The primary aim was to determine the rate of complications and re-intervention rate in a consecutive series of operatively managed distal radius fractures. Data was retrospectively collected on 304 adult distal radius fractures treated at our institution in a year. Acute unstable displaced distal radius fractures surgically managed within 28 days of injury were included. Demographic and injury data, as well as details of complications and their subsequent management were recorded. There were 304 fractures in 297 patients. The mean age was 57yrs and 74% were female. Most patients were managed with open reduction and internal fixation (ORIF) (n=278, 91%), with 6% (n=17) managed with manipulation and Kirschner wires and 3% (n=9) with bridging external fixation. Twenty-seven percent (n=81) encountered a post-operative complication. Complex regional pain syndrome was most common (5%, n=14), followed by loss of reduction (4%). Ten patients (3%) had a superficial wound infection managed with
Digital Mucous Cysts (DMCs) arise from the distal inter-phalangeal joints of the digits. They often rupture spontaneously and nail deformities are common. Although surgical excision is recognised as the most successful treatment, there is no clear consensus as to the most appropriate operative technique. We performed a retrospective review identifying all patients who underwent excision of a DMC using a local rotation skin flap by the senior author over a ten-year period. Patients were all seen pre-operatively and at a minimum of six months post-operatively. Sixty-nine patients were included in the study and were reviewed at an average of 37.7 months post-operatively. No patients were lost to follow-up. There was only one cyst recurrence (1.4%). Sixty-seven (97.1%) patients were happy with the scar and sixty-three patients (91.3%) said they would have the procedure performed again. Sixty-six patients (95.7%) were content with their post-operative range of movement, which was on average 8.1° less than pre-operative values. Thirty-six patients had a nail deformity pre-operatively and twenty-one reported that the deformity grew out following the procedure. Only one patient (3.0%) developed a new deformity post-operatively. Five patients reported infection post-operatively with four prescribed
We reviewed the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, at 6 weeks, 6 and 12 months, and annually until 10 years post-op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 20 out of the remaining 24 were available for follow-up. Complications included lateral malleoli fracture (3), superficial peroneal nerve injury (2), one early death, unrelated to the surgical procedure, delayed syndesmotic union (1), non-union (6) and deep infection (2), of which one underwent removal of the implant; the other receives long-term
This study aimed to investigate the clinical characteristics and outcomes associated with culture-negative limb osteomyelitis patients. A total of 1,047 limb osteomyelitis patients aged 18 years or older who underwent debridement and intraoperative culture at our clinic centre from 1 January 2011 to 31 December 2020 were included. Patient characteristics, infection eradication, and complications were analyzed between culture-negative and culture-positive cohorts.Aims
Methods
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. Between May 2012 and December 2020, 203 patients with infected segmental bone defects treated with the IMT were enrolled. The digital medical records of these patients were retrospectively analyzed. Factors associated with unfavourable outcomes were identified through logistic regression analysis.Aims
Methods
Introduction. Medial column insufficiency in patients with painful acquired flatfoot can be difficult to appreciate. The reverse Coleman block test is used in this study to predict medial column instability. Methods. Patients who underwent a procedure for medial column insufficiency with use of the reverse Coleman block test pre-operatively were investigated. Weight bearing radiographs were used to determine the joints in the medial column contributing to the deformity and also to estimate the angle which the first ray must be depressed to re-establish hindfoot neutrality. The reverse Coleman block test corrects a mobile valgus heel to a neutral position by placing a block, of appropriate height, under the first metatarsal head. With the heel in neutral and the relative forefoot supination compensated the foot returns to a neutral anatomic position. Gender, age, complications and radiological outcomes were investigated. Results. Over the last three years 25 medial column procedures were performed for painful insufficiency on 17 females and five males by the senior author. Three patients underwent staged bilateral procedures. The average age was 62 years old. Three feet had been on operated on the medial column previously. The pre-operative weight bearing lateral radiographs showed instability in the medial column greater than 5° in 12 cases. With the reverse Coleman block test instability was seen in 25 cases and the deformity increased from an average of 7° (range 0° to 25°) to 14° (range 5° to 30°). Post-operative weight bearing radiographs, with fusion of the unstable joint, the average medial column alignment was 1° (range −10° to 10°). Three patients developed superficial infections requiring
The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients. In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis.Aims
Methods
About 81,000 total knee replacements are implanted in the United Kingdom annually. Conventionally pneumatic tourniquet and surgical drains have been used in total knee arthroplasty. However, no definite evidence or guidelines exist to support their use. The present study aims to look for any difference in perioperative recovery and complications following use of pneumatic tourniquet and surgical drains in knee replacement surgery. We retrospectively analysed 60 total knee arthroplasties performed by 3 different surgeons at our hospital during January 2007 to June 2010. A sample size of 20 patients in each group was evaluated. Group 1: used tourniquet and drain; Group 2: used tourniquet but no drain; Group 3: didn't use tourniquet but used drain. Data was collected and analysed using statistical means, t-test & analysis of variance. Parameters compared were surgical (anaesthetic) time, mean postoperative haemoglobin at 24 hrs, blood transfusion rate, haematoma formation, wound infection, pain, deep vein thrombosis and infection at discharge. At 6 weeks clinical follow up letters were analysed. Our results reveal that there is no significant difference in duration of surgery in either group. Use of tourniquets didn't improve on surgical time (123–133 minutes). Our Local Hospital Pain Score was used (1 no pain, 2 mild, 3 moderate, 4 severe and 5 worst imaginable pain). No difference at discharge was seen in either group. Similarly no difference was seen in either group with postoperative haematoma formation with one case (5%) in Group 1 and 3 respectively. Although the immediate postoperative haemoglobin (Hb%) was comparable in all 3 groups, Group 3 patients received more blood transfusion compared to other groups based on clinical grounds. About 50 % of Group 3 needed blood transfusion compared to 10% in Group 1 and 5% in Group 2. There was only one proven case of superficial infection at 6 weeks (Group 2) which responded well to antibiotics. There were 4 cases of cellulitis noted at 6 weeks (3 in Group 2 and 1 in Group 3) which responded to
To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes.Aims
Methods
The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative complications and revision surgery. A retrospective case series was undertaken of all displaced clavicular fractures that underwent plate fixation over a ten-year period (2007 to 2017). Patient demographics, time to surgery, complications, and mode of failure were collected. Logistic regression was used to identify independent risk factors contributing towards operative complications. Receiver operating characteristic (ROC) curve analysis was used to determine if a potential ‘safe window’ exists from injury to delayed surgery. Propensity score matching was used to construct a case control study for comparison of risk.Aims
Patients and Methods
The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) Aims
Patients and Methods
Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59).Aims
Methods
In this randomized study, we aimed to compare quality of regenerate in monolateral Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study.Aims
Patients and Methods
The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients. We undertook a retrospective comparison of two methods of fixation, using a locking plate without an associated fibular strut allograft (LP group) and with a fibular allograft (FA group) for the treatment of these fractures. The outcome was assessed for 52 patients in the LP group and 45 in the FA group, with a mean age of 74.3 years (52 to 89), at a mean follow-up of 14.2 months (12 to 19). The clinical results were evaluated using a visual analogue scale (VAS) score for pain, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the range of movement. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH).Aims
Patients and Methods
The aim of this study was to compare the cost-effectiveness of
treatment with an osseointegrated percutaneous (OI-) prosthesis
and a socket-suspended (S-) prosthesis for patients with a transfemoral
amputation. A Markov model was developed to estimate the medical costs and
changes in quality-adjusted life-years (QALYs) attributable to treatment
of unilateral transfemoral amputation over a projected period of
20 years from a healthcare perspective. Data were collected alongside
a prospective clinical study of 51 patients followed for two years.Aims
Patients and Methods
This is a prospective randomised controlled trial comparing the
functional outcomes of plate fixation and elastic stable intramedullary
nailing (ESIN) of completely displaced mid-shaft fractures of the
clavicle in the active adult population. We prospectively recruited 123 patients and randomised them to
either plate fixation or ESIN. Patients completed the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) score at one to six weeks post-operatively.
They were followed up at six weeks, three and six months and one
year with radiographs, and their clinical outcome was assessed using
both the DASH and the Constant Score.Aims
Patients and Methods
Tibial nonunion represents a spectrum of conditions
which are challenging to treat, and optimal management remains unclear
despite its high rate of incidence. We present 44 consecutive patients
with 46 stiff tibial nonunions, treated with hexapod external fixators
and distraction to achieve union and gradual deformity correction.
There were 31 men and 13 women with a mean age of 35 years (18 to
68) and a mean follow-up of 12 months (6 to 40). No tibial osteotomies
or bone graft procedures were performed. Bony union was achieved
after the initial surgery in 41 (89.1%) tibias. Four persistent
nonunions united after repeat treatment with closed hexapod distraction,
resulting in bony union in 45 (97.8%) patients. The mean time to
union was 23 weeks (11 to 49). Leg-length was restored to within
1 cm of the contralateral side in all tibias. Mechanical alignment
was restored to within 5° of normal in 42 (91.3%) tibias. Closed
distraction of stiff tibial nonunions can predictably lead to union
without further surgery or bone graft. In addition to generating
the required distraction to achieve union, hexapod circular external
fixators can accurately correct concurrent deformities and limb-length
discrepancies. Cite this article:
We define the long-term outcomes and rates of
further operative intervention following displaced Bennett’s fractures
treated with Kirschner (K-) wire fixation between 1996 and 2009.
We retrospectively identified 143 patients (127 men and 16 women)
with a mean age at the time of injury of 33.2 years (18 to 75).
Electronic records were examined and patients were invited to complete
the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire
in addition to a satisfaction questionnaire. The time since injury
was a mean of 11.5 years (3.4 to 18.5). In total 11 patients had
died, one had developed dementia and 12 patients were lost to follow-up.
This left 119 patients available for recruitment. Of these, 57 did
not respond, leaving a study group of 62 patients. Patients reported
excellent functional outcomes and high levels of satisfaction at
follow-up. Median satisfaction was 94% (interquartile range 91.5
to 97.5) and the mean DASH score was 3.0 (0 to 38). None of the patients
had undergone salvage procedures and none of the responders had
changed occupation or sporting activities. Long-term patient reported
outcomes following displaced Bennett’s fractures treated by closed
reduction and K-wire fixation show excellent functional results
and a high level of patient satisfaction. The rate of infection
is low and similar to other surgical procedures with percutaneous
K-wires. Cite this article:
We report a prospective single-blind controlled
study of the incidence of early wound infection after internal fixation for
trauma in 609 patients, of whom 132 were HIV-positive. Wounds were
assessed for healing using the ASEPSIS score. There was no significant
difference in the rate of infection between HIV-positive and HIV-negative
patients undergoing clean surgery (4.2% We conclude that clean implant surgery in HIV-positive patients
is safe, with no need for additional prophylaxis.
Patients with transfemoral amputation (TFA) often
experience problems related to the use of socket-suspended prostheses.
The clinical development of osseointegrated percutaneous prostheses
for patients with a TFA started in 1990, based on the long-term
successful results of osseointegrated dental implants. Between1999 and 2007, 51 patients with 55 TFAs were consecutively
enrolled in a prospective, single-centre non-randomised study and
followed for two years. The indication for amputation was trauma
in 33 patients (65%) and tumour in 12 (24%). A two-stage surgical
procedure was used to introduce a percutaneous implant to which
an external amputation prosthesis was attached. The assessment of
outcome included the use of two self-report questionnaires, the
Questionnaire for Persons with a Transfemoral Amputation (Q-TFA)
and the Short-Form (SF)-36. The cumulative survival at two years’ follow-up was 92%. The
Q-TFA showed improved prosthetic use, mobility, global situation
and fewer problems (all p <
0.001). The physical function SF-36
scores were also improved (p <
0.001). Superficial infection
was the most frequent complication, occurring 41 times in 28 patients
(rate of infection 54.9%). Most were treated effectively with oral
antibiotics. The implant was removed in four patients because of loosening
(three aseptic, one infection). Osseointegrated percutaneous implants constitute a novel form
of treatment for patients with TFA. The high cumulative survival
rate at two years (92%) combined with enhanced prosthetic use and
mobility, fewer problems and improved quality of life, supports
the ‘revolutionary change’ that patients with TFA have reported
following treatment with osseointegrated percutaneous prostheses. Cite this article: