Aims. Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters. Methods. We searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term “electric scooter”. We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t-tests and p-values < 0.05 were considered significant. Results. We studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs. Conclusion. The leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost. Cite this article: Bone Jt Open 2022;3(9):674–683

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To compare the cost-effectiveness of high-dose, dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults.

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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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Fracture-related infections (FRIs) are a devastating complication of fracture management. However, the impact of FRIs on mental health remains understudied. The aim of this study was a longitudinal evaluation of patients’ psychological state, and expectations for recovery comparing patients with recurrent FRI to those with primary FRI.

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Femoral periprosthetic fractures are rising in incidence. Their management is complex and carries a high associated mortality. Unlike native hip fractures, there are no guidelines advising on time to theatre in this group. We aim to determine whether delaying surgical intervention influences morbidity or mortality in femoral periprosthetic fractures.

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The aims of this study were to identify means to quantify coronal plane displacement associated with distal radius fractures (DRFs), and to understand their relationship to radial inclination (RI).

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The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients.

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Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria.

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The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries.

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The purpose was to compare operative treatment with a volar plate and nonoperative treatment of displaced distal radius fractures in patients aged 65 years and over in a cost-effectiveness analysis.

Best Practice Tariff (BPT) recommends operation for hip fracture within 36 hours. Anticoagulation reversal often delays this. Audit of our service, to establish the impact on BPT of anticoagulation reversal, showed a loss of revenue and delays. Subsequently an ‘early trigger’ Intravenous Vitamin K (IVK) pathway was introduced and re-audit completed. Hip fracture patients admitted over a 32-month period were reviewed. Primary outcome was time to theatre for warfarinised and non-warfarinised patients. This was analysed using independent t-tests. A change in practice, involving nurse led administration of 2mg IVK in the Emergency Department prior to knowledge of the coagulation screen, was instigated. Three months later a re-audit occurred. In the first audit cycle, 83 patients were admitted on warfarin with a median time to theatre of 49.7 hours. 21% of these patients gained BPT. Following protocol change, over three months, 14 warfarinised hip fracture patients were admitted. Twelve patients achieved satisfactory reversal; eight with one IVK administration. Median time to theatre was 33.9h. Compliance with BPT in terms of delay due to anticoagulation was 86%. Our audit demonstrates that ‘early-trigger’ IVK reduces delays to theatre and helps reduce BPT related financial loss. It enables high quality patient-centred care within financial constraints

Introduction. Total hip replacements using highly cross-linked polyethylene show excellent clinical outcomes, low wear, and minimal lysis at 5 years follow-up. A recent RSA study reports a significant increase in femoral head penetration between 5 and 7 years. This study is a multi-center radiographic analysis to determine whether the RSA observation is present in a large patient cohort. Methods. Six centers were enrolled for radiographic analysis of primary total hip arthroplasty for standard head sizes (26mm, 28mm, or 32mm). Radiographic inclusion criteria required a minimum of four films per patient at the following time points: 1 year; 2–4.5 years; 4.5–5.5 years; and 5.5–11 years. The Martell Hip Analysis Suite was used to analyze pelvic radiographs resulting in head penetration values. Wear rates were determined in two ways: the longest follow-up radiograph compared to the 1 year film, and individual linear regressions for the early and late periods. For both methods, average wear rates from the early period (1 to 5.5 years) and late period (>5.5 years) were compared using t-tests. Results. We present the completed analysis of 235 of the 250 hips under active analysis with 3160 film comparisons. Average follow-up was 7.2±0.99 years (range 5.4–10.1). Based on latest follow-up, the average wear rate was not significantly different during the early and late periods (10.1±95μm/year and −3.8±235μm/year respectively, p=0.518). Based on the group regression, the average wear rate was not significantly different during the early and late periods (7.5μm/year and −36μm/year respectively, p=0.13). Conclusion. In this large multicenter radiographic study, we found no late increase in femoral head penetration into highly cross-linked polyethylene as suggested by the RSA report. Additional centers and patients are being recruited in order to reduce the variation in the late period

