The objectives of our study were to compare patient reported outcome measures between manual and robotic-assisted total hip arthroplasty. Between 1st May 2021 and 31st August 2022, 539 consecutive patients who underwent 564 primary total hip arthroplasties were identified from the local registry database. Data were prospectively collected, and included patient demographics, American Society of Anaesthesiologists (ASA) grade, surgical approach, robotic-assistance, Oxford Hip Score (OHS), EQ-5D-3L and EQ-VAS pre-operatively and at twelve months. Robotic-assistance, compared against manual total hip arthroplasty, was associated with an enhanced median (interquartile range) OHS (46 [42 – 48] vs 43 [36 – 47], p-value < 0.001), EQ-5D-3L (5 [5 – 7] vs 6 [5 – 8], p-value 0.002), and EQVAS (90 [75 – 95] vs 80 [70 – 90], p-value 0.003) at twelve months after surgery. Robotic-assistance was confirmed to be an independent predictor of a greater OHS at twelve months on a multivariate linear regression analysis (p-value 0.001). Robotic assistance was superior to manual total hip arthroplasty in enhancing patient reported outcomes at twelve months after surgery

Aims. Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. Methods. The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p < 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL. Results. For patient and surgical factors, only pre-injury quality of life and isolated fracture showed a statistical effect on all four HRQoL outcomes, while high-energy injury mechanism, smoking, and race or ethnicity, demonstrated statistical significance for three of the four HRQoL outcomes. Patients who did not require reoperation in response to infection, the need for bone grafts, and/or the need for implant exchanges had statistically superior HRQoL outcomes than those who did require intervention within one year after initial tibial fracture nailing. Conclusion. We identified several baseline patient factors, surgical factors, and post-intervention procedures within one year after intramedullary nailing of a tibial shaft fracture that may influence a patient’s HRQoL. Cite this article: Bone Jt Open 2021;2(1):22–32

Aims. The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. Patients and Methods. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) versus early plate fixation (n = 86) of displaced midshaft clavicular fractures. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). The Six-Dimension Short-Form Health Survey (SF-6D) score was used as the preference-based health index to calculate the cost per QALY at 12 months after the injury. Results. The mean 12-month SF-6D was 0.9522 (95% confidence interval (CI) 0.9355 to 0.9689) following conservative management and 0.9607 (95% CI 0.9447 to 0.9767) following fixation, giving an advantage for fixation of 0.0085, which was not statistically significant (p = 0.46). The mean cost per patient was £1322.69 for conservative management and £5405.32 for early fixation. This gave an ICER of £480 309.41 per QALY. For a threshold of £20 000 per QALY, the benefit of fixation would need to be present for 24 years to be cost-effective compared with conservative treatment. Linear regression analysis identified nonunion as the only factor to adversely influence the SF-6D at 12 months (p < 0.001). Conclusion. Routine plate fixation of displaced midshaft clavicular fractures is not cost-effective. Nonunion following conservative management has an increased morbidity with comparable expense to early fixation. This may suggest that a targeted approach of fixation in patients who are at higher risk of nonunion would be more cost-effective than the routine fixation of all displaced fractures. Cite this article: Bone Joint J 2019;101-B:995–1001

The primary aim of this study was to undertake a cost-effectiveness analysis (CEA) of acute fixation versus conservative management of displaced midshaft clavicle fractures. The secondary aim was to conduct a sensitivity analysis of patient characteristics that may influence a threshold of £20,000 per quality-adjusted life year gained (QALY). A CEA was conducted from a randomised control trial comparing conservative management (n=92) to acute plate fixation (n=86) of displaced midshaft clavicle fractures. The incremental cost effectiveness ratio (ICER) was used to express the cost per QALY. The short form 6-dimensional (SF-6D) score was the preference based index to calculate the cost per QALY. The 12-month SF-6D advantage of acute fixation over conservative management was 0.0085 (p=0.464) with a mean cost difference of £4,096.22 and resultant ICER of £481,908.24/QALY. For a threshold of £20,000/QALY the benefit of acute fixation would need to be present for 24.1 years. Linear regression analysis identified nonunion as the only independent factor to influence the SF-6D at 12-months (p<0.001). Conservatively managed fractures that resulted in a nonunion (n=16) had a significantly worse SF-6D compared to acute fixation (0.0723, p=0.001) with comparable healthcare cost at 12-months (£170.12 difference). Modelling the ICER of acute fixation against those complicated by a nonunion proved to be cost effective at £2,352.97/QALY at 12-months. Routine plate fixation of displaced midshaft clavicle fractures is not cost-effective. Patients with nonunion after conservative management have increased morbidity with comparable expense to those undergoing acute fixation which suggests targeting these patients is a more cost-effective strategy

