Introduction. This study was performed prospectively and randomly to compare clinical outcomes of modified-Brostrom procedure using single and double suture anchor for chronic lateral ankle instability. Material & Methods. Forty patients were followed up for more than 2 years after modified-Brostrom procedure for chronic lateral ankle instability. Twenty modified-Brostrom procedures with single suture anchor and 20 procedures with double suture anchor randomly assigned were performed by one surgeon. The mean age was 30.6 years, and the mean follow-up period was 2.6 years. The clinical evaluation was performed according to the Karlsson scale and Sefton grading system. The measurement of talar tilt angle and anterior talar translation was performed through anterior and varus stress radiographs. Results. At the last follow-up, the Karlsson scale had improved significantly from preoperative average 45.4 points to 90.5 points in single suture anchor group, from 46.2 points to 91.3 points in double suture anchor group. There were 8 excellent, 10 good, and 2 fair results according to the Sefton grading system in single anchor group, and 9 excellent, 8 good, 3 fair results in double anchor group. Therefore, 18 cases (90%) in single anchor group and 17 cases (85%) in double anchor group achieved satisfactory results. Talar tilt angle had improved significantly from preoperative average 15.7° to 6.1° in single anchor group, from 16.8° to 4.2° in double anchor group. There was significant difference in postoperative talar tilt angle between single and double anchor group. Conclusion. Significant differences in clinical and functional outcomes were not found between single and double suture anchor technique. On stress radiographs for evaluation of mechanical stability, modified-Brostrom procedure using double anchor showed less talar tilt angle than single anchor technique

Aim. The purpose of this study was to analyze the patellofemoral kinematics in neglected adult developmental dysplasia of the hip patients with patellofemoral symptoms and tried to clarify the affect of the severity of dislocation, the amount of limb length discrepancy, the deviation of mechanical axis and the changes in femoral anteversion on patellofemoral alignment. Methods. The dynamic patellofemoral CT results of 39 patients with DDH suffering from knee pain were reviewed. The mean age was 40.07 (range: 22–61). 14 of them were bilateral and 25 were unilateral neglected DDH patients. The CT results of 12 patients suffering from unilateral patellofemoral pain following the treatment of locked intramedullary nailing was taken as control group. In this patients atraumatic and asymptomatic normal site was taken as control group. Results. In unilateral neglected DDH patients there was significantly higher medial patellar displacement in 0, 15, 30, 60 degrees flexion in the knee at the site of dislocation. Again in uninvolved site medial patellar displacement in 15, 30, 60 degrees flexion was higher with respect to control group. In the involved extremity the PTA angle in 0, 15, 30, 60 degrees flexion were significantly higher than in control group. This increase in PTA angle corresponding to medial patellar tilt was observed only in involved extremity. In the knees of patients with bilateral DDH there was significant medial patellar displacement in every flexion degrees with respect to control group. Besides in bilateral DDH patients, the PTA angle in 15, 30, 60 degrees flexion were significantly higher than control group corresponding to medial patellar tilt. The amount of leg length discrepancy and the severity of dislocation as well as mechanical axis deviation were not affecting the patellofemoral parameters in both unilateral and bilateral DDH patients. Conclusion. Both in unilateral and bilateral DDH patients there are major changes in patellar tracking on femur during knee flexion. Increased medial shift and medial patellar tilt were seen in these patient groups. The neglected DDH patients suffering from knee pain should be analyzed not only for tibiofemoral abnormalities but also for patellofemoral malignment

Aims

The aims of this study were to identify means to quantify coronal plane displacement associated with distal radius fractures (DRFs), and to understand their relationship to radial inclination (RI).

Aims

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.

