Background. The cementless acetabular component fixed with several screws is one of the most widely used approaches in THA. These screws rely on contact pressure and the resultant friction between the screw head and the cup to control translation and angulation of the prosthesis. However, intraoperative change of the acetabular component alignment during screw fixation should be hardly detected. Acetabular component alignment can be assessed using computer-assisted navigation systems with realtime adjustments for component position. The purpose of the current study was to evaluate intraoperative change of acetabular component alignment during screw fixation using navigation system. Patients and Methods. Primary THAs were performed in 74 hips using CT based fluoroscopic matching navigation system (VectorVision, BrainLAB). The patients were 18 men and 56 women with a mean age of 64.4 years (range, 47–78 years) at operation. Intraoperative acetabular component inclination and anteversion were measured at the time of press-fit, and after screw fixation using the cup verification function in the system. Mean of the absolute difference between at the time of press-fit and after screw fixation was evaluated as intraoperative change of acetabular component. We measured the distance from the center of the femoral head to the inter-teardrop line as a horizontal and vertical reference on the postoperative radiograph. The number of screws was also investigated. Results. Mean inclination and anteversion at the time of press-fit were 40.6° ± 3.6° and 14.6° ± 9.3°, respectively. Mean inclination and anteversion after screw fixation were 40.7° ± 4.4° for inclination and 14.5° ± 9.6° for anteversion. Mean intraoperative change of acetabular component was 1.9° ± 1.7° for inclination and 1.9° ± 1.9° for anteversion. The use number of the screw was an average of 1.46 (1 to 4). The intraoperative change of acetabular component anteversion correlated with number of screws (r = 0.381, p = 0.017), and vertical distance(r = 0.265, p = 0.05). The intraoperative change of acetabular component inclination also correlated with horizontal distance (r = 0.313, p = 0.02). Discussion. Many studies have shown that multiple bone screws are very helpful aids for cementless acetabular cup fixation. The multiple-screw fixation could have an effect on micromotion of the acetabular component. However, the change of acetabular alignment during inserting screws has not been clearly reported. The current study showed mean intraoperative change of acetabular component was 1.9° for inclination and 1.9° for anteversion. However, maximum change of acetabular component was 5° for inclination and 13° for anteversion. These findings suggest that the alignment of acetabular component could change during screw fixation, and the change might cause malalignment of the acetabular component, and could increase the risks of impingement, dislocation, and accelerated wear. The change of acetabular alignment correlated with number of screws and radiographycal measurements in this series. Therefore, bone quality and bone stock could affect stability of acetabular component. In conclusion, navigation can show potential to help quantify intraoperative acetabular component alignment change during screw fixation and potentially reduce the risk for malpostion of acetabular components

The treatment of undisplaced femoral neck fracture in the elderly population is still controversial. We analysed the outcome of cancellous screw fixation for undisplaced femoral neck fracture in patients over 70 years. Materials and methods. From 1998 to 2003, ninety-seven patients with undisplaced femoral neck fracture, aged over 70 and treated with cancellous screw fixation were retrospectively identified. Full clinical data was available for 79 of the 97 patients identified. All patients had in situ fracture fixation. Results. Of the 79 patients, M:F was 22:57, average age was 81.3 years. The average inpatient stay was 13.2 days. The mean follow-up was 12 months. 24 patients had Garden type I and 55 type II fractures. 26 (32.9%) patients did not return to their pre-morbid mobility status, 5 (6.3%) did not return to their preadmission dwelling (2 went to residential homes and 3 to nursing homes). We had documented radiographic details in 46 patients: 41 patients had a healed fracture on radiographs (89.1%), 5 patients had AVN, 4 patients had non-union and 1 patient had AVN with non-union. The radiographic failure rate was 22%. 15 patients had evidence of screw back out with healed fracture. 12 of the 46 complained of pain post-operatively of which 9 (19.6%) patients had re-operation; 6 (13%) underwent revision surgery and 3 (6.5%) required screw removal. 30-day mortality was 3.7%. 1-year mortality was 23.2% of which 16 died within the first 6 months (19.5%). Conclusion. This study shows that, in our unit, cancellous screw fixation of undisplaced femoral neck fractures in patients over the age 70 had a good outcome with a 20% re-operation rate and 22% radiographic failure rate. One third of the patients did not return to their preadmission mobility level/dwelling

Purpose of study. Unstable pelvic ring injuries usually occur in polytrauma patients and are associated with high mortality and morbidity. Percutaneous screw fixation of sacro-iliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and is increasingly gaining popularity. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers the advantages of minimally invasive surgical techniques. It is however a technically demanding procedure with reported complications including hardware failure, misplacement of screws, nerve injury and poor posterior reduction. The purpose of the study is to report clinical results of patients treated with closed reduction and percutaneous ilio-sacral screw fixation for unstable pelvic ring fractures by a single surgeon. Methods. A review of prospectively collected data was performed on all patients who had percutaneous sacro-iliac fixation between 2009 and 2012. Thirty five percutaneus sacro-iliac screws were inserted in 30 patients with a mean age of 25.6 years (range 17–62). Fracture types included 10 AO type B, and 20 AO type C. The mean follow-up period was 11.6 months (range 3–38). The complications assessed were screw misplacement, neurovascular complications, hardware breakage and loss of reduction. Results. All patients had a satisfactory initial reduction. One patient (2.8%) had misplacement of a screw with resultant temporary neurological fallout. One patient (2.8%) had screw misplacement without neurological fallout. Both of these patients initially had two screws inserted and the misplaced screws were removed and not reinserted. One patient (2.8%) had screw cut-out with loss of reduction. This screw was removed, open reduction peformed and the screw was re-inserted. Conclusion. The use of percutaneous sacro-iliac screws provides a safe and effective technique for the management of unstable posterior pelvic ring injuries. Our combined complication rate is comparable to published literature. NO DISCLOSURES

Purpose. To evaluate the use of cutaneous marking of the sacrum for percutaneous iliosacral screw fixation. Iliosacral screw placement is dependent upon spatial perception, multiplanar fluoroscopic imaging, and an appreciation of pelvic anatomy which often makes learning the technique difficult for residents. Cutaneous marking of the sacrum may facilitate iliosacral screw insertion by providing additional cues to the orientation of the sacrum. Method. A cross-over study design was used for placing iliosacral screws in whole cadaver specimens using standardized operative and imaging techniques with and without cutaneous sacral markings. Lateral fluoroscopic imaging and a radio-opaque straight edge were used to trace the lateral profile of the sacrum with a marking pen. Total procedure time and fluoroscopy time were recorded. A total of 14 residents (6 seniors and 8 juniors) each placed two iliosacral screw guide-wires in a total of seven whole cadavers (14 SI joints). Group 1 performed the procedure first with no markings and then with markings. Group 2 performed the procedure first with markings and then without markings. Statistical analysis included T test, Wilcoxon Rank Sum Test, and Signed-Rank Test for Difference (p = 0.05). Participants also reported their opinions on each technique. Results. Mean procedure time for Group 1 was 8.83 minutes (3.77 17.17) and mean fluoroscopy time was 0.77 minutes (0.4 1.2) for the no-marking attempt and 10.33 min (5.88 15.25) and 1.06 min (0.6 2.3) respectively for the marking attempt. Mean procedure time for Group 2 was 11.3 min (6.33 16.5) and mean fluoroscopy time was 1.19 min (0.6 2.3) for the marking attempt and 7.22 min (2.83 17.27) and 0.97 min (0.4 1.8) respectively for the no-marking attempt. There were no significant differences between groups. T test analysis of all marking vs. no marking showed no significant difference for total procedure time (p= O.7020) or fluoroscopy time (p= 0.8297). Wilcoxon Rank Sum Test analysis showed no significant difference for total procedure time (p= 0.4415) or fluoroscopy time (p=0.7486) and Signed-Rank Test for Difference showed no significant difference for total procedure time (p=0.0625) or fluoroscopy time (p=0.1459). Senior residents reported they found the cutaneous marking helpful and would use it again whereas junior residents had mixed feelings on its utility. Conclusion. Cutaneous marking of the sacrum did not significantly impact total procedure time or fluoroscopy time but was generally reported to be helpful for residents learning percutaneous iliosacral screw fixation

