Correct femoral tunnel position in anterior cruciate ligament reconstruction (ACLR) is critical in obtaining good clinical outcomes. We aimed to delineate whether any difference exists between the anteromedial (AM) and trans-tibial (TT) portal femoral tunnel placement techniques on the primary outcome of ACLR graft rupture. Adult patients (>18year old) who underwent primary ACLR between January 2011 – January 2018 were identified and divided based on portal technique (AM v TT). The primary outcome measure was graft rupture. Univariate analysis was used to delineate association between independent variables and outcome. Binary logistic regression was utilised to delineate odds ratios of significant variables. 473 patients were analysed. Median age at surgery was 27 years old (range 18–70). A total of 152/473, (32.1%) patients were AM group compared to 321/473 (67.9%) TT. Twenty-five patients (25/473, 5.3%) sustained graft rupture. Median time to graft rupture was 12 months (IQR 9). A higher odds for graft rupture was associated with the AM group, which trended towards significance (OR 2.03; 95% CI 0.90 – 4.56, p=0.081). Older age at time of surgery was associated with a lower odds of rupture (OR 0.92, 95% CI 0.86 – 0.98, p=0.014). There is no statistically significant difference in ACLR graft rupture rates when comparing anteromedial and trans-tibial portal technique for femoral tunnel placement. There was a trend towards higher rupture rates in the anteromedial portal group.
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 retrospective study of survivors of
recent conflicts with an open fracture of the femur. We analysed
the records of 48 patients (48 fractures) and assessed the outcome.
The median follow up for 47 patients (98%) was 37 months (interquartile
range 19 to 53); 31 (66%) achieved union; 16 (34%) had a revision
procedure, two of which were transfemoral amputation (4%). The New Injury Severity Score, the method of fixation, infection
and the requirement for soft-tissue cover were not associated with
a poor outcome. The degree of bone loss was strongly associated
with a poor outcome (p = 0.00204). A total of four patients developed
an infection; two with This study shows that, compared with historical experience, outcomes
after open fractures of the femur sustained on the battlefield are
good, with no mortality and low rates of infection and late amputation.
The degree of bone loss is closely associated with a poor outcome. Cite this article:
Controversy continues to surround the management
of patients with an open fracture of the lower limb and an associated
vascular injury (Gustilo type IIIC). This study reports our 15-year
experience with these fractures and their outcome in 18 patients
(15 male and three female). Their mean age was 30.7 years (8 to
54) and mean Mangled Extremity Severity Score (MESS) at presentation
was 6.9 (3 to 10). A total of 15 lower limbs were salvaged and three underwent
amputation (two immediate and one delayed). Four patients underwent
stabilisation of the fracture by external fixation and 12 with an
internal device. A total of 11 patients had damage to multiple arteries
and eight had a vein graft. Wound cover was achieved with a pedicled
flap in three and a free flap in six. Seven patients developed a
wound infection and four developed nonunion requiring further surgery.
At a mean follow-up of five years (4.1 to 6.6) the mean visual analogue
scale for pain was 64 (10 to 90). Depression and anxiety were common.
Activities were limited mainly because of pain, and the MESS was
a valid predictor of the functional outcome. Distal tibial fractures
had an increased rate of nonunion when associated with posterior
tibial artery damage, and seven patients (39%) were not able to
return to their previous occupation.