Background. Floating shoulder (FS) is, according to Goss et al, a double disruption of the superior shoulder suspensory complex which usually results from a glenoid neck fracture and a ipsilateral midclavicular fracture. However, the interruption can interest the whole scapular belt from acromion to sterno-clavicular joint. It occurs mostly after a violent traumatism with direct lateral impact on the shoulder. That leads to complex therapeutic issues with sometimes uncertain results. Material. Between 1984 and 2009, 35 patients (30 men, 5 women), mean age 35 years [16–72] with FS, were treated in our department. Most of them sustained road accident (31cases) with polytraumatism context in 12 cases. A CT scan was realized in the majority of cases to specify the scapular fracture and look for intra-thoracic immediate complications. Mostly, glenoid neck fracture associated with a clavicular fracture has been found out (15cases). Orthopaedic treatment has been realized in 18 cases. Surgical management has been decided for open reduction of sterno-clavicular joint in 2 cases, isolated fixation of the clavicle in 9 cases, of the scapula in 3 cases, and of both scapula and clavicle in 3 cases. Criteria for clinical evaluation were an algo-functional scale (Oxford Shoulder Score, OSS), a subjective Constant Shoulder Score, a functional incapacity scale (Shoulder Simple Test, SST), scales of life quality (DASH and SF12) and global indications (Single Assessment Numeric Evaluation, SANE). Results. we noted a single migration of material. A patient presented a secondary displacement after orthopaedic treatment, and had additional surgical fixation before 6 months. In the mean follow up of 135 months [9–312], three patients were deceased and seven were unreachable. Five complained about rare pains, three of an important stiffness and chronic pains, and only one of brachial plexus injury. Functional results were satisfactory: OSS 14,75/60 [12–28], Subjective Constant score 79 [60–100], SST 10,75/12 [4–12], DASH 13,75/100 [0–84], SF12 physical 49,4 [36,8–54,8], SF12 mental 59,7 [57,2–61,8] andSANE 79% [50–100]. Discussion/conclusion. FS presents an immediate gravity because of possible intrathoracic injuries which can delay surgical treatment. FS which allowed orthopaedic treatments or required isolated fixation of the clavicle have excellent results. Scapular fractures which required surgical repair because of a significant displacement andan articular extension have more pejorative results

A multicenter retrospective analysis of patients treated for tibial fracture was conducted to develop a score that correlates with fracture healing time and, ultimately, to identify the risk gradient of delayed healing. The clinical records of 93 patients treated for tibial fracture at three orthopaedic centers were evaluated. Patients were considered healed when full weight bearing was allowed and no further controls were scheduled. For the purpose of our analysis, we separated patients healed within or after 180 days. Patient's risk factors known to be associated to delay healing, as well as fracture morphology and orthopaedic treatment were recorded in an electronic Case Report Form (e-CRF). Information available in the literature was used to weight the relative risk (RR) associated to each risk factor; values were combined to calculate a score to be correlated to the fracture healing time: L-ARRCO (Literature-Algoritmo Rischio Ritardo Consolidazione Ossea). Among all information collected in e-CRFs, we identified other risk factors, associated to delayed healing, that were used to calculate a new score: ARRCO. Univariate logistic analysis was used to determine a correlation between the score and healing time. Analysis by receiver operating characteristic (ROC) and calculation of the area under the curve (AUC) were used for sensitivity and specificity. Complete information was available for 53 patients. The mean value of the L-ARRCO score among patients healed within 180 days was 5.78 ± 1.59 and 7.05 ± 2.46 among those healed afterwards, p=0.044. The mean value of the ARRCO score of patients healed within 180 days was 5.92 ± 1.78 and 9.03 ± 2.79 among those healed afterwards, p<0.0001. The ROC curve shows an AUC of 0.62±0.09 for L-ARRCO and an AUC of 0.82±0.07 for ARRCO, (p<0.0001). We have shown that the ARRCO score value is significantly correlated to fracture healing time. The score may be used to identify fractures at risk of delayed healing, thus allowing surgeon's early intervention to stimulate osteogenesis

Introduction. In an ageing population the incidence of patients sustaining a neck of femur fracture is likely to rise. Whilst the neck of femur fracture is thought to be a pre-terminal event in many patients, there is little literature following this common fracture beyond 1 year. With improving healthcare and increasing survival rate, it is likely that a proportion of patients live to have subsequent fractures. However little is known about if these occur and what the epidemiology of these fractures are. Aim. To describe the epidemiology of fractures sustained over a ten year period in patients who had an “index” neck of femur fracture. Method. All patients from the Lothian region, who sustained a neck of femur fracture and were admitted to the Royal Infirmary of Edinburgh in Scotland between 01/01/2000 and 31/12/2000 were prospectively identified and had their orthopaedic notes and where appropriate death records retrospectively reviewed in Aug 2010, to identify further fractures and orthopaedic treatments. Patients admitted from without the Lothian region were excluded from the study. Other information regarding their pre-injury medical history, what surgery was performed, age, social status, co-morbidities and where relevant cause and date of death were recorded. Results. In the year 2000 there were 628 patients identified as having sustained a neck of femur fracture giving an incidence of 12/10,000/year. 534 (85%) of the 628 fractures were sustained by falls, with the remainder being direct trauma, pathological or an unknown cause. The mean age of patient at the time of sustaining the neck of femur fracture was 87.5 years old, with a range of 17 to 101 years old. 136 (21.7%) patients went on to sustain further fractures. The top five most frequent fractures involved the contralateral neck of femur (55; 31%), radius (34; 19%), humerus (24; 13.4%), ipsilateral femur (19; 10.6%) and tibia (10; 5.6%). 32 (23.5%) people sustained multiple fractures after the initial hip index fracture. 24% of patients had previously sustained some form of fracture prior to their index neck of femur fracture. Conclusion. Our results demonstrate that over a fifth of patients who sustain a neck of femur fracture will sustain a further fracture in the next ten years. Rather than regarding a neck of femur fracture as a terminal event, resources and support should be directed at preventing further fractures in this high risk population. As patients live longer and health care and the treatment of neck of femur fractures improves it is likely that the incidence of further fractures will rise. We believe our results will be useful for all departments treating neck of femur fractures

Aims

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.

We prospectively analysed the epidemiology of acetabular fractures over a period of 16 years in order to identify changes in their incidence or other demographic features. Our study cohort comprised a consecutive series of 351 patients with acetabular fractures admitted to a single institution between January 1988 and December 2003.

There was no significant change in the overall incidence of acetabular fractures, which remained at 3 patients/100 000/year. There was, however, a significant reduction in the number of men sustaining an acetabular fracture over the period (p < 0.02). The number of fractures resulting from falls from a height < 10 feet showed a significant increase (p < 0.002), but there was no change in those caused by motor-vehicle accidents. There was a significant reduction in the median Injury Severity score over the period which was associated with a significant decrease in mortality (p < 0.04) and a reduction in the length of hospital stay. The incidence of osteoarthritis noted during follow-up of operatively-treated fractures declined from 31% to 14%, reflecting improved results with increasing subspecialisation. Our findings suggest that there will be a continuing need for some orthopaedic surgeons to specialise in the management of these fractures. In addition, the reductions in the Injury Severity score and mortality may be associated with improved road and vehicle safety.

We randomly allocated 60 consecutive patients with fractures of the waist of the scaphoid to percutaneous fixation with a cannulated Acutrak screw or immobilisation in a cast. The range of movement, the grip and pinch strength, the modified Green/O’Brien functional score, return to work and sports, and radiological evidence of union were evaluated at each follow-up visit. Patients were followed sequentially for one year.

Those undergoing percutaneous screw fixation showed a quicker time to union (9.2 weeks vs 13.9 weeks, p < 0.001) than those treated with a cast. There was a trend towards a higher rate of nonunion in the non-operative group, although this was not statistically significant. Patients treated by operation had a more rapid return of function and to sport and full work compared with those managed conservatively. There was a very low complication rate.

We recommend that all active patients should be offered percutaneous stabilisation for fractures of the waist of the scaphoid.