Over a five-year period, adult patients with marginal impaction of acetabular fractures were identified from a registry of patients who underwent acetabular reconstruction in two tertiary referral centres. Fractures were classified according to the system of Judet and Letournel. A topographic classification to describe the extent of articular impaction was used, dividing the joint surface into superior, middle and inferior thirds. Demographic information, hospitalisation and surgery-related complications, functional (EuroQol 5-D) and radiological outcome according to Matta’s criteria were recorded and analysed. In all, 60 patients (57 men, three women) with a mean age of 41 years (18 to 72) were available at a mean follow-up of 48 months (24 to 206). The quality of the reduction was ‘anatomical’ in 44 hips (73.3%) and ‘imperfect’ in 16 (26.7%). The originally achieved anatomical reduction was lost in12 patients (25.8%). Radiologically, 33 hips (55%) were graded as ‘excellent’, 11 (18.3%) as ‘good’, one (1.7%) as ‘fair’ and 15 (25%) as ‘poor’. A total of 11 further operations were required in 11 cases, of which six were total hip replacements. Univariate linear regression analysis of the functional outcome showed that factors associated with worse pain were increasing age and an inferior location of the impaction. Elevation of the articular impaction leads to joint preservation with satisfactory overall medium-term functional results, but secondary collapse is likely to occur in some patients. Cite this article: Bone Joint J 2013;95-B:230–8

25–40% of unicompartmental knee replacement (UKR) revisions are performed for unexplained pain possibly secondary to elevated proximal tibial bone strain. This study investigates the effect of tibial component metal backing and polyethylene thickness on cancellous bone strain in a finite element model (FEM) of a cemented fixed bearing medial UKR, validated using previously published acoustic emission data (AE). FEMs of composite tibiae implanted with an all-polyethylene tibial component (AP) and a metal backed one (MB) were created. Polyethylene of thickness 6–10mm in 2mm increments was loaded to a medial load of 2500N. The volume of cancellous bone exposed to <−3000 (pathological overloading) and <−7000 (failure limit) minimum principal (compressive) microstrain (µ∊) and >3000 and >7000 maximum principal (tensile) microstrain was measured. Linear regression analysis showed good correlation between measured AE hits and volume of cancellous bone elements with compressive strain <−3000µ∊: correlation coefficients (R= 0.947, R2 = 0.847), standard error of the estimate (12.6 AE hits) and percentage error (12.5%) (p<0.001). AP implants displayed greater cancellous bone strains than MB implants for all strain variables at all loads. Patterns of strain differed between implants: MB concentrations at the lateral edge; AP concentrations at the keel, peg and at the region of load application. AP implants had 2.2 (10mm) to 3.2 (6mm) times the volume of cancellous bone compressively strained <−7000µ∊ than the MB implants. Altering MB polyethylene insert thickness had no effect. We advocate using caution with all-polyethylene UKR implants especially in large or active patients where loads are higher

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To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial.

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Frailty greatly increases the risk of adverse outcome of trauma in older people. Frailty detection tools appear to be unsuitable for use in traumatically injured older patients. We therefore aimed to develop a method for detecting frailty in older people sustaining trauma using routinely collected clinical data.

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Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery.

Aims and objectives. The aim of this study was to statistically analyse the calcaneal fractures occurring in the community and distribution within the various age groups divided into decades. Methods and materials. Records of calcaneal fractures were retrieved from the audit department of the hospital using the various codes to identify patients reviewed in the clinics or admitted to the hospital between 1997 and 2009. The data collected included the total number of calcaneal fractures, total number in either gender, age at the time of incident, month of the year the incident occurred. Annual distribution of incidence of forearm fractures was calculated for every year and every month of the year. The age of the patients was divided into decades. Linear regression analysis and correlation coefficients were calculated between the incidence of fractures and different variables including age, gender and the time of the injury. Results. A total of 770 fractures were calculated including 511 males and 259 females (M/F=1.97). The average age of was 43.17 years (males=39.9 yrs, females=49.7 years). In both the sexes, there was a linear increase in the incidence of fractures in the first three decades of life with the rate of increase in males (R=0.999, r2=0.99) being 3 times that of females (R=0.96, r2=0.92). The incidence in females remained almost constant from 3rd decade to the 9th decade. The incidence in males reached a peak in the 3rd decade and then decreased steadily until the 10th decade. The incidence of fractures in females equalled that of males in the 8th decade; after which the incidence in males fell below females. There was a strong correlation between the increase in the incidence of fractures from February to August (R=0.9, r2=0.81) every year, after which the incidence reduced in the following months. There was a weak correlation between the increase in fractures from 1997 to 2009. Conclusion. There is a significant increase in the incidence of calcaneal fractures in the first three decades of life in both males and females. In males, the rate of increase in fractures is almost thrice than that of females. It can be said that men in their late twenties are more prone to sustain calcaneal fractures than any other age group or females. More injuries should be expected in August compared to the other months of the year. Further studies need to be done to look into the mechanism of injury. This could be helpful in prevention and reduction of the fracture incidence in the young and active age groups

Aims. The aim of this study was to statistically analyse the incidence and distribution of humerus fractures in the adult age group between 3rd and 10th decades. Methods. The total number of patients was retrieved from the audit department of the hospital using the codes to identify patients between 1997 and 2009. The data included total number of patients aged 20 to 100 years who were either reviewed in the fracture clinics or admitted to the hospital with forearm fractures along with patient gender, age at the time of incident and time of the year the incident occurred. Annual incidence of fractures along with the distribution of fracture incidence per year and per individual month was calculated. The patients’ age were classified in to 3rd to 10th decades. Linear regression analysis was carried out to identify the relationship between fracture incidence and the age or time of the injury. Correlation coefficients(R) and r2 were calculated for all the regression analyses. SPSS (version 16) and Microsoft Excel 2007 were used for statistics. Results. A total of 1280 fractures were identified that included 524 males and 756 females (F/M=1.44). The average age of patients was 60.87 years. Comparing the different months of the year for fracture incidence, the average of incidence of fractures was found to be highest in july per year. There was a linear increase in the incidence of fractures from january to september (R=0.94, r2=0.89) followed by a drop in subsequent months. The total number of humerus fractures per year increased from49 in 1997 to 137 in 2009. In both males and females, there was strong relation to linearity in the increase in the incidence of fractures per year from 1997 to 2009 (Females: R=0.89, r2=0.79, Males: R=0.87, r2=0.76). On comparison of the linear equations for males and females, the rate of increase in the incidence of fractures in females was found to be approximately 1.5 times that of males. In females, There was a linear increase in the fracture incidence from the 3rd to the 9th decade (R=0.96, r2=0.92) followed by a sudden drop in the 10th decade. In men, there was a linear decrease in the fracture incidence from the 3rd to the 9th decade (r2=0.81, R=0.90). Conclusion. In the last 13 years, there has been an increase in the incidence of humerus fractures in both men and women; however, the rate of increase in the incidence in women is almost 1.5 times that of men. There was a strong correlation between age and incidence of fractures in both men and women: with increasing age, the incidence of fracture increased in women and decreased in men. The drop in fractures in women the 10th decade can be attributed to a reduced living population after 90 years. The obtained linear equations can be useful in predicting the number of fractures occurring in a certain age group in a community

Introduction. Spinal aBMD only explains 50–80% of vertebral strength, and the application of aBMD measurements in isolation cannot accurately identify individuals who are likely to eventually experience bone fracture, due to the low sensitivity of the test. For appropriate treatment intervention, a more sensitive test of bone strength is needed. Such a test should include not only bone mineral density, but also bone quality. Quantitative computed tomography-based finite element methods (QCT/FEM) may allow structural analyses taking these factors into consideration to accurately predict bone strength (PBS). To date, however, basic data have not been reported regarding the prediction of bone strength by QCT/FEM with reference to age in a normal population. The purpose of this study was thus to create a database on PBS in a normal population as a preliminary trial. With these data, parameters that affect PBS were also analyzed. Methods. Participants in this study comprised individuals who participated in a health checkup program with CT at our hospital in 2009. Participants included 217 men and 120 women (age range, 40–89 years). Exclusion criteria were provided. Scan data of the second lumber vertebra (L2) were isolated and taken from overall CT data for each participant obtained with simultaneous scans of a calibration phantom containing hydroxyapatite rods. A FE model was constructed from the isolated data using Mechanical Finder software. For each of the FE models, A uniaxial compressive load with a uniform distribution and uniform load increment was applied. For each participant, height and weight were measured, BMI was calculated. Simple linear regression analysis was used to estimate correlations between age and PBS as analyzed by QCT/FEM. Changes in PBS with age were also evaluated by grouping participants into 5-year age brackets. One-way analysis of variance was used to compare average PBS for participants in each age range. Mean PBS in the 40–44 year age range was taken as the young adult mean (YAM). The ratio of mean PBS in each age group to YAM was calculated as a percentage. A multivariate statistical technique was used to determine how PBS was affected by age, height, weight, and BMI. Result/Discussion. Mean PBS was lower in women than in men for all age ranges. PBS in men and women significantly decreased with age. Simple linear regression between age and PBS showed the annual rate of decline in PBS was 55 N/year in men and 164 N/year in women. Mean PBS in the 75–79 year age range was 77% of YAM in men and in women, that in the 70–79 year age range was 47% of YAM. PBS was strongly dependent on age, while physical status had less effect

Aims

The aim of this study was to report the outcomes of patients with severe open fractures of the lower limb in the five years after they took part in the Wound management for Open Lower Limb Fracture (WOLLF) trial.

