A single antegrade Rush nail was used to treat 37 fractures of the
Between 1995 and 2000, 19 consecutive patients with fractures of the
The primary aim of this study was to identify risk factors for developing neuritis and its impact on outcome following open reduction internal fixation (ORIF) of
Nine children sustained a second fracture of the
We assessed the inter- and intraobserver variation in classification systems for fractures of the
The treatment of multifragmentary, intra-articular fractures of the
Introduction. Adequate exposure is a prerequisite for treatment of distal humeral fractures. In this study, we compared the clinico-radiological and functional outcome of TRAP approach with that of olecranon osteotomy for
Between 1993 and 2000 we treated 14 patients with nonunion of fractures of the
Our study describes a posterolateral approach to the
The COVID-19 pandemic presented a significant impact on orthopaedic surgical operating. This multi-centre study aimed to ascertain what factors contributed to delays to theatre in patients with shoulder and elbow trauma. A retrospective cohort study of 621 upper limb (shoulder and elbow) trauma patients between 16/03/2020 and 16/09/2021 (18-months) was extracted from trauma lists in NHS Tayside, Highland and Grampian and Picture Archiving and Communication Systems (PACS). Median patient age =51 years (range 2-98), 298 (48%) were male and 323 (52%) female. The commonest operation was olecranon open reduction internal fixation (ORIF) 106/621 cases (17.1%), followed by
The best method of managing a fracture of the
distal humerus in a frail low-demand patient with osteoporotic bone remains
controversial. Total elbow arthroplasty (TEA) has been recommended
for patients in whom open reduction and internal fixation (ORIF)
is not possible. Conservative methods of treatment, including the
‘bag of bones’ technique (acceptance of displacement of the bony
fragments and early mobilisation), are now rarely considered as
they are believed to give a poor functional result. We reviewed 40 elderly and low-demand patients (aged 50 to 93
years, 72% women) with a fracture of the
A series of 26 children was referred to our specialist unit with a ‘pink pulseless hand’ following a supracondylar fracture of the
An increasing number of distal humeral fractures are presenting as fragility fractures in low demand elderly patients. The optimal management of these injuries remains controversial. The primary aim of this study was to document the short and long term outcomes of these fractures treated with primary nonsurgical intervention. All patients were identified from a prospective trauma database from 1995 to 2010. All conservatively managed, isolated fractures of the
Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.Aims
Methods
This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements. Data capture was by collaborative approach. Patients undergoing procedures from 22 August 2022 and operated on before 31 October 2022 were included. Arm one captured weekly caseload and theatre capacity. Arm two concerned patient and injury demographics, and time to surgery for specific injury groups.Aims
Methods
A 16-year-old boy was involved in an agricultural accident in which he sustained a large wound to the right arm and forearm. Radiological examination showed loss of the distal half of the humerus. A posterior splint was applied and after two months there was regeneration of the
Background. For the treatment of proximal humeral fractures two major therapeutic principles can be employed: Intramedullary nailing (PHN) or locking plate osteosynthesis. Aim of this study was to evaluate and compare clinical and radiological long-term outcome of proximal humeral fracture stabilization using PHN or angular stable plating. In addition, we discussed advantages and disadvantages of both techniques and aimed at establishing criteria which operative technique should preferentially be utilized for selected fracture configurations. Materials and Methods. In a prospective study between 2003 and 2010 we analyzed 72 patients with proximal humeral fracture who had been treated by PHN (44 patients) or angular stable plating (28 patients) in a European Level 1 Trauma Center. In the two cohort groups the following epidemiologic data was found. 46 patients were women, and 26 men with a mean age of 60.6 years (range 18–91). Follow-up was performed 38–82 months after accident, on average. Mechanism of injury was fall in 59, motor cycle accident in 4, bike accident in 8 patients, and fall from horse in 1 patient. Duration time between accident and operation was 2.8 days on average. Osteoporosis was previously known in 20 out of all evaluated patients (plate: 7/28; nail: 13/44). Fractures were classified using the Neer classification and Binary description system: There were 35 3-part fractures (PHN: 26; plate: 9) and 37 4-part fractures (PHN: 18; plate: 19), respectively. Functional and radiological outcome was assessed in a range of 38–82 months after trauma using Constant Score. Results. No clinical symptoms after 3 years were observed in 40 patients, whereas in 32 patients clinical symptoms were evaluated related to pain and/or loss of function. Secondary revision after plate fixation had to be performed in 5 out of 28 patients and in 11 out of 44 patients in the PHN group. Functional outcome using the Constant score demonstrated a total score of 72.9 (ipsi-lateral side) vs. 88.4 (contra-lateral side) in all evaluated patients, on average. Complete metal removal was performed in 34 out of 72 patients (PHN: 17; plate: 17). Conclusion. Both i.m. nailing and angular stable plating are adequate treatment options for proximal humeral fractures. No significant differences in outcome between implants regarding fracture healing, nonunion, and infection were found. Locked plating can be utilized for all
The aim of this study was to determine the current incidence and epidemiology of humeral diaphyseal fractures. The secondary aim was to explore variation in patient and injury characteristics by fracture location within the humeral diaphysis. Over ten years (2008 to 2017), all adult patients (aged ≥ 16 years) sustaining an acute fracture of the humeral diaphysis managed at the study centre were retrospectively identified from a trauma database. Patient age, sex, medical/social background, injury mechanism, fracture classification, and associated injuries were recorded and analyzed.Aims
Methods
Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis.Aims
Methods
To evaluate interobserver reliability of the Orthopaedic Trauma
Association’s open fracture classification system (OTA-OFC). Patients of any age with a first presentation of an open long
bone fracture were included. Standard radiographs, wound photographs,
and a short clinical description were given to eight orthopaedic
surgeons, who independently evaluated the injury using both the
Gustilo and Anderson (GA) and OTA-OFC classifications. The responses
were compared for variability using Cohen’s kappa.Aims
Patients and Methods