Reduced length of stay (LOS) is logistically, economically and physiologically beneficial. Although a high proportion of total joint arthroplasty (TJA) patients are suitable for same day admission (SDA), removable barriers persist in many centres. This study aimed to determine factors limiting SDA and quantify the impact of implementing both SDA and a targeted enhanced recovery programme on length of stay. This single-centre retrospective cohort study collected data on elective TJA patients aged <60. Qualitative service reviews identified opportunities for optimisation. Improvements were implemented in 2017, including: obtaining consent at the pre-assessment clinic and robustly assessing suitability for SDA. A targeted rapid recovery program was implemented in June 2018. Data was collected prior to changes in 2017, and following changes in 2018. 106 of 108 screened patients were eligible for inclusion. There were no significant between-year differences in baseline health characteristics. Significantly greater proportions of 2018 patients were consented at their pre-assessment clinic (56% vs 8.9%, p<0.001) and assessed as suitable for SDA (94% vs 57.1%, p<0.001). Pre-operative LOS was significantly reduced in 2018 for both total hip replacements (median [IQR]: 0[0,0] vs 1[1,1], p<0.001) and total knee replacements (median [IQR]: 0[0,0] vs 0[0,1], p=0.002). The departmental mean LOS improved from 4.7 days to 3.7 days following SDA. This was further shortened to 3.2 days after introduction of the rapid recovery program. When a larger proportion of patients were deemed suitable for SDA, this correlated with reduction of LOS. The department now performs above national standards in both of these parameters

Introduction. For the increasing number of frail elderly patients in Japan, mobility is crucial to stay independent and maintain quality of life. After failure reports with standard implants, a prospective multicentre study was performed to evaluate whether an implant designed for Asians enables rapid recovery after unstable trochanteric fractures. Materials and methods. Patients with an AO 31A2 or A3 fracture sustained less than 7 days before fracture fixation with the Asian version of the Proximal Femoral Nail Antirotation. Those with severe dementia and bedridden or confined to a wheelchair were excluded. Outcome parameters were quality of life (SF36v2, EQ5D), mobility (Parker Mobility score PMS) and range of motion (ROM). Results. Median age of the 176 pat. was 84 yrs; 88% had comorbidities, 25% were underweight/severely underweight. After 1 year, mean relative ROM was 90% for flex/ext, 88% for abd/add compared to the healthy side. Although the median PMS decreased from initial 9 to 6 points at 1 year, 42% returned to within 1 point of their pre-injury level. 60% and 76% returned to their pre-injury residential status at 6 and 12 months, resp. 43% and 65% of patients at 1-year had no problems with their mobility and self-care assessed with the EQ5D. All 8 SF36 dimensions were similar at pre-injury, 6 and 12 months. Discussion. Frail elderly patients can achieve good function and quality of life after a trochanteric fracture treated with a size and geometry adapted implant

Aims

To investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients.

Fractures of the scaphoid are most common in young men; immobilisation in a cast usually means a long period away from work and athletic activities. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply of the scaphoid. For minimally displaced or undisplaced B1 or B2 fractures, these problems can be overcome by percutaneous fixation. We report our technique and the results of a pilot study in 15 patients. There was no immobilisation; patients were allowed movement soon after operation, but union was obtained in all at a mean of 57 days (38 to 71). The range of movement after union was equal to that of the contralateral limb and grip strength was 98% of the contralateral side at three months. Patients were able to return to sedentary work within four days and to manual work within five weeks. Our initial results show that percutaneous scaphoid fixation for acute fractures is satisfactory and gives rapid functional recovery

ACL (anterior cruciate ligament) partial tears include various types of lesions, and an high rate of these lesions evolve into complete tears. Most of the techniques described in literature for the surgical treatment of chronic partial ACL tears, don't spare the intact portion of the ligament. Aim of this study was to perform a prospective analysis of the results obtained by augmentation surgery using gracilis and semitendinosus tendons to treat partial sub-acute lesions of the ACL. This technique requires an “over the top” femoral passage, which enables salvage and strengthening of the intact bundle of ACL. The study included 97 patients treated consecutively at our Institute from 1993 to 2004 with a mean injury-surgery interval of 23 weeks (12–39). Patients were followed up by clinical and instrumental assessment criteria at 3 months, 1 year and 5 years after surgery. Clinical assessment was performed with the IKDC form. Subjective and functional parameters were assessed by the Tegner activity scale. Instrumental evaluation was done using the KT-2000 instrument: the 30 pound passive test and the manual maximum displacement test were performed. We obtained good to excellent results in 95.9% of cases. We didn't observed recurrences in ligamentous laxity. We believe that the described technique has the advantage of being little invasive, compatible with the ACL anatomy, and enables very rapid functional recovery and return to sport

Background. In elderly patients with complex proximal humerus fractures and osteoporotic bone reconstruction is not always possible. Although hemiarthroplasty is an alternative, non-union or tuberosity migration can lead to inferior functional results. Implantation of a Reverse Total Shoulder Arthroplasty (RTSA) seems to be an interesting alternative. In the present study we retrospectively analyzed the short-term results of RTSA for complex proximal humerus fractures in the elderly. Methods. From 31.10.2005 to 20.07.2010 RTSA was performed in 29 patients (average age 80 years [67;90], 25 women, 4 man) with subcapital, three- or four-part fracture of the proximal humerus as a primary treatment. All procedures were performed using the Anatomical Inverse Shoulder (Zimmer) with fracture stem. A deltopectoral approach was used in every case with reattachment of the tuberosities. Pain, range of motion, subjected shoulder value (SSV) as well as the Constant score (CS) were used to evaluate shoulder function. Implant positioning and signs of loosening were analyzed on standard x-rays. Results. Included were 23 patients with a minimal follow-up of 12 month. The average follow-up was 17 month (12 month to 5 years). The mean SSV was 81% [40;100]. The absolute CS averaged 67 points [34;84] and the relative CS 97% [52;139]. The mean pain score (VAS) was 13.7 of 15, the mean activity score 18.4 of 20, the mean mobility score 28.6 of 40 and the mean strength score 5.1 of 25. The mean active anterior elevation was 130° [80;160], the mean active abduction 128° [80;170] and the mean active external rotation in 0° abduction 21° [-30;70]. All patients reached the same activity level as before surgery and could return to independent living. The results after 12 month were already comparable to those after 24 month (10 patients). Radiographically no signs of loosening were detected. There was a total of 3 complications and reoperations, two due to a hematoma and one because of a periprosthetic fracture. Conclusions. In elderly patients with complex proximal humerus fractures and osteoporotic bone RTSA seems to be a very satisfactory procedure. The short-term clinical results are excellent and predictable with a rapid postoperative recovery of daily comfort. The complication rate is low and acceptable

Objectives

The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.

We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain.

This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.