Aims. The aim of this study was to statistically analyse the incidence and distribution of forearm fractures in the adult age group (3rd–10th Decades) between 1997 and 2009. Methods. Records of patients with forearm fractures were retrieved from the hospital audit department using the predetermined codes to identify patients. The data included total number of patients between 20 and 100 years who were either reviewed in the fracture clinics or admitted to the hospital with forearm fractures along with patient gender, age at the time of incident and time of the year the incident occurred. Incidence of total fractures per year and per each month in the year was calculated. The patients were divided into age groups between 2nd to 10th decades. Linear regression analysis was carried out to identify the relationship between fracture incidence and the age or time of the injury. Correlation coefficients(R) and r2 were calculated for all the regression analyses. Fractures were also classified according to the Orthopaedic Trauma Association (OTA) classification system. SPSS (version 16) and Microsoft Excel 2007 were used for statistics. Results. A total of 1815 fractures were identified that included 573 males and 1242 females (F/M=2.17). The average age of patients was 59.8 years. Comparing the different months of the year for fracture incidence, the incidence of fractures was found to be highest in september per year. There was a linear increase in the incidence of fractures from January to September (R=0.9, r2=0.81) followed by a drop in subsequent months. There was a linear increase in the incidence of fractures per year from 70 in 1997 to 200 in 2009 (R=0.94, r2=0.885). Comparing the slopes of linear equations for males and females, the rate of increase in fractures in females was found to be approximately 3 times that of males. In women, There was a linear increase in the fracture incidence from the 3rd decade to the 9th decade (R=0.91, r2=0.84) followed by a sudden drop in the 10th decade. In men, there was a linear decrease in the fracture incidence from the 3rd to the 9th decade (r2=0.9559, R=0.98). 177 fractures were classified according to the OTA classification. OTA 23 type of fractures accounted for 85.3% percent of the forearm fractures followed by OTA 21 type (11.9%) and 22 type (2.8%). Further analysis showed the distribution to be: 23A-43.7%, 23B-9.9%, 23C-46.4%. Conclusion. In the last 13 years, there has been an increase in the total incidence of forearm fractures in both men and women; however, the rate of increase in women is almost 3 times that of men. With increasing age, the incidence of fracture increases in women and decreases in men. The drop in fractures in women the 10th decade can be attributed to a reduced living population after 90 years. The obtained linear equations can be useful in predicting the number of forearm fractures occurring in a certain age group in community

Aims

The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures.

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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).

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This study assessed the association of classes of body mass index in kg/m² (classified as normal weight 18.5 kg/m² to 24.9 kg/m², overweight 25.0 kg/m² to 29.9 kg/m², and obese ≥ 30.0 kg/m²) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures.

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Hemiarthroplasty of the hip is usually carried out through either a direct lateral or posterior approach. The aim of this prospective observational study was to determine any differences in patient-reported outcomes between the two surgical approaches.

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The aim of this double-blind prospective randomised controlled trial was to assess whether low intensity pulsed ultrasound (LIPUS) accelerated or enhanced the rate of bone healing in adult patients undergoing distraction osteogenesis.

Several studies have reported the rate of post-operative mortality after the surgical treatment of a fracture of the hip, but few data are available regarding the delayed morbidity. In this prospective study, we identified 568 patients who underwent surgery for a fracture of the hip and who were followed for one year. Multivariate analysis was carried out to identify possible predictors of mortality and morbidity. The 30-day, four-month and one-year rates of mortality were 4.3%, 11.4%, and 18.8%, respectively. General complications and pre-operative comorbidities represented the basic predictors of mortality at any time interval (p < 0.01). In-hospital, four-month and one-year general complications occurred in 29.4%, 18.6% and 6.7% of patients, respectively. After adjusting for confounding variables, comorbidities and poor cognitive status determined the likelihood of early and delayed general complications, respectively (p < 0.001). Operative delay was the main predictor of the length of hospital stay (p < 0.001) and was directly related to in-hospital (p = 0.017) and four-month complications (p = 0.008).

Cite this article: Bone Joint J 2015;97-B:383–90