Introduction. Patellofemoral complications remain a very common post-operative problem in association with total knee arthoplasty (TKA). As malrotation of the femoral component is often considered crucial for the outcome, we analyzed absolute rotational femoral alignment in relation to patellar tracking pre- and postoperatively and matched the results with the two year functional outcome. Methods. Femoral rotation and component rotation was assessed by axial radiography using condylar twist angle (CTA). The lateral patellar displacement, patellar tilt and Insall-Salvati index were measured on conventional radiographs. All assessments were done pre-operatively and at 2-year follow up. The series included 48 consecutive TKA (21 men, 27 women) performed at a single high-volume joint-replacement-center in 2008. All operations were performed using a tibia first-ligament balancing technique without patella resurfacing. The implant used was a condylar unconstrained ultracongruent rotating platform design. Outcome was assessed using the international knee society score (KSS) and the Kujala Score for anterior knee pain. Results. Preoperative CTA showed 6.4±2. 5° (X±SD) of internal femoral rotation (IR) (range, 1° of external rotation (ER) to 12° of IR) compared to postoperative CTA of 3.9°±2.98° (X±SD) of IR (range, 9.5° IR to 3.8°of ER) Preoperative patella lateral displacement showed a mean of 1.1mm (−2mm, 6mm), compared to postoperative patella lateral displacement with a mean of 1.7mm (−3mm, 6mm). Postoperative mean patella tilt was 6.65° (1.8°, 11.7°) postoperatively compared to 8.55° (4.3°,11.5°) preoperatively. No correlation was found between CTA post surgery and patella positioning (r=0.034, 95% CI). IR of the femoral component >3°did not show increased patella lateral displacement/tilt compared to 0° or ER. No correlation was found between the Kujala score and internal rotation of the component (r=0.082, p=0.05). At 2 year post OP KSS reached > 185 of max. 200 points in over 82% of patients. Conclusion. The influence of IR of the femoral component on patellofemoral kinematics remains controversial. As demonstrated, IR does not imperatively lead to patella maltracking and/or patellofemoral symptoms. Functional outcome in this series shows that relative rotation of the femoral component in accordance with natural variations as seen in the pre-operative assessment allows for good and excellent results

Background. The recommended indications for total ankle replacement (TAR) are limited, leaving fusion as the only definitive alternative. As longer-term clinical results become more promising, should we be broadening our indications for TAR?. Materials and Methods. Our single-centre series has 133 Mobility TARs with 3–48 months' follow-up. 16 patients were excluded who were part of a separate RCT. The series was divided into two groups. ‘Ideal’ patients had all of the following criteria: age >60y, BMI <30, varus/valgus talar tilt <10°, not diabetic, not Charcot, not post-traumatic. The ‘Not ideal’ group contained those who did not fit any single criteria. We compared complications and outcome scores between both groups. Results. The ‘Ideal’ group contained 44 ankles vs. 80 in the ‘Not ideal’ group (124 ankles in 117 patients). Complications were (‘Ideal’ vs. ‘Not ideal’): infection: 1 (deep) vs. 3; DVT/PE: 0; periprostheticfracture: 4 vs. 7; CRPS: 2 vs. 2; revision: 0 vs. 2. AOFAS scores showed variable significance (mean values). Pre-op: 27.9 vs. 25.7 (p = 0.459); 3months: 79.4 vs. 73.2 (p = 0.041); 6 months: 79.9 vs. 75.4 (p = 0.053); 12 months: 79.7 vs. 75.8(p = 0.228), 36 months: 77.3 vs. 79.0 (p = 0.655). Further subgroup analysis has been performed. Discussion. Our results show that indications for TAR can be widened without further morbidity. Each case must be treated individually and accounted for other factors. Varus/valgus tilt can be corrected with appropriate calcaneal osteotomy +/- tendon transfers as a staged or combined procedure. TAR may be considered in younger patients based on functional and occupational demands. We may no longer be able to deter patients on BMI alone. Diabetic patients do not appear to have a higher complication rate. Conclusion. We have increasing evidence that we should now be considering TAR as the primary treatment for disabling ankle arthritis rather than fusion

Introduction. Distal radius fractures (DRF) are a common injury in the A&E departments, being a major cause of disability of the upper extremity. The aim of this prospective study is to assess the possible association between objective physical variables such as wrist range of movement (ROM), radiological parameters, and upper extremity disability (measured by the DASH questionnaire), after conservative treatment of DRF. Patients and methods. 44 patients with non-operatively managed DRF were enrolled in a prospective cohort study from July 2007 till September 2009. Inclusion criteria: unilateral DRF in skeletally mature patients, treated non-operatively with closed reduction and cast. Patients who sustained a previous fracture of the wrist, or bilateral wrist fracture, or with dementia, were excluded. After the closed reduction and inmovilization of the fracture in the A&E department we asked the patients to complete the DASH questionnaire, referring to their baseline pre-fracture state. All fractures were classified according to the AO classification. After one year, 36 patients were still available for follow-up purposes. We assesed the following objective physical variables: ROM of both wrists: flexion/extension arc and pronation/supination arch. We recorded the following radiologic parameters: radial angulation, volar angulation and radial shortening. The patient-perceived results were measured by the DASH questionnaire, while pain was measured using the VAS scale. Statistical analysis was performed using the SPSS 15.0. Results. Average follow up: 13,39 months (range 12.3–16.43). Mean age: 62.5 years (18–91). 75% of the fractures were 23A and 24,1% 23B. Average pre-fracture DASH score was 19.6 and 42.1 at the end of follow-up. Radial tilt: 18.18°. Volar tilt: 3,35°. Radial shortening: 5,76mm. ROM for flexion/extension of the involved wrist: 103.6° and non-involved wrist: 131.2°. ROM for pronation/supination involved wrist: 145.7° and non-involved wrist: 173.8°. Post-fracture VAS score: 3.5. We didn't find any significant statistical correlation between the lost of ROM, neither with radiological malaligment nor with patient-perceived outcomes. But we found a significant association between items 24–28 of the DASH (except item 26) questionnaire and the VAS score. Conclusions. The results of the present study show that, conservative treatment of DRF seems to deteriorate the patient self-reported outcomes measured by the DASH questionnaire

Objectives. For a long time lateral release (LR) was performed as a standard procedure both, for patellofemoral pain syndrome (PFPS) and patellofemoral instability (PFI). However, recent biomechanical studies have shown that LR is not useful for decreasing the lateral force onto the patella, but is increasing not only medial but also lateral PFI. Furthermore, pain on palpation over the lateral patellofemoral joint space can result in patients treated with extensive LR. We postulate that in case of persistent PFI or PFPS after failed LR the reconstruction of the lateral retinaculum as an addition of the reconstruction of the medial patellofemoral ligament (MPFL) is necessary in terms of decreasing medial PFI as well as lateral pain. Materials and Methods. In between 03/07 and 04/09 we have seen a total of 25 patients (20 f, 5 m) with persistent PFI and palpatory pain over the lateral retinaculum due to unsuccessful treatment of PFI with a LR. These patients have undergone revision surgery with an anatomical reconstruction of the released lateral retinaculum in combination with a reconstruction of the medial patellofemoral ligament (MPFL) in an aperture-technique using the gracilis tendon. The average age at time of operation was 26.2 ± 9.8 years. Preoperatively, as well as 6 weeks, 3 months, 6 months, and 12 months postoperatively, clinical examinations were performed and subjective as well as objective scores (Kujala-, Tegner-, IKDC-score) were evaluated. Regarding radiological parameters measurement of patellar tilt and shift was carried out on axial radiographs before and after the operation. Results. During the first twelve months after the operation only one redislocation could be recorded. Pain on palpation over the reconstructed lateral retinaculum was remaining in four patients (16%). Although several patients complained about persistent patellofemoral pain on exertion or after enduring flexion of the knee, all of them reported about an improvement of their pain situation. This fact is reflected in a highly significant improved but still moderate IKDC- (from 46.5 ± 14.9 to 68.9 ± 22.7, p<0.001) and Kujala-score (from 47.7 ± 15.3 to 74.8 ± 24.8, p<0.001) at the one year follow up. As far as sports activity is concerned, a statistically significant improvement of the Tegner-score up to 4.7 ± 2.4 (preoperative 2.3 ± 1.5, p<0.001) could be achieved. The radiological analysis showed a highly significant decrease of both, patellar tilt (from 15.4 ± 6.5 to 10.3 ± 6.2, p<0.001) and patellar shift (from 4.3 ± 3.3 to 2.5 ± 1.3, p=0.002). Conclusions. After one or more unsuccessful previous efforts of stabilizing the patella by LR, the technique performed in this essay leads to a considerable improvement of subjective scores and objective clinical and radiological parameters as well as sports activity

Introduction. Patellar tracking in total knee replacements has been extensively studied, but little is known about patellar tracking in isolated patellofemoral replacements. We compared patellar tracking and the position of the patellar groove in the natural knee, followed by implantation of the femoral component of a PFR (patella unresurfaced) and after implantation of the femoral & patellar component of the PFR. Methods. Computer navigation was used to track the patella in eight whole lower extremities of four cadavers in the natural knee, in the same knee with the femoral component of the PFR (PFR-P) and with the femoral and patellar component of the PFR (PFR+P, patella resurfaced) (Depuy Sigma PFR). The form and position of the trochlea in the natural knee and the patellar groove of the femoral component was also analysed. Values are means+/−SD, two tailed Student's t-test for paired samples. Results. With a PFR-P the patella had a slightly more lateral tilt (0.8+/−0.8° to 2.8+/−2.5° at 40–100° of flexion, p<0.05 vs. Nat), this was more pronounced with the PFR+P (2.0+/−0.7° to 4.9+/−1.8° at 20–90° flexion, p<0.05 vs. Nat., p<0.05 vs. PFR-P at 20–80° flexion). No differences in patella rotation were seen between the three groups. In the PFR-P group the patella tracked a little more medially compared to the natural knee (0.6+/− 0.7mm to 1.3+/−2.6mm, p<0.05 at 20°,80°,90° flexion). The difference was more pronounced after patella resurfacing (PFR+P) (2.1+/−2.0mm to 3.0+/−2.2mm, p<0.05 vs. Nat. at 10°–100°, p<0.05 vs. PFR-P from 10–100°). When analysed relative to the patellar groove of the trochlea/femoral component the patella in the natural knee tracked slightly lateral to the groove (2.0+/−1.7mm to 2.9+/−2.0mm at 50–100° p<0.05), so did the patella of PFR-P (2.0+/−2.3mm to 2.3+/−2.3mm at 60–90° flexion, p<0.05), whilst the PFR+P tracked right on the groove (0.6+/−3.7mm medially to 0.6+/−2.9mm laterally, p<0.05 vs Nat at 10–30° & 70–100°, p<0.05 vs. PFR-P at 10–100°). Distance from the patellatot the epicondylar axis was slightly larger in the PFR-P group (0.6+/− 0.7mm to 1.3+/−1.4mm, p<0.05 vs. Natu at 20,80 & 90°. This was more pronounced with patellar resurfacing (2.1+/−2.0 to 3.0+/−2.2mm, p<0.05 vs. Nat at 10–100°, p<0.05 vs. PFR-P at 20–100°) The patella groove on the natural knee and the implanted femoral component of the implanted PFR had the same radius, inclination relative to the femoral mechanical axis, antero-posterior position and medio-lateral orientation. As intended by the designers the groove of the patellar component extended about 13mm further superiorly and 0.5mm more inferiorly. Discussion. The patella groove on the femoral component of the PFR reproduces the natural trochlear anatomy well. Patella tracking in the PFR-P shows only minor differences compared to the natural knee. Resurfacing of the patella in the PFR+P group causes the patella to tilt a little more laterally and track a little more medially, the distance to the epicondylar axis is slightly larger but this allows the patella to engage better in the patellar groove of the femoral component

Aims

To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years.

