen. Regarding to pain, in the ORIF group the patients rated their pain as milder in compare to those in the prosthetic group. Conclusions: Both methods result in stable elbow but the ORIF group showed tendency to experience less pains and the prosthesis group showed tendency to better ROM

Aims: In prospective study the author asked, what are the results of ORIF (open reduction, internal fixation) in displaced intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the sub-talar joint influence these results. Methods: Forty-three displaced intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV; Sanders) were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed (median: day 7). Motion was encouraged immediately, partial weight-bearing after 5–6 weeks, and full weight-bearing after 3–4 month. Following surgery subtalar joint was congruent in 33 (77%) and non-congruent (within 2mm) in ten fractures. Results: Thirtysix fractures were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86%) and not satisfactory in five. All fractures with unsatisfactory results were comminutive (Type III or IV). Four fractures with congruent subtalar joint had unsatisfactory, whereas eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse (p=0,002). However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint. Conclusions: ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. Comminution in the subtalar joint is a negative prognostic factor; furthermore, comminution is a negative prognostic factor irrespectless of the postreduction congruity in the subtalar joint, if step-off is less than 2mm

The term os-acromiale denotes the failure of fusion of acromial apophysis to the scapular spine. The prevalence of os is considered to be about 8% in the general population with higher prevalence in African Americans and males. The treatment options for a symptomatic os acromiale range from arthroscopic excision to decompression to ORIF and bone grafting. In this study, we reviewed retrospectively patients who had undergone ORIF and bone grafting for a painful os acromiale. Patients surgically treated for os acromiale from 1998 to 2009 were included in the study. All patients were diagnosed to have a symptomatic os acromiale clinically and radiologically. A pre operative MRI of the affected shoulder was done in all patients. All patients had failed conservative management. The surgical technique was standard in all patients. The rotator cuff was repaired if it was torn. Patients were followed up at 3, 6 and 12 months postoperatively. Post operative X-rays were done at 3 months to assess healing. An ASES scoring was done at the final follow up at a mean of 30.5 months post op. 16 patients with 17 shoulders which included 10 males and 6 females were available for the last follow up. 11 shoulders involved dominant hand, 15 shoulders had a history of trauma. Surgery was performed after an average of 7.2 months of conservative management. 11 out of the 17 shoulders had associated rotator cuff tears. Out of the 6 patients with intact cuff, 2 had associated clavicle fractures and 1 patient had an Acromio clavicular joint dislocation. A clinical and radiographic union was achieved in all patients. Mean ASES score in patients without rotator cuff tear was 89 whereas patients with associated rotator cuff tear had an ASES score of 74. Pain score and percentage ADL score were better in patients without rotator cuff tear (92 and 1.3) as compared to those with a cuff tear (83 and 2.2). There was no significant difference in scores in patients who had second surgery at final follow up. 15 of the 16 patients were satisfied with the surgery and would have the surgery on the other side for a similar problem. Open reduction and internal fixation of symptomatic os acromiale yields predictable clinical outcome. Bigger studies randomising treatment methods in similar group of patients may be needed to find out the superiority of one method over the other

Introduction. Venous thromboembolism (VTE) represents a major cause of morbidity, mortality and financial burden to the NHS. Acquired risk factors are well documented, including immobilisation, lower limb plaster cast and surgery. NICE guidance on VTE prophylaxis within orthopaedics currently excludes operative ankle fracture fixation (ankle ORIF). Aims. Ascertain the local incidence of VTE; compare our local VTE rates with published data from other institutions; review guidelines, scientific literature and other hospitals policies; formulate a local policy for VTE prophylaxis. Method. Retrospective analysis of records of all patients undergoing ankle ORIF in our hospital over a continuous 5 year period, identifying cases of VTE, individual risk factors and surgical duration. Results. 380 patients underwent ankle ORIF; 3 developed VTE; no mortality. VTE incidence 0.79% (0.26%DVT; 0.53%PE). Operative duration 88 +/− 34mins (mean +/− 1S.D); in those with VTE, duration was 35, 90&85min. There is no statistically significant difference (p=0.18) observed between our local and national VTE incidence rates. Operative duration was not a significant factor in those developing VTE. Additional risk factors were identified in one patient with VTE. Discussion. The incidence of heparin induced thrombocytopenia is 0.5%, its associated mortality 10% (i.e. 1:2000). To prevent one fatal PE in foot & ankle surgery, 10,000 must receive VTE prophylaxis. Therefore, heparin associated mortality exceeds VTE associated mortality in foot & ankle surgery. Conclusion. Our local VTE rates are comparable to national rates. Risk of pharmacological prophylaxis exceeds benefit; therefore routine use not justified. Individual risk should be assessed; higher risk patients may benefit

Femoral neck fractures continue to be one of the most common orthopaedic injuries treated today. Owing to the increased longevity of patients, enduring activity of older patients, and widespread osteoporosis in the population, there are more femoral neck fractures treated nowadays than ever before. Over 1 million femoral neck fractures were treated in the >65-year-old population, in the United States, between the years 1991–2008. The treatment of femoral neck fractures is unique because some fractures are amenable to internal fixation, while others require endoprosthetic replacement, either with a hemiarthroplasty or total hip replacement. Traditionally, less displaced fractures are treated with internal fixation; however, in younger patients, an attempt to fix the displaced fractures may be performed, in order to avoid a joint replacement in this population. The age at which an attempt at internal fixation is performed is still controversial, and treatment must be individualised to each patient. In general, patients younger than 60 would likely have internal fixation of the femoral neck fracture, rather than joint replacement. The paradigm for the treatment of femoral neck fractures has been changing in the last 10 years, due to advances in implant technology, surgical technique, and scientific papers that have compared the results of all three treatment options. Larger diameter femoral heads in combination with highly crosslinked polyethylene, or dual mobility head options, provide greater joint stability today than was possible in the past, thus making THA a more appealing option. Furthermore, greater use of the direct anterior approach to THA may also reduce the postoperative dislocation rate, due to preservation of the posterior capsule and short external rotators. Therefore, the author will propose the use of arthroplasty for displaced femoral neck fractures in patients younger than 60 years of age, owing to the reliability and reproducibility of THA over ORIF. Furthermore, the advances in arthroplasty materials and surgical techniques can restore function in this group of younger patients, with greater longevity of the implant than in the past

Aims. Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone. Patients and Methods. A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed. Results. No patient in the CHP group required further hip surgery, giving THA a survival rate of 100% (95% confidence interval (CI) 100 to 100) after three years, compared with 28.6% hip joint survival in the ORIF group (95% CI 12.5 to 65.4; p = 0.001). No dislocations or deep infections occurred in the CHP group. No patient died within the first year after index surgery, but patient survival was lower in the CHP group after three years. There were no relevant differences in patient-reported outcomes. Conclusion. The CHP confers a considerably reduced need of further surgery when compared with ORIF alone in elderly patients with complex acetabular fractures. These findings encourage both further use of, and larger prospective studies on, the CHP. Cite this article: Bone Joint J 2019;101-B:478–483

Aims. The aim of this study was to determine both the incidence of, and the reoperation rate for, postoperative periprosthetic femoral fracture (POPFF) after total hip arthroplasty (THA) with either a collared cementless (CC) femoral component or a cemented polished taper-slip (PTS) femoral component. Methods. We performed a retrospective review of a consecutive series of 11,018 THAs over a ten-year period. All POPFFs were identified using regional radiograph archiving and electronic care systems. Results. A total of 11,018 THAs were implanted: 4,952 CC femoral components and 6,066 cemented PTS femoral components. Between groups, age, sex, and BMI did not differ. Overall, 91 patients (0.8%) sustained a POPFF. For all patients with a POPFF, 16.5% (15/91) were managed conservatively, 67.0% (61/91) underwent open reduction and internal fixation (ORIF), and 16.5% (15/91) underwent revision. The CC group had a lower POPFF rate compared to the PTS group (0.7% (36/4,952) vs 0.9% (55/6,066); p = 0.345). Fewer POPFFs in the CC group required surgery (0.4% (22/4,952) vs 0.9% (54/6,066); p = 0.005). Fewer POPFFs required surgery in males with a CC than males with a PTS (0.3% (7/2,121) vs 1.3% (36/2,674); p < 0.001). Conclusion. Male patients with a PTS femoral component were five times more likely to have a reoperation for POPFF. Female patients had the same incidence of reoperation with either component type. Of those having a reoperation, 80.3% (61/76) had an ORIF, which could greatly mask the size of this problem in many registries. Cite this article: Bone Joint J 2024;106-B(2):144–150

This is a case series report on the outcomes of patients that have received ORIF of their calcaneal fractures at Craigavon Hospital, Northern Ireland, for the first 2 years since it opened. It is a one surgeon series. Methods. Patients were identified from the theatre logbook. The patient recalled to clinic for interview and examination. Outcome was assessed using The Ankle-Hindfoot Scale devised by the American Orthopaedic Foot and Ankle Society. This was recorded with data for the patient's notes and CT scans. These data included age, date of surgery, mechanism of injury, associated injuries and previous function. The calcaneal fractures were classified according to the Sanders Classification. Results. Sixteen patients identified from the theatre register. Of these patients, 10 patients were contactable and attended for evaluation. The data from these 10 patients was then analysed. There 9 male patients and one female. Time from operation from 9.5 months to 33 months. All patients had fractures classified as Sanders Type IV. All implants were Variax calcaneal plates. One patient had metalwork removed at 15 months. All patients had commenced weightbearing at 3 months. Outcome scores ranged from 52–97 (mean 78.3, median 79). Six of the ten had returned to work at this review. Subtalar motion was universally affected. Discussion. This one surgeon case series reflects the current literature on calcaneal fractures, in that there is a variation in outcome which is multifactorial. There is also a difficulty in defining a classification system which can reflect outcome. The results of this series suggest that there is a trend of improving outcome scores as time from injury progresses, and that outcome score tends to decrease as age at injury increases

Aim: To present and analysis the neurological complications after ORIF with plates of bicondylar fractures of the humerus. Material and Methods: For the period 1996 – 2003 77 bicondylar fractures were operated with plates. All of them were followed up. 36 Man and 41 women. Dominant hand was affected in 43 patients. The AO types were C1- 25, C2 – 28, C3 – 24. There were 18 open fractures (I–II degree). High-energy trauma caused 19 fractures. 14 were with associated ipsilateral fractures of the upper limb. All patients were operated by the standard AO technique. In all patients the ulnar nerve was identified. There was no case where the radial nerve was exposed. In 36 patients the nerve was transposed anteriorly subcutaneosly and for the rest it was not. Results: We observed 20 postoperative ulnar and radial nerve disfunctions (19 ulnar nerve and 1 radial nerve disfunctions). Electromiography was performed in all cases. 7 of 36 (with transposition) cases finished with temporary ulnar nerve palsy. 3 of 41 (without transposition) cases finished with permanent ulnar nerve palsy and the other 9 of 41 finished with temporary disfunction. The disfunction of the radial nerve was temporary. The temporary neurological disfunctions recovered completely for 3–7 months. Neurolysis and anterior transposition of the ulnar nerve was performed in the cases with permanent ulnar nerve palsy. Conclusions: We suggest that ulnar nerve transposition is a method of choice in operative treatment of bicondylar fractures of the humerus. Careful management of the ulnar nerve is mandatory. Meticulous soft-tissue dissection and hemostasis help to prevent perineural fibrosis

Femoral neck fractures continue to be one of the most common orthopaedic injuries treated today. Owing to the increased longevity of patients, enduring activity of older patients, and widespread osteoporosis in the population, there are more femoral neck fractures treated nowadays than ever before. Over 1 million femoral neck fractures were treated in the >65 year old population, in the United States, between the years 1991–2008. The treatment of femoral neck fractures is unique because some fractures are amenable to internal fixation, while others require endoprosthetic replacement, either with a hemiarthroplasty or total hip replacement. Traditionally, less displaced fractures are treated with internal fixation; however, in younger patients, an attempt to fix the displaced fractures may be performed, in order to avoid a joint replacement in this population. The age at which an attempt at internal fixation is performed is still controversial, and treatment must be individualised to each patient. In general, patients younger than 60 would likely have internal fixation of the femoral neck fracture, rather than joint replacement. The paradigm for the treatment of femoral neck fractures has been changing in the last 10 years, due to advances in implant technology, surgical technique, and scientific papers that have compared the results of all three treatment options. Larger diameter femoral heads in combination with highly crosslinked polyethylene, or dual mobility head options, provide greater joint stability today than was possible in the past, thus making THA a more appealing option. Furthermore, greater use of the direct anterior approach to THA may also reduce the post-operative dislocation rate, due to preservation of the posterior capsule and short external rotators. Therefore, the author will propose the use of arthroplasty for displaced femoral neck fractures in patients younger than 60 years of age, owing to the reliability and reproducibility of THA over ORIF. Furthermore, the advances in arthroplasty materials and surgical techniques can restore function in this group of younger patients, with greater longevity of the implant than in the past

Introduction: An ankle fracture represents the most frequent osseous injury in both the elderly and non-elderly population. To date, only a limited number of retrospective studies have addressed medium-term outcome following ankle Open Reduction and Internal Fixation (ORIF). The purpose of this study was to assess residual pain and functional outcome 10 to 20 years after operative treatment of ankle fractures and to evaluate the incidence of symptomatic and radiographic ankle osteoarthritis (OA). Methods: We designed a retrospective study including all consecutive patients who underwent ankle ORIF between January 1988 and December 1997 in a University Hospital setting. Pilon and talus fracture as well as pediatric patients were excluded. Patients were seen by two senior residents 10–20 years after their index surgery. Residual pain was measured using the Visual Analog pain Scale. Function and general health status were assessed using the Olerud and Molander Ankle Score, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the 12-item short-form health survey (SF-12). Ankle OA on standard radiographs was scored according to the revised Kellgren and Lawrence (K& L) scale. Results: 374 patients (56% men) underwent ankle surgery during the defined period. 10% of the patients had a Weber A fracture, 57% a Weber B and 33% a Weber C fracture. Mean age at the time of operation was 42.9 years (+/− 17.1; range 16–86 years). 10–20 years after surgery, 47 patients had died, 126 had left the country and were lost to follow-up, 99 did not respond or refused to participate, and 102 patients were seen at the follow-up visit. These patients did not differ in terms of age, gender distribution, BMI and type of fracture from those who were not seen. The mean duration of follow up was 17.3 years (+/− 3.3). Advanced radiographic OA (K& L grade 3 and 4) was present in 34.3 % of the patients. Symptomatic OA was reported by 34.3 % of the patients (AOFAS pain score < 40). Both clinically symptomatic and radiographic ankle OA was found in 18 patients (17.6%). Function was good in 85% of the cases (total AOFAS hindfoot score between 80 and 100 points; mean total AOFAS hindfoot score 89.9, +/−14.6). The mean Olerud and Molander ankle score was 86.5 (+/−18.7). The general health status (SF-12) was similar to representative values of the general population with a similar mean age. Conclusion: 10–20 years after operative treatment of an ankle fracture, the incidence of advanced radiographic post-traumatic ankle OA was 35%, symptomatic OA was present in one third of the patients and about one fifth had both. The majority of the patients reported good function

Objectives. The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Methods. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared. Results. The relative displacement of the EFLIF was less than that of the plate (0.1363 mm to 0.1808 mm). The highest von Mises stress value on the plate was 33% higher than that on the EFLIF. A normal restoration of the Böhler angle was achieved in both groups. No significant difference was found in the clinical outcome on the American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale, or on the Visual Analogue Scale between the two groups (p > 0.05). Wound complications were more common in those who were treated with ORIF (p = 0.028). Conclusions. Both EFLIF and ORIF systems were tested to 160 N without failure, showing the new construct to be mechanically safe to use. Both EFLIF and ORIF could be effective in treating Sanders type 2 calcaneal fractures. The EFLIF may be superior to ORIF in achieving biomechanical stability and less blood loss, shorter surgical time and hospital stay, and fewer wound complications. Cite this article: M. Pan, L. Chai, F. Xue, L. Ding, G. Tang, B. Lv. Comparisons of external fixator combined with limited internal fixation and open reduction and internal fixation for Sanders type 2 calcaneal fractures: Finite element analysis and clinical outcome. Bone Joint Res 2017;6:433–438. DOI: 10.1302/2046-3758.67.2000640

Objective. To identify risk factors for surgical site infections and to quantify the contribution of independent risk factors to the probability of developing infection after definitive fixation of tibial plateau fractures. Methods. A retrospective analysis was performed at a Level I trauma center between 2004 and 2010. A total of 251 consecutive patients (256 cases) were divided into two groups, those with and those without a surgical site infection. Preoperative and perioperative variables were compared between these groups and risk factors were determined by univariate analyses and multivariate logistic regression. Results. The overall rate of surgical site infection after tibial plateau ORIF was 7.8% (20 of 256). The most common causative pathogens was Staphylococcus aureus (n=15, 75%). Independent predictors of surgical site infection identified by multivariate analyses were open tibial plateau fracture (odds ratio =3.9; 95% confidence interval=1.3–11.6, p =0.015) and operative time (odds ratio=2.7; 95% confidence interval=1.6 − 4.4; p < 0.001). Conclusions. Both open fracture and operative time are independent risks factors for post operative infection

Purpose: The purpose of this study was to review our results in patients with pilon fractures treated with ORIF in which surgical planning involved multiple skin incisions, ensuring that the distance incisions overlapped was less than the distance between them. We hypothesized that soft-tissue complications would be minimal despite incisions placed < 7-cm apart. Method: A retrospective chart review identified 37 pilon fractures in 32 patients treated by three orthopedic traumatologists at The Ottawa Hospital between August 2000 and February 2007. Follow-up included measurements of incision placement and functional outcome measures. Results: There were nine OTA type B and 28 OTA type C fractures; 28 were closed and nine were open. The mean age was 46.5 ±14.5 years, and average follow-up was 3.2 ±1.7 years. Of the patients reviewed, the average number of incisions was 3.7 ±1.1. The average overlap between incisions was 4.6-cm ±1.9 and the average skin bridge between incisions was 5.9-cm ±1.9, with 80% of the skin bridges < 7-cm. Average ROM was 4.3° ±7.1 dorsiflexion and 39.1° ±11.6 plantarflexion. The mean AMA lower extremity impairment score was 18.9% ±12.4, and mean SIP ambulation score was 9.6 ±8.8. Complications included two superficial infections, one deep infection, and three non-unions. There were no cases of wound dehiscence or necrosis, or cases requiring revision soft-tissue coverage. These outcomes were comparable to recent reports with similar injuries. Conclusion: With careful planning and good soft-tissue management, incisions can be placed to maximize articular exposure based on fracture lines. It does not appear that the dogma of keeping incisions > 7-cm apart must be followed in most cases. Prudent surgical timing and meticulous soft-tissue handling can allow for multiple incisions to be placed as necessary for fracture reduction and optimal fixation while maintaining a low rate of complications