CECS is an exercised induced condition that causes pain, typically in the lower limbs, and is relieved by rest. It is often seen in military personnel significantly restricting their duties. Conservative treatment is rarely successful and patients often require surgical decompression by fasciotomy or fasciectomy. All IMP (intramuscular pressure) tests (n=286) carried out between December 2007 and October 2010 on patients with suspected CECS in the anterior compartment of the lower leg were reviewed. The treatment and outcomes of those referred for surgery were analysed. Pre- and post-surgery military medical grading for leg function was extracted from the medical records system. Independent t-tests compared differences between patients that had surgery or did not. The Wilcoxon signed-rank test compared grades before and after surgery. According to the diagnostic criterion, 80% of patients undergoing IMP testing had CECS. Of these, 179 (68%) patients underwent surgery, 17 (9%) of these were for recurrent symptoms. Almost all decompressions were bilateral (95%). The majority of operations (121) were fasciectomies of the anterior compartment only and were performed by 2 surgeons. The remaining operations (58) were performed by 6 surgeons and were fasciotomies of both anterior and lateral compartments. The mean time from testing to surgery was 24 (median 11) weeks. There were 23 (13%) complications other than recurrence including 16 wound infections, 6 seromas and 1 haematoma. Pre- and post-surgery grading was available for 67% of patients. These patients had significantly better leg function after surgery (Z=−3.67, p<0.001). Of these, 47% improved, 38% showed no improvement and 15% had a poorer outcome had. Those who had a fasciectomy were significantly more likely to improve than those who had a fasciotomy (p=0.023, rho=−1.96). Our results demonstrate that patients generally improve lower limb function following surgical decompression. However, 53% showed no improvement or deteriorated in their medical grading. In addition, there is a high diagnosis rate for CECS following IMP measurement. This may reflect the poor validity of the diagnostic criterion or this could be due to good clinical selection for testing. Furthermore, fasciectomy shows a greater correlation with improved outcome than fasciotomy. There is a need to develop more accurate diagnostic criteria and to evaluate the benefits of standardising surgical technique

Compression and absolute stability are important in the management of intra-articular fractures. We compared tension band wiring with plate fixation for the treatment of fractures of the olecranon by measuring compression within the fracture. Identical transverse fractures were created in models of the ulna. Tension band wires were applied to ten fractures and ten were fixed with Acumed plates. Compression was measured using a Tekscan force transducer within the fracture gap. Dynamic testing was carried out by reproducing cyclical contraction of the triceps of 20 N and of the brachialis of 10 N. Both methods were tested on each sample. Paired t-tests compared overall compression and compression at the articular side of the fracture. The mean compression for plating was 819 N (. sd. 602, 95% confidence interval (CI)) and for tension band wiring was 77 N (. sd. 19, 95% CI) (p = 0.039). The mean compression on the articular side of the fracture for plating was 343 N (. sd. 276, 95% CI) and for tension band wiring was 1 N (. sd. 2, 95% CI) (p = 0.038). During simulated movements, the mean compression was reduced in both groups, with tension band wiring at −14 N (. sd. 7) and for plating −173 N (. sd. 32). No increase in compression on the articular side was detected in the tension band wiring group. Pre-contoured plates provide significantly greater compression than tension bands in the treatment of transverse fractures of the olecranon, both over the whole fracture and specifically at the articular side of the fracture. In tension band wiring the overall compression was reduced and articular compression remained negligible during simulated contraction of the triceps, challenging the tension band principle

Background. Though less common than in females, osteoporosis and osteoporosis-related fractures are not uncommon in males. Our primary objectives were (1) to compare the rates of osteoporosis and osteopenia in adult Brazilian males versus females, 55 years old and over and presenting for bone mineral densitometry (BMD); and (2) to compare males and females as to past osteoporosis screening and management. Methods. From our clinic population, we prospectively surveyed 343 males and 493 females, all at least 55 years of age, who had presented for BMD testing, to identify baseline demographic and clinical characteristics; risk factors for osteoporosis and osteoporotic fractures; overall osteoporosis and 10-year fracture risk; and evidence of prior assessment for and/or management/prevention of osteoporosis. Final osteoporosis risk was determined using the results of BMD testing and the FRAX® tool. Gender comparisons were performed using Pearson 2 analysis for nominal and ordinal variables, Student's t-tests for normally-distributed continuous variables, and Mann-Whitney U tests for non-normally-distributed continuous variables, with all tests 2-tailed and p=0.05 set as the threshold for statistical significance. Binary logistic regression was performed to identify predictors of prior hormonal treatment and BMD. Results. There were no differences in the rates of prior fracture, spinal fracture or long-bone fracture between the sexes, though women were more likely to have osteoporosis of the spine and femur, and had higher estimated risks of future osteoporotic fracture (all p < 0.001). Women also were significantly more likely to have received treatment for their osteoporosis (7.9 vs. 3.1%, p=0.004) and to have had prior BMD testing (80.7 vs. 16.2%, p < 0.001). Ten-year probabilities of hip fracture were 4.8% in males and 5.2% in females; and for a major osteoporotic fracture 5.6% and 24.3%., respectively (both p < 0.001). Age, gender and spinal osteoporosis predicted prior hormonal treatment; but gender was the only predictor of prior BMD, with males 95% less likely to have undergone prior testing than females. Conclusions. Despite similar past fracture rates, and lower but still appreciable future fracture risk, far fewer males than females had received prior screening or management of their osteoporosis

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We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial.

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Echocardiography is commonly used in hip fracture patients to evaluate perioperative cardiac risk. However, echocardiography that delays surgical repair may be harmful. The objective of this study was to compare surgical wait times, mortality, length of stay (LOS), and healthcare costs for similar hip fracture patients evaluated with and without preoperative echocardiograms.