Background. The usefulness of arthroscopic reduction for the intra-articular fracture of the distal radius has been reported, although it is technically difficult. Hypothesis. Our hypothesis is that the reduction using the external fixator is useful as equivalent to the arthroscopic reduction for the intra-articular fracture of the distal radius fracture in the fixation with the volar locking plate. Materials & Methods. The surgery was performed in both methods randomly for 40 patients; average age 64(24 to 92) years, 11 male, 29 female. Image evaluations were performed at 24 weeks after surgery. Ulnar variance, Radial inclination, Volar tilt in the X-ray image, and gap and step in the computed tomogram were evaluated. Clinical evaluation was performed at 6, 12, 24 weeks after surgery. Objective evaluations were ranges of motion and grip strength. Subjective evaluations were disabilities of the arm, shoulder, and hand (DASH). Results. The results of image and objective evaluation had no significant difference between the two groups. DASH in arthroscopic group was significantly inferior at 24 weeks because of minor complications. Discussion & Conclusion. The external fixator and the arthroscopy are equally valuable in reduction of articular surface

Magnetic resonance imaging (MRI) validation of a novel method of assessing Distal Radial Fracture (DRF) reduction using the hypothesised constant relationship between the dorsal radial cortex (DC) and the superior pole of the lunate (SL). MRI scans of 28 normal wrists were examined. Scans included the distal third of the radius to the proximal carpal row. Beginning 5cm proximal to the distal radius articular surface, a line was superimposed upon the DC extending distally through the metaphyseal flare. Lunate height (LH) and distance from the DC line to the SL (DC-SL) were measured at 5-degree rotational increments around the radial shaft central axis to a total of 30 degrees of supination and pronation (S+P). The DC-SL/LH ratio was compared to 0 degrees (anatomical lateral) using the two-tailed paired student t-test. There was no significant difference in DC-SL:LH between 0 degrees of rotation and any 5-degree increment up to 30 degrees of S+P (lowest p=0.075). The DC line lay consistently dorsal to the SL. A constant DC-SL relationship exists with up to 30 degrees of S+P. This reference can be quickly and accurately used to assess DRF reduction in poorly-taken films with malrotation up to 30 degrees from anatomical lateral. Research comparing DC-SL distance with volar tilt to assess DRF reduction is needed

Introduction. A tibial insert with choices in size, thickness, and posterior slope is proposed to improve ligament balancing in total knee arthroplasty. However, increasing posterior slope, or the angle between the distal and proximal insert surfaces, will redistribute ultra-high molecular weight polyethylene (UHMWPE) thickness in the sagittal plane, potentially affecting wear. This study used in-vitro testing to compare wear for a standard cruciate-retaining tibial insert (STD) and a corresponding 6° sloped insert (SLP), both manufactured from direct-compression molded (DCM) UHMWPE. Our hypothesis was slope variation would have no significant effect on wear. Methods. Two of each insert (STD and SLP) were tested on an Instron-Stanmore knee simulator with a force-control regime. The gait cycle and other settings followed ISO 14243-1 and -2, except for reference positions. The STD insert was tilted 6° more than the SLP insert to level the articular surfaces. Wear was gravimetrically measured at intervals according to strict protocol. Results. No statistical difference (p=0.36) in wear rates was found for the STD (9.5 ±1.8 mg/Mc)) and SLP (11.4 ±0.5 mg/Mc) inserts. Discussion. The overall wear rate measured was higher than previously published rates for implants similar to the STD inserts. This may result from increased shear loads due to the shift in reference position and 6° slope. This is the first time the effect of tibial insert slope on wear has been evaluated in-vitro. For inserts made from DCM UHMWPE with a slope limited to 6°, this test suggests altering tibial insert slope has an insignificant effect on wear

In 1980, we developed a specially designed brace for treating supracondylar fractures of the humerus in children, along with an easy and safe technique of reduction by skeletal traction. This method, which takes into consideration only the medial tilting and anterior angulation of the distal fragment, achieves complete reduction, ignoring any lateral, posterior and minor rotational displacements of the fragment. Skeletal traction is applied through a screw inserted into the olecranon and the angulation at the fracture site is reduced regardless of the anatomical position without manipulation. We treated 193 children with displaced supracondylar fractures of the humerus using this method between 1980 and 2001. Only four children (2%) developed cubitus varus. The majority obtained an excellent range of movement at the elbow; one had a 25° limitation of flexion. This technique is an effective and easy method of treating supracondylar fractures of the humerus in children

A randomised, prospective study was carried out on 60 patients with unstable fractures of the distal radius to compare bridging with non-bridging external fixation using pins placed in the distal fragment of the radius. The radiological results showed significant improvement in the non-bridging group at all stages of review. In particular, normal volar tilt and carpal alignment were regained and maintained. The functional results at six weeks, three months, six months and one year showed statistically better grip strength and flexion in the non-bridging group at all stages of review. Other ranges of movement showed an early advantage in the non-bridging group. Non-bridging external fixation is the treatment of choice for unstable fractures of the distal radius which have sufficient space for the placement of pins in the distal fragment

Introduction. Distal radius fractures are one of the most common injuries attended in hospitals. Throughout the years the treatment has change from simple cast to ORIF. Objectives. To compare the functional and radiographic results in the treatment of the distal intrarticular radial fractures treated by volar buttress plate (T plate AO® Synthes, Oberdorf, Suiza) and fixed volar angle locking plate (DVR® Depuy, Warsaw, Indiana, USA). Material and Methods. We performed a comparative retrospective study between two series of patients treated by fixed volar angle locking plate (40 patients) or volar buttress plate (36 patients). Distal radius fractures were classified by the AO/ASIF Müller classification after X-ray study in two views (Anteroposterios and lateral views), surgical treatment was indicated by the type of fracture (unstable fractures) and open fractures. Demographic information was gathered, injury mechanism and postoperatory complications. The minimal follow-up was 10 months. We performed clinical and radiographic evaluations before surgery, postoperatory, to 3 months and at the end of the follow-up (Palmar tilt, radial inclination, radial height and the radioulnar index were measured). Lidström's and Quick Dash scale, by means of telephonic survey, were used for the functional evaluation. Results. The time from fracture to surgery was on average 3.74 days in the group of DVR ® plates and 1.69 days for the group treated with T buttress plates. Henry's approach was realized in every case and the average time spent in surgery was 74 minutes for patients treated with T buttress plate and 80 minutes for patients treated with plate DVR®. In some cases K wires had to be used in 9 cases in the DVR® group and 7 in the other group. DVR® group obtained better results in radiological evaluation except in the radial inclination. In the Quick Dash scale, conducted a telephone survey, the average for the DVR® group was 26.40 (CI: 13.6 to 81.8) and 33.37 (CI: 10.2–90) for the group of T buttress plate (p=0.055). Conclusion. The potential advantages of ORIF in the distal radius fractures are low complication rate, stable subchondral fixation and early active movement of the wrist in the postoperative period. The disadvantages are a high cost, greater complexity and surgical exposure. Locking plates were designed to prevent postoperative collapse of the fracture also allows a better fix system in osteoporotic bone. Both types of plates obtained good results radiological and functional at the end of follow-up but we have obtained better results in the patients treated with locking plates

Objective. Overviewing the literature, pain and redislocation after surgical treatment of patellofemoral instability (PFI) is described with up to 30 %, especially with techniques involving the extensor mechanism, the lateral retinaculum or the medial vastus. However, outcome data about revision surgery is missing. Therefore, it was the purpose of this prospective study to evaluate the clinical outcome after revision surgery with an isolated or a combined reco. of the medial patellofemoral ligament (MPFL) with a follow up of 12 months. The indication for additional procedures such as distal femoral osteotomies (DFO), trochleoplasty, reclosing of the lateral retinaculum (RLR) or lateralisation of the tuberosity (LT) were performed depending on the clinical and radiological pathomorphologies. Methods. In between 3/07–4/09, 42 pat. with a mean age of 24 years (13–46ys) were revised due to persistent PFI after mean 1.8 failed previous operations (lateral release, medial gather/VMO-distal., medial. of the tuberosity) in our department. An isolated reco. of the MPFL was performed in 15 cases, while a combination with a DFO due to massive femoral axis deformity (n=5), trochleoplasty due to a convex trochlear morphology (n=1) and/or LT (n=4) and/or RLR due to medial instability or lateral pain (n=22) was done in 27 cases. The clinical result was evaluated by the pre- and postop. IKDC/Kujala/Tegner-score and by a subjective questionnaire. Radiologically, the patellashift/-tilt/-height and level of the eventual degeneration were defined preop. and at the point of follow up with the help of straight lateral radiographs and by MRI. Significance level was set at p=.05, statistical calculation was done by the use of the t-test. Results. 87 % were very satisfied/satisfied with the treatment., None redislocation of the patella occurred during the follow up. We could evaluate a significant decrease of the pain during daily activities. The IKDC/Kujala/Tegner score have shown a significant increase overall. However, a significant difference concerning the scores could not be noticed in between the groups without and with additional procedures. Patellar shift, tilt, height decreased significantly to anatomical values. The level of preexisting degeneration showed no aggravation. Conclusion. Since it is known that PFI is a multifactorial problem, revision surgery should set about only after comprehensive examinations. Regarding our results, isolated or combined MPFL reco. seems to be a very effective treatment of recurrent patella dislocation and results in a significant increase of stability, functionality as well as in a reduction of pain. Additional pathomorphologies of the bony structures or a lateral release, which causes pain or an aggravation of instability, have to be addressed additionally to reach same results like with an isolated therapy. Level of Evidence. II

Aims

A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome.

Aims

The aim of this study was to examine trends in the management of fractures of the distal radius in Ireland over a ten-year period, and to determine if there were any changes in response to the English Distal Radius Acute Fracture Fixation Trial (DRAFFT).

This multicentre prospective clinical trial aimed to determine whether early administration of alendronate (ALN) delays fracture healing after surgical treatment of fractures of the distal radius. The study population comprised 80 patients (four men and 76 women) with a mean age of 70 years (52 to 86) with acute fragility fractures of the distal radius requiring open reduction and internal fixation with a volar locking plate and screws. Two groups of 40 patients each were randomly allocated either to receive once weekly oral ALN administration (35 mg) within a few days after surgery and continued for six months, or oral ALN administration delayed until four months after surgery. Postero-anterior and lateral radiographs of the affected wrist were taken monthly for six months after surgery. No differences between groups was observed with regard to gender (p = 1.0), age (p = 0.916), fracture classification (p = 0.274) or bone mineral density measured at the spine (p = 0.714). The radiographs were assessed by three independent assessors. There were no significant differences in the mean time to complete cortical bridging observed between the ALN group (3.5 months (se 0.16)) and the no-ALN group (3.1 months (se 0.15)) (p = 0.068). All the fractures healed in the both groups by the last follow-up. Improvement of the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, grip strength, wrist range of movement, and tenderness over the fracture site did not differ between the groups over the six-month period. Based on our results, early administration of ALN after surgery for distal radius fracture did not appear to delay fracture healing times either radiologically or clinically.

Cite this article: Bone Joint J 2013;95-B:1544–50.