There has been a trend towards operative management of pelvic injuries. Posterior pelvic integrity is more important for functional recovery. Percutaneous iliosacral screw fixation is being increasingly preferred for posterior pelvic stabilisation. Outcome reporting for this procedure remains inconsistent and un-standardised. Retrospectively, all percutaneous iliosacral screw fixations done at this institute during a 5-year period (2008–2012) were reviewed. 28 patients, who had had at least 12 months follow-up, were contacted and clinical scoring was done by postal correspondence. Radiographs were measured for displacements and leg-length discrepancy. Possible factorial associations and correlations were investigated. Mean Majeed score was 83 (median 87), mean EQ-Visual Analog Score (EQ-VAS) was 75.5 (median 80) and the two scores were correlated with statistical significance. Tile AO type C injuries produced worse outcomes and patients who'd anterior pelvic fixation did better. Our results show high patient-reported outcomes, excellent radiologically measured reductions and unions. The incidence of complications is very low. There is a significant correlation between the EQ-VAS arm of the EQ5D instrument and the Majeed score in this patient population. Incidence of non-pelvic surgical procedures in these patients was significantly associated with worse outcomes. Leg length discrepancies appeared to increase after patients were fully weight bearing

Minimally invasive (MIS) screw fixation for Hangman's fracture can decrease iatrogenic soft-tissue injury compared with conventional open approach, but increase the risk of instrumentation-related complications due to lack of anatomical landmarks. With the advantages, the intra-operative three-dimensional fluoroscopy-based navigation (ITFN) system seems to be an inherent partner for MIS techniques. The purpose of this study was to evaluate the accuracy and feasibility of MIS techniques incorporating with ITFN for treating Hangman's fracture. 20 patients with Hangman's fracture underwent C2-C3 pedicle screw fixation using ITFN. 6 patients used MIS technique, with the other 14 patients using conventional open technique. Preoperative visual analogue score (VAS) was 5.7±1.4 in CAOS-MIS group and 5.5±0.9 in CAOS-open group. Operative time, blood loss and postoperative neurovascular complications were recorded. The accuracy of screw positions was studied by postoperative CT scan. All patients were followed up for at least 6 months and the fusion status was ascertained by dynamic radiographs. The average operative time was 134.2±8.0 min in CAOS-MIS group and 139.3±25.8 min in CAOS-open group, and there was no significant difference between the two (p>0.01). The blood loss was 66.7±25.8 ml in CAOS-MIS group and 250.0±141.4 ml in CAOS-open group. Statistical difference existed with CAOS-MIS group significant less than CAOS-open group (p<0.01). A total of 80 screws were inserted. No screw-related neurovascular injury was observed. Post-operative CT scan revealed 83.3% (20/24) screws of grade 1 and 16.7% screws of grade 2 (4/24) in CAOS-MIS group, meanwhile 89.3% screws of grade 1 (50/56) and 10.7% screws of grade 2 (6/56) in CAOS-open group. There was no grade 3 screw detected. Fisher's exact test showed there was no statistical difference between these two groups (p>0.01). There was no statistical difference in pre-operative VAS between these two groups (p>0.01). Compared with the CAOS-open group (1.7±0.6), neck pain VAS at 6-month follow-up in CAOS-MIS group (0.3±0.5) was significantly lower (p<0.01). Solid fusion was demonstrated in all the cases by dynamic radiographs. So it is feasible and safe for percutaneous minimally invasive C2-C3 pedicle screw fixation for Hangman's fracture using intra-operative three-dimensional fluoroscopy-based navigation, which can also decrease the incidence of post-operative neck pain

Purpose. To evaluate the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with four fold Hamstring Tendon Graft using Transfix and Bioabsorbable Interference Screw Fixation. Study Design. Retrospective review. Methods. Sixty-five patients (66 knees) were retrospectively identified by chart review as having undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction, with four fold Hamstring Tendon Graft, using Transfix and Bioabsorbable Interference Screw Fixation. All patients underwent a minimum two-year follow-up. Results. Data were collected on 48 knees in 47 patients (73%) at an average 30.2 months (range 24 to 43) after surgery. Thirty-six patients (37 knees) returned for clinical evaluation (56% return) and subjective follow-up only was obtained in 11 patients (17%). The mean Lysolm knee score was 91 (range, 45 to 98), with a mean of 97 for the uninvolved knee. The mean Tegner activity score was 5.7 (range 3 to 7). The KT-1000 arthrometer mean side-to-side difference for manual maximum displacement was 2.03 mm (range -1 to 8). The mean International Knee Documentation Committee knee score was 83 (range 47 to 100). Patients who underwent associated partial meniscectomy or meniscal repair had significantly lower International Knee Documentation Committee scores than patients without associated procedures (P < 0.01). Conclusions. Quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation is comparable with other methods of anterior cruciate ligament reconstruction in terms of patient satisfaction, knee stability, and function

Scaphoid injuries remain a challenge in both diagnosis and subsequent management. Untreated scaphoid non-union leads to inevitable osteoarthritis. Non-unions are picked up via an established management pathway in out trust and treated surgically with a standardised technique of non-vascularised bone grafting and retrograde screw fixation. Patients that underwent primary screw fixation and grafting for scaphoid non-union between 2004-2008 were reviewed. These patients were followed up clinically and radiologically. They were assessed for time to union, complications, DASH score, patient satisfaction and return to work. In addition comparison was made between the use of Herbert screw and Twinfix screw fixation and between tricortical iliac crest graft and corticocancellous distal radial bone graft. Forty-two consecutive patients underwent surgery of which 35 (83%) were available for follow up. Mean follow up was 39 months (range 13-72). 31 (89%) patients had gone on to radiological union. Of those united the mean DASH score was 11. Mean time to union was 4.4 months (range 2-15 95% CI 3.3 – 5.5). 95% of patients were satisfied with their operation and would recommend it to a friend in the same situation. No significant difference in outcomes were identified between Herbert screw and Twinfix screw fixation or between iliac crest or distal radial bone grafting techniques. This study has shown encouraging results for an established protocol for management of scaphoid non-union. Outcomes are as a good as any published comparable series in the literature and provide further support to the use of this technique

Introduction. In this cohort study, the TightRope® fixation technique has been compared with the traditional screw fixation for ankle syndesmosis injuries, with respect to the accuracy of the syndesmotic reduction and their clinical correlation. Patients and Methods. This cohort study included consecutive patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial CT scans of both the ankles together were performed at the level of syndesmosis, 1 cm above the tibial plafond. More than 2 mm widening of syndesmosis as compared to normal contra-lateral ankle was considered as significant malreduction. Clinical outcomes were measured using AOFAS and FADI Scores. Results. Forty-six out of 55 eligible patients attended for the study. Twenty three patients were in the tightRope group and 23 in the syndesmosis screw group. Mean follow-up was 2.5 (1.5–3.5) years. Average age was 41.6 years in tightrope group and 39.8 years in syndesmosis screw group. The mean width of normal syndesmosis was 4.01 + 0.89 mm. In tightRope group the mean width of syndesmosis was 4.37 + 1.12 mm (t-test, p = 0.30) as compared to 5.16 + 1.92 mm in screw group (t-test, p = 0.01). Five (21.7%) out of 23 ankles in screw group had syndesmotic mal reduction, while none of the tightRope group showed mal-reduction on CT scans (fisher's exact test, p = 0.04). There was no significant difference in mean post operative AOFAS score (89.56 and 86.52) and FADI score (82.42 and 81.22) between two groups. Conclusion. The results of this study indicate that tightRope provides more accurate method of syndesmosis stabilization as compared with screw fixation. Syndesmosis malreduction is the most important independent predictor of clinical outcomes; therefore care should be taken to reduce the syndesmosis accurately

Acute scaphoid fractures are commonly treated with cast for 8–12 weeks. With this prolonged period of immobilisation patients can encounter joint stiffness and muscle wasting requiring extensive physiotherapy. Despite best practice, these fractures also pose a risk of non-union and suboptimal function. Fracture location, duration of time lost from work and impairment in activities of daily living are key factors in scaphoid fracture management. The aim of our study was to compare percutaneous screw fixation of the scaphoid with other operative fixation techniques. Parameters documented were length of conservative treatment, mechanism of injury, post-op complications and patient satisfaction levels with each technique using a standardised questionnaire. Economic benefit was also measured by examining time to return to work, number of x-rays and outpatient visits required per treatment group. In this study, 76 patients requiring operative scaphoid fixation were evaluated. 27 patients underwent percutaneous fixation. Waist fractures accounted for 66% (n= 18), proximal pole fractures 33% (n=8) and distal pole fractures 4% (n=1). There were 16 non-displaced fractures (59%) and 11 displaced fractures (41%). The average length of conservative treatment was 77 days (range: 2–256 days). Within the percutaneous group 2 patients developed non-union. We did not encounter any wound infection or superficial radial nerve damage. Patients treated with early percutaneous fixation had highest satisfaction levels, returned to work earlier and required less follow-up (P< 0.001). In conclusion percutaneous screw fixation provides earlier bone union and avoids the need for prolonged immobilisation when compared to other treatment modalities. The economic benefit of early percutaneous fixation must also be considered when managing patients with scaphoid fractures

Meniscal root tears can result from traumatic injury to the knee or gradual degeneration. When the root is injured, the meniscus becomes de-functioned, resulting in abnormal distribution of hoop stresses, extrusion of the meniscus, and altered knee kinematics. If left untreated, this can cause articular cartilage damage and rapid progression of osteoarthritis. Multiple repair strategies have been described; however, no best fixation practice has been established. To our knowledge, no study has compared suture button, interference screw, and HEALICOIL KNOTLESS fixation techniques for meniscal root repairs. The goal of this study is to understand the biomechanical properties of these fixation techniques and distinguish any advantages of certain techniques over others. Knowledge of fixation robustness will aid in surgical decision making, potentially reducing failure rates, and improving clinical outcomes.

19 fresh porcine tibias with intact medial menisci were randomly assigned to four groups: 1) native posterior medial meniscus root (PMMR) (n = 7), 2) suture button (n = 4), 3) interference screw (n = 4), or 4) HEALICOIL KNOTLESS (n = 4). In 12 specimens, the PMMR was severed and then refixed by the specified group technique. The remaining seven specimens were left intact. All specimens underwent cyclic loading followed by load-to-failure testing. Elongation rate; displacement after 100, 500, and 1000 cycles; stiffness; and maximum load were recorded.

Repaired specimens had greater elongation rates and displacements after 100, 500, and 1000 cycles than native PMMR specimens (p 0.05). The native PMMR showed greater maximum load than all repair techniques (p 0.05). In interference screw and HEALICOIL KNOTLESS specimens, failure occurred as the suture was displaced from the fixation and tension was gradually lost. In suture button specimens, the suture was either displaced or completely separated from the button. In some cases, tear formation and partial failure also occurred at the meniscus luggage tag knot. Native PMMR specimens failed through meniscus or meniscus root tearing.

All fixation techniques showed similar biomechanical properties and performed inferiorly to the native PMMR. Evidence against significant differences between fixation techniques suggests that the HEALICOIL KNOTLESS technique may present an additional option for fixation in meniscal root repairs. While preliminary in vitro evidence suggests similarities between fixation techniques, further research is required to determine if clinical outcomes differ.

Treatment of syndesmotic injuries is a subject of ongoing controversy. Locking plates have been shown to provide both angular and axial stability and therefore could potentially control both shear forces and resist widening of the syndesmosis. The aim of this study is to determine whether a two-hole locking plate has biomechanical advantages over conventional screw stabilisation of the syndesmosis in this pattern of injury. Six pairs of fresh-frozen human cadaver lower legs were prepared to simulate an unstable Maisonneuve fracture. The limbs were then mounted on a servo-hydraulic testing rig and axially loaded to a peak load of 800N for 12000 cycles. Each limb was compared with its pair; one receiving stabilisation of the syndesmosis with two 4.5mm quadricortical cortical screws, the other a two-hole locking plate with 3.2mm locking screws (Smith and Nephew). Each limb was then externally rotated until failure occurred. Failure was defined as fracture of bone or metalwork, syndesmotic widening or axial migration >2mm. Both constructs effectively stabilised the syndesmosis during the cyclical loading within 1mm of movement. However the locking plate group demonstrated superior resistance to torque compared to quadricortical screw fixation (40.6Nm vs 21.2Nm respectively, p value <0.03). Conclusion. A 2 hole locking plate (3.2mm screws) provides significantly greater stability of the syndesmosis to torque when compared with 4.5mm quadricortical fixation

Flexible fixation techniques combined with anatomic (open) syndesmosis reduction have demonstrated improved functional outcomes and rates of malreduction. Suture-button devices allow physiologic motion of the syndesmosis without need for implant removal, which may lower the risk of recurrent syndesmotic diastasis. There is limited longer-term assessment of the maintenance of reduction between static and flexible syndesmotic fixation using bilateral ankle CT evaluation.

This is an a priori planned subgroup analysis of a multi-centre, randomized clinical trial comparing static syndesmosis fixation (two 3.5 mm screws) with flexible fixation (single knotless Tightrope) for patients with AO- OTA 44-C injuries. Patients who completed bilateral ankle CT scans at 3- and 12-month follow-up were included. The primary outcome measure was syndesmotic malreduction based on bilateral ankle CT scans, using the uninjured, contralateral ankle as a control. Anterior (ASD), middle (MSD), and posterior (PSD) syndesmosis distance were calculated to measure syndesmosis reduction. Secondary outcomes included re-operation, adverse events and functional outcomes including the EQ5D, Olerud-Molander Ankle Score (OM), Foot and Ankle Disability Index (FADI), and Work Productivity Activity Impairment Questionnaire (WPAI). Paired samples t-tests were used to compare injured to control ankles (R, v 3.5.1).

42 patients (24 Group S, 18 Group T) were included. ASD for Group T was 5.22mm (95%CI 4.69–5.77) at 3 months compared to 4.26mm (95%CI 3.82–4.71; p=0.007) in controls and 5.38mm (95%CI 4.72–6.04) at 12 months compared to 4.44mm (95%CI 3.73–5.16; p=0.048) in controls. ASD for Group S was 4.63mm (95%CI 4.17– 5.10) at 3 months compared to 4.67mm (95%CI 4.24–5.10; p=0.61) in controls, but significantly increased to 5.73mm (95%CI 4.81–6.66) at 12 months compared to 4.65mm (95%CI 4.15–5.15; p=0.04) in controls. MSD results were similar; Group T had a larger MSD than control ankles at 3 months (p=0.03) and 12 months (p=0.01), while the MSD in Group S was not different at 3 months (p=0.80) but increased at 12 months (p=<0.01). 88% (21/24) of Group S had broken or removed screws by 12 months. Unplanned re-operation was 15% in Group S and 4% in Group T (p=0.02), with an overall re-operation rate of 30% in Group S. There was no significant difference between treatment groups for EQ-5D, OM, FADI or WPAI at 3- or 12-month follow-up.

Tightrope fixation resulted in greater diastasis of the ASD and MSD compared to contralateral, uninjured ankles at 3- and 12-months post-fixation. Group S initially had syndesmotic reduction similar to control ankles, but between 3- and 12-months post-fixation, there was significantly increased syndesmosis diastasis compared to controls. The majority of Group S (88%) had either broken screws or scheduled screw removal, which may explain the increased tibio-fibular diastasis seen at 12-months.

Introduction

Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations.

Objective. To report clinical results of patients who underwent closed reduction and percutaneous iliosacral screw fixation for Tile Type C fractures. Materials and Methods. Retrospective, we collected data using medical records and images of patients treated in our centre. Prospectively, we followed up patients with two questionnaires. Minimum follow up time was 12 months with the mean being 24 months. 36 patients were followed up with a mean age 34 years (range 14- 65) from 2001-2009. Fracture types included 1 C1-1, 18 C1-2, 26 C1-3. Functional status was assessed using the Majeed pelvic score and the Iowa pelvic Score. Results. Types of injury included 38% road traffic accidents, 16% pedestrians hit by a car, 11% crush injuries, 11% falls from a significant height (>10ft),and 9% forklift injury. 32% of injuries occurred at work. The most commonly associated injury was pubic rami fractures closely followed by spinal injury and femoral fractures. The average Majeed score for those unemployed, pre injury, was 68 (good) and those employed was 67 (fair). The average Iowa score was 71 (good). 36% of patients returned to work, 36% were unable to return to work, 4% retired and, 22% were unemployed pre and post injury. The average visual pain score was 3.9/10 and 20% of patients experience no pain. Surgical complications included 2 non unions requiring open reduction and internal fixation, and 1 wound infection requiring removal of metalwork. Three patients required removal of metalwork due to ongoing back pain, of these 2 patients symptoms improved. Conclusion. Our patients experienced a low rate of complications and had a good functional outcome after undergoing closed reduction and percutaneous iliosacral fixation for Tile Type C fractures

Introduction

Proper positioning of the baseplate and optimal screw placement are necessary to avoid loosening or failure of the glenoid component in RTSA. Several in vitro and anatomic studies have documented ideal number, size, length and angulation of baseplate screws. However, such fixation can often be tenuous, as the anatomy of scapula bone varies. Furthermore, it can be difficult to identify regions with the best bone stock intraoperatively even though surgeons have an understanding of scapular anatomy with potential screw trajectories in mind. This often leads to variable screw lengths and angulations in the clinical setting. The purpose of this study was to measure optimal screw lengths and angles to reach ideal regions in cadaveric scapulae and to compare the clinical experiences of three surgeons with each other and against a cadaveric model with screw lengths and angulations.

Introduction

Failure of intertrochanteric fracture fixation often occurs in patients, who have poor bone quality, severe osteoporosis, or unstable fracture patterns. Hip arthroplasty is a good replacement procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. The purpose of this study is to evaluate the outcomes of total hip arthroplasty (THA) as the replacement for failed fixation of intertrochanteric fractures of the femur.

Introduction

It is recommended that the ankle be held in dorsiflexion at the time of placement of syndesmosis screw. We assessed the validity of this recommendation.

Reverse polarity total shoulder arthroplasty (RTSA) has gained popularity over recent years for the treatment of the painful cuff deficient shoulder. Although proposed over 20 years ago and despite good clinical outcomes the RTSA has struggled to gain popularity due to reported high levels of complications.

One such complication is post-operative instability with frequencies of up to 30% (De Wilde 2002). The Bayley-Walker RTSA was designed specifically for patients with difficult reconstruction problems in whom an unconstrained prosthesis would not offer sufficient stability. It is a reverse anatomy fixed fulcrum constrained prosthesis. The glenoid component has a long HA-coated tapered helical screw, with large pitch and depth, fixation is augmented by a grooved HA coated glenoid plate.

The purpose of this study was to review the clinical experience from The Royal National Orthopaedic Hospital Stanmore and to ascertain the rate of glenoid component loosening. We also carried out a radiographic review to correlate loosening with patterns of lucency on post-operative radiographs. One hundred and five B-W TSRs in 103 patients were included, 24% of which were performed as revision of previous failed arthroplasty. In total, 8/105 glenoids required revision. Of those eight patients, two were cases of septic loosening. Of all nine specified areas of glenoid, tip lucency on x-ray appeared to be most strongly associated with need for glenoid revision. 5/9 cases with tip lucency progressed to loosening of the glenoid. Where tip lucency was not seen, 93/96 glenoid components remained secure, giving tip lucency a negative predictive value of 97%. Excluding the two infected cases, the glenoid remained secure in 97/103 patients undergoing BW-TSR with follow-up up to 13 years. The BW-TSR is a satisfactory and durable solution to the cuff-deficient shoulder in variety of challenging groups including younger patients and as a salvage procedure following failed, cuff-deficient arthroplasty.

The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole DHS in Garden I and II neck of femur fractures in patients more than 60 years with a minimum follow up of one year.

We retrospectively reviewed 51 consecutive patients aged more than 60 years who underwent DHS fixation for Garden I and II fractures. Demographics, fracture classification, time to surgery, pre-operative AMTS, preoperative posterior tilt angle, quality of reduction, pre and post-operative haemoglobin(hb), creatinine and comorbidities were analysed for correlation with AVN using Chi-Square test, Independent Sample and paired t test.

There were 40 (78.4%) females and the mean age of the cohort was 77 years. 28 and 23 were Garden I and II NOF fractures respectively. Union was observed in all our patients except one(kappa =1). 12/51(23.5%) developed AVN of the femoral head. Statistically significant higher incidence of AVN was noted in patients with a pre-op tilt angle > 200 (p = 0.006). The mean drop in Hb was higher in patients who developed AVN (21.5 g/L) versus the non-AVN group (15.9 g/L) (p = 0.001). There was no difference in AVN rates with respect to laterality, mean time to surgery, pre-op AMTS and Charlson comorbidity index. 4/52 (7.6%) had re-operations (one hardware prominence, two conversions to arthroplasty, one fixation failure during the immediate post-op period). The 30-day and one year mortality rates were 1.9 % and 11.7 % respectively.

2-hole DHS fixation in undisplaced NOF fractures has excellent union rates. A pre-operative posterior tilt angle of >200 and a greater difference in pre and post operative haemoglobin were found to correlate positively with the progression to AVN . No correlation was observed between AVN and time to surgery, laterality, quality of reduction and comorbidities.