Summary. Strong mechanical fixation is critical to the success of rotator cuff repairs. In this comparative study in cadaveric shoulders, single-tendon full-thickness supraspinatus tears were repaired using two different types of PEEK knotless suture anchors-ReelX STT (Stryker) and Opus Magnum PI (Arthrocare)-using a single-row technique in both instances. Cyclic testing was performed followed by loading until mechanical failure. No significant difference was observed in gap formation, measured as the distance between the supraspinatus tendon and bone at the repair site, during cyclic loading. However, the maximum load was statistically higher for repairs with the ReelX anchor. Purpose. The objective of this study was to compare the gap formation during cyclic loading and maximum repair strength of single-row full thickness supraspinatus repairs performed using two different types of PEEK knotless suture anchors in a cadaveric model. Methods. Nine matched pairs of cadaveric shoulders were used in this study. All soft tissue was removed except for the supraspinatus, and a full thickness tear was formed. Single-row repairs were performed with two anchors per repair using either the Opus Magnum PI (Arthrocare) or the ReelX STT (Stryker). The specimens were mounted to an Instron at 45° to simulate an anatomic direction of load, and fiducial markers were placed on the repair in anterior and posterior positions. A 10 N preload was applied and held for 60 seconds, and then the tendon was cycled from 10 N to 90 N at 0.25 Hz for 500 cycles, followed by load to failure at 1 mm/s. A video digitizing system was used to track the markers and measure gap formation during loading. Gap formation was calculated by subtracting the distance between the markers at 10 N preload from the maximum displacement at 5 and 500 cycles. Paired t-tests were used to compare the cyclic displacement and max load. Results. One specimen from each of two matched pairs (one from each anchor group) failed during cyclic loading, leaving seven matched pairs for analysis. No significant difference was found in cyclic displacement between the two groups in either anterior or posterior positions at 5 and 500 cycles. However, maximum load to failure was significantly greater for repairs performed with the ReelX STT anchors (289N ± 57N) as compared to the OPUS anchors (178N ± 36N), with a p=0.009. Conclusions. These results suggest that the anchor type chosen for cuff repairs may affect the overall stability of the repair. Achieving stable fixation is critical for promoting healing of the tendon back to bone and to the long-term success of the repair, and using anchors that provide stronger fixation may decrease the occurrence of post-surgical tears and instability. The ReelX STT anchor outperformed the Opus Magnum PI anchor in terms of supporting significantly higher loads before failure, potentially leading to stronger repairs clinically

Cam type femoroacetabular impingement (FAI) is due to an aspheric femoral head, which is best quantified by the alpha angle described on MRI and CT-scan. Radiographic measurement of the alpha angle is not well codified and studies from the literature cannot conclude on the best view to measure it. Most authors also describe a mixed type FAI which associates an aspheric femoral head with an excessive anterior acetabular coverage of the femoral head. Anterior center edge (ACE) angle has been described on the false profile view to measure anterior acetabular coverage in hip dysplasia and has never been evaluated in FAI. In this study, we developed a new lateral hip view which associates a lateral view of the femoral neck and a false profile view of the acétabulum, which we called profile view in impingement position (PVIP). Twenty six patients operated for FAI had CT-scan, the PVIP and the false profile view of one or two hips according to pain. A control group of 19 patients who did not suffer from the hip had the PVIP. Alpha angles were measured twice on 17 CT scan of FAI patients by two observers and compared with the alpha angles measured on the corresponding hip PVIP by a correlation analysis. Alpha angles were measured twice on 45 PVIP in FAI patient and on 19 PVIP in the control group by three observers. ACE angles were measured once on 15 PVIP and on 15 false profile views. Means were compared by two tail paired t-tests, intra- and inter-observer reliability were measured by intraclass correlation coefficient. Mean alpha angle on CT scan was 65.8° and 65.6° for observers 1 and 2 respectively (p>0.05). It was 63.6° and 64.3° on the PVIP (p>0.05). No significant difference was found between CT scan and radiographic measurements, and Pearson's correlation coefficients were good at 0.74 and 0.8. ICC was 0.86 for inter-rater reliability, and 0.91 for intra-rater reliability for CT-scan alpha angle measures. ICC for PVIP measures varied from 0.82 to 0.9 for intra-rater reliability and from 0.6 to 0.9 for inter-rater reliability. Mean alpha angle measured on PVIP in FAI patients was 63.3° and was 44.9° in control subjects and the difference was significant (p<0.001) for the three observers. None of the FAI patients and 88% of the control subjects had an alpha angle < 50°. Mean ACE angle was 26.8° on PVIP and 32.8° on the false profile view, the difference was significant (p=0.015), and the Pearson's correlation coefficient was moderate (r=0.58). The PVIP is a reliable radiographic view to measure the alpha angle. It allows a good quantification of the alpha angle comparable to CT-scan measurements and permits to differentiate patients from control subjects. PVIP is not a good view to quantify anterior edge angle probably because of acetabular retroversion due to the hip flexion needed in this view. Mean ACE angle measured on the false profile view in FAI patient was comparable to ACE angle in general population reported in the literature